What we don’t do
We will not ‘plug’ you into machines, ‘crack’ your joints or put hot/cold packs on your body. This approach does not work and only leads to unnecessary treatment. You must become an active participant it the rehabilitation process for a successful outcome.
Our treatments are evidence based and they change as more research is produced. Pain research has exploded in the last 10 years and we have a better idea what causes people to develop chronic pain and how different strategies are needed for rehabilitation to be successful.
The pain spectrum
Some people are not frighted about their pain and have a predominately mechanical component to their pain. They have learned abnormal movement patterns and this is often the result of previous trauma, surgery or compensating for pain. These people often continue to work and pursue their interests, but the pain limits their life to some extent. At the other end of the spectrum, some people present with over whelming pain that is frightenening and causes them to stop functioning. They often don’t sleep and are on large quantities of medication. They are distressed, anxious and often depressed. They avoid most movement and their lives, and those of their family, are severely affected. Most patients are somewhere between these two points and after a thorough examination we develop an idea of where we need to start. This is different in every patient as no recipe exists.
Identifying your beliefs
What do you think is causing your pain? What explanations have health professionals given you to explain why you are not improving? Do you think you will get better? Are you frightened to move as you believe the pain indicates more damage? What do your scans and x-rays show? Why did previous treatment fail? Does you mood influence pain? Can you sleep or do you feel tired most of the time? Do you think you wil return to work or do you continue working but struggle? What do your family do to help?
All these questions are important for the physiotherapist to understand the wider aspects of your problem and to help formulate a reasoned, structured and individual programme that helps dispel any fears you might have developed. A ‘barrier’ is produced to rehabilitation if you still think you are damaging yourself with movement. Explaining pain helps reduce fear and changes behaviour.
So you are not worried about your pain but frustrated to why you are not improving. I saw a 70 year old woman who complained of left sided low back pain at the clinic this year. She stood with most of her weight on the left leg and she was reluctant to move to the right. Why did you not stand on the right leg? When she was 15 years old she fractured her right leg and was put in a non weight bearing cast for 8 weeks. She had learned to walk for 55 years without putting full weight through the right side of her body. The body learns to compensate and unless an active attempt to change is made the faulty movement pattern remains-even after 55 years!
Correcting faulty movement patterns is not easy, but help is at hand. Our physiotherapists are highly training in movement analysis and utilising different strategies to help you move again. For example, pain causes muscles to contract around the painful area. This contraction is learned and becomes ‘normal’ for us. Massaging painful muscles helps, but only for a short time. Unless you are shown how to relax the muscle and make it move normally, any improvement will be temporary. We think you have better things to do than attend physiotherapy clinics so we aim to get you to change rapidly.
Exercise and pain
If exercise was a tablet it would be the new wonder drug. The effects on our body with exercise are many and helping to change chronic pain is no exception. As we exercise we pump blood around the body and this helps vascularise tissues and this even includes the brain. Joints rely on movement for lubrication and nutrition. As tight, stressed muscles contract they eventually relax and this helps function and regulates sleep patterns. By improving sleep we reduce stress levels, improve our immune system and cope with pain better. Many people living with chronic pain have not exercised for years and it is great to see people return to cycling, running, walking, gardening or playing with grandchildren. It’s important to do something you enjoy as learning to have fun again and sharing social activities is vital for recovery.
Fear and anxiety
Understandably, after various experts have examined you and they can’t seem to find a cause to your ongoing pain some people experience anxiety about their future and become fearful to move. The body’s natural response to pain is to rest and guard the painful area. However, this over protection can immobilise us to the point that we compound the problem. This response is entirely normal and with the amount of negative information many people are given it is not a surprise. As the link between pain and ‘damage’ is made we can fear any movement. Even imagining a painful movement is sufficient to cause pain as our brain ‘fires’ that movement and adds pain automatically.
Fear and anxiety are reduced by giving you a reasoned explanation as to why you continue to have pain. Remembering many people in chronic pain are products of a series of unfortunate events and misinformation. By reducing fear of movement you can start moving again but this process must be gradual and achievable for you. We help you begin to move.
Tablets are useful in acute pain but if the pain continues their effectiveness reduces. Doses are increased and stronger medication is prescribed. This might help but the chances of side effects increase and many people become dependent on them. Our brains produce powerful pain killers (endogenous opioids) and trying to access this system is important. With your Doctors guidance we try to reduce, and finally stop, the use of tablets. We aim to tap into other ways to reduce the pain: exercise, movement, fear reduction and returning to a normal life.
The body is strong
One commonly heard comment when talking to patients is: “You are the first person I have seen in years who has said something positive about my condition”. The body is amazingly robust and can repair itself if given the correct conditions. When living with pain, it’s easy to believe your body is ‘falling to pieces’ and a slow deterioration towards old age is inevitable. This is not the case! We love giving positive messages about your body and demonstrate to you the potential to make improvements. To see someone bend their back or lift an arm above their head after 10 years of thinking they could not do that is wonderful. That’s why we keep working with people who continue to live with chronic pain.