This third and final instalment of a 3-part blog series on pain management is written by Pat Stanziano, Sport Physiotherapist and Certified McKenzie Practitioner at Leaps and Bounds: Performance Rehabilitation. It discusses the important role of movement and exercise in acute and chronic pain management, and offers you the ability to take over control of your pain experience.
If you’ve been keeping up-to-date with this pain blog series, you’ve learned that there are plenty of things that can be offered to you that will help with your pain and make you feel better: massages, like we discussed in Blog 1 Pain: Not Just French Bread, along with various other manual treatments; and acupuncture, like we discussed in Blog 2 Acupuncture and Its Effects on PAIN, along with various other passive modalities. But there is a difference between feeling better and actually making yourself better. Read that again: making . . . yourself . . . better. Just so I’m not confusing you, I’m talking about something exceptional that induces physiological changes in your body that makes it better, not just gives you the perception that you’re feeling better.
BEFORE I GET TO THAT . . .
Remember, it was previously discussed that pain is an individual sensory experience that is perceived when there is tissue damage and, often times, when there is no (or no longer) tissue damage. Pain that is present in acute stages can mostly be inflammatory in nature, like rolling your ankle, having it swell up on you, and pain being pretty constant until that swelling goes away. It can also be mechanical in nature, like pulling your finger back and your brain telling you (through a painful warning) not to pull back harder or something will tear; yet when you release the finger, the pain goes away. So, in one instance (the ankle) there was damage, and in the other instance (the finger) there was no damage; yet in both instances, there was a painful experience that was felt.
Chronic pain can also be the result of inflammatory processes, or it can be the result of mechanical loading too. But when pain is chronic, there’s a good bet that there are other factors contributing to that painful experience that may or may not necessarily be related to your biology. We’ve hinted to these in our previous blogs and we’ve also provided some good resources (see links below) that help you become aware of them, how they are related to the pain that you are feeling, and what you can do about them.
In either case, whether acute or chronic, know that there is one therapeutic modality that needs no other when it comes to exacting its benefits on you. A great RMT will show after your session what you need to be doing between visits, and so will that great chiropractor or physiotherapist. Most people already know to do it without much thought, and the pain usually goes away. For some people, they need a little reminder to do it before their pain is abolished. But to a small fraction of people, they need a very specific form of this therapeutic modality prescribed to them in order to start feeling better. It’s no secret. It’s something that’s been known for decades now. But sometimes it’s hard for people to get around, and sometimes people look for easier alternatives that only make them “feel” better.
My Apologies on Behalf of all Therapy Providers
However, we as health professionals (whether MDs, nurses, physios, chiros, RMTs, etc), (A.) have traditionally done a poor job at getting this point across, or (B.) we, typically, have not been well-versed in prescribing this therapeutic modality, or (C.) for some reason (*ah hem cough . . . financial) our professions have contributed to this pandemic by providing more services that make people feel better and not enough of the one that makes people better. And I’ll probably take some flack for spilling the beans, or get some glares and sneers from others. But at this point, I feel that it needs to be out there.
The Big Reveal: #SURPRISENOTSURPRISED
MOVEMENT is your medicine; to a lesser degree exercise; and to an even smaller one, specific exercises or exercise prescriptions. Here’s a way to view the pain response to movement on a funnel chart where the width of the funnel represents the number of people at each stage. (I don’t want to take 100% credit for this chart. I feel like I’ve seen it somewhere; so, if anyone knows an original source, please let me know and I can give credit where it is due.)
- Pain that gets better on its own by keeping active and moving (no intervention required). Most people who have a painful experience, we never see, because they get better on their own. These people are typically non-sedentary and not confined to static positions for long periods of time. Essentially, they are movers.
- Pain that gets better with general exercise prescription (minimal intervention required). We start to see people in a clinical setting when pain hasn’t gone away for some period of time. Really, any exercise we give them for that particular area of pain will make them feel better. People in this section also get better with yoga, pilates, and general strength and conditioning routines. Sometimes these people need a little reminder to get moving again and stay moving.
- Pain that gets better w/ specific exercises and/or loading strategies under the direction of a therapist. This group is small in number. The pain is intense because it has progressively gotten worse due to inactivity, or perhaps the person was anxious and loaded an area with too much repetition or too much weight that led to a flare-up or injury. Ironic, isn’t it, that these people will get better with specific movements and exercise prescriptions.
- Pain that requires specific medical intervention. Alas, there are those of you that we can’t help and should not try to help beyond a few sessions, if our assessment skills are up to par and we truly care for patient outcomes and not making a quick and easy buck by keeping you coming longer than what is needed. These people need to be referred to a specialist that can range from a general family practitioner, a physiatrist, a surgeon, or perhaps even a mental health professional. No, I’m not saying you are crazy, but sometimes pain is conditioned to make an appearance in response to external factors that may have been present at the same time you were initially experiencing your pain.
Remember Pavlov’s dog from your Psych 101 class?
Your pain can respond similarly:
You will need to identify and sort out these issues before we can get you to progress into one of the other categories that are responsive to some type of movement or exercise.
In some cases, for those that get referred on to an MD or a specialist, we get them back. I already gave you an example of someone getting referred to a mental health professional before returning for their exercise prescription. But in other cases, a medical intervention like a pain-relieving injection, is needed before you are responsive to any specific movements or exercise prescription.
What You Should Expect
When you come into the clinic, we look for specific identifying factors during our initial assessment that tell us where you fall into the funnel. If we nail a diagnosis within 2-3 sessions, we can get you a tailor-made movement strategy or exercise prescription in place for the particular area(s) you need it and check back on occasion to note your progress and modify the program, as needed. Your particular problem can be a rapid responder to specific movements, and therefore, you can be relatively pain free with 5-6 sessions. Conversely, you may have an injury that requires specific and progressive loading to a tissue (eg. like an achilles tendinopathy) through resistance training. These types of injuries can take 4-6 months to heal sometimes, and if someone tells you otherwise, they either don’t know the facts or they’re lying through their teeth. In each case, it’s important to look outside the box that is your injury and focus on general strengthening, if not both strength and conditioning. Don’t be satisfied with just your pain going away. Just because it’s gone, doesn’t mean you’re better. You need to be fit to return to play or work; and strengthening is an important part of that. Being fit means different things for different people. So a pre-made sheet with exercises is not good enough. A program needs to be tailored to your specific needs.
Your ultimate goal should be to climb back to the top of the funnel where you will get typical aches and pains; but because you are active, fit, and generally healthy you you’ll typically stay away from doctors’ and therapists’ offices for these issues. But the same way we can move you back up the funnel, you can work yourself down the funnel too. My words of advice to prevent this from happening would be to give your body time to adapt to increased loads, repetitions, volume, intensity, and all the other training parameters. Essentially, you should have a plan to be executed over a significant period of time if you’re thinking about running a half marathon, looking into that co-ed soccer league, or any other physically demanding activity.
So, you now know that there are different therapists offering different therapeutic interventions. Movement or exercise is at the top of the mountain when it comes to research showing what is actually making people feel better and should be the main focus of any therapist’s treatment plan for you. Whether it’s the main focus of your individual sessions is variable from therapist to therapist, but it should be the only focus of your home treatment plan. Other interventions, like massage and acupuncture, can play a role in reducing pain through a mechanism called neuromodulation. They have some support in research, and they should be used as a means to get you moving better and eventually exercising. Then, there are some things that therapists use that have no real support in research at all. It’s possible that these things can make you feel better, but not actually make you better. Furthermore, these types of treatments create more detriments than they provide perceived benefits (this will be a topic for another day).
You also learned that life plays a role in what you feel. Sometimes pain can be present in the absence of tissue damage or does not correlate to the damage that is actually there. And no, that does not make you crazy; that makes you human. So look outside the box that is your body for some answers when things about your injury seem to be confusing or get you frustrated.
Finally, being fit and being active comes in many different body shapes and sizes. When your therapist recommends strengthening, he’s not telling you to look like Arnold (unless you want to look like Arnold). The benefits of strengthening are impactful on the mind and body. The benefits of exercise, in general, are even more so! But you can’t get there unless you’re moving well. SO GET MOVIN’!
Manage your pain better and improve your function with Leaps & Bounds: Performance Rehabilitation. If you have you missed Part 1 & Part 2 of this blog series you can catch up on the first 2 parts of this series here; Massage Therapy Effects on Pain & Acupuncture and it’s Effects on Pain.
DISCLAIMER: Pat is a trained practitioner, certified in the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). This is a philosophy of active patient involvement and education that is trusted and used by clinicians and patients all over the world for low back, neck and extremity problems. A key feature is the initial assessment – a safe and reliable way to reach an accurate diagnosis and then make the appropriate treatment plan. Furthermore, his qualifications as a strength and conditioning specialist enables him to help you work toward your performance goals. If you have a question for Pat about an injury, feel free to send him and email to email@example.com. If you’re looking to book an appointment with him, or a member of his team, you can give us a call at 905-847-5227 or book online right here.