Understanding, Managing, and Preventing Chronic Pain: Part 3
Updated: Aug 25, 2022
How to Break Out of the Viscous Chronic Pain Cycle Once You’re in it
Once you’re in this chronic pain cycle that we spoke about in the previous blog post it can be difficult to break that cycle. Understanding the science behind pain as we discussed in Parts 1 and 2 of this blog series, is the first step in the road to recovery. When you have a more complete understanding of why you may be in pain, you can start to better manage your perceptions by simply being less fearful and apprehensive that something is “damaged” and more hopeful that your body not only has healed to some extent but can heal more with the proper treatment.
After educating my patients on pain science, I then move toward something called graded exposure. People with chronic pain have had numerous negative movement experiences. For example, let’s say you have low back pain that is exacerbated specifically when you bend forward.
Now consider how many times you have to bend forward just to function in everyday life. Whether you’re lifting something heavy or reaching down to tie your shoes, or feeding the dog, or just to pick up something you dropped. If you have pain or discomfort every time you bend forward, your body remembers this.
So, what we must do is slowly and progressively expose you to positive movement experiences. We have to allow your nervous system, on a subconscious level, realize that moving in modified versions of what is known to elicit pain, is O.K. and not harmful to your health.
It is my job as a physical therapy and movement specialist to use graded exposure to help slowly desensitize you when bending forward. This is easier said and done obviously and takes time and the help of a skilled clinician to be able to do systematically. Real life and real cases tend to be much more complex than this example.
In addition to slowly desensitizing your nervous system and reduce the fear and apprehension with certain movements that have caused pain in the past, we then we must load the system.
I mentioned previously that if you don’t use it, you lose it.
Not only have you developed this apprehension to certain movement patterns that have elicited pain in the past, but you have compensated in the way that you move. Maybe you completely avoid forward bending as much as possible now. And if you rarely perform that movement the requirements to forward bend such as strength and flexibility in your glutes, hamstrings, and core along with mobility in the lumbar spine and hip joints is lost. We have to regain strength and mobility to better support the spine and prevent further tissue damage and help build confidence. But before this, we have to address something referred to as motor control is lost.
Motor control is basically your muscle memory. I spend a good majority of a client's first few sessions practicing motor control exercises and improving motor control.
The ability of your brain and specific muscles to communicate in a more efficient and effective way is vital. This involves adapting coordination and teaching you how to fire certain muscles again while also cueing you to relax those that have been deemed to be in charge of compensating. This process actually takes thousands of repetitions to actually make physical changes in your motor cortex which is known as neuroplasticity. Reshaping the motor cortex requires attention to detail by both the patient and their therapist and takes time.
I remind my patients there’s no quick fix to chronic pain. If you’ve been in pain for months or years, it will take more than a few sessions to make significant and permanent changes. Like I said, it takes thousands of reps to change the motor control and recruitment of muscles.
Once the muscles are contracting and relaxing as desired, then we begin to load the system to make strength and mobility gains. Most people don’t realize this, but it takes over four weeks of steadily loading a muscle for it to just BEGIN to get minutely stronger. As I said this takes time.
But there is a way out. I never promise to rid my patients of their pain; especially if they’ve been in pain for a long time. But at Movement Driven, we do promise that your pain will decrease, and your function will increase.
If you’re reading this blog, I’m willing to bet you’re suffering from some type of chronic pain, or you would have stopped reading a while ago. If you could increase your function by 50%, but still be in the same amount of pain, would you take that deal? Why wouldn’t you? And when you’re functioning better it leads to a snowball effect in a positive direction. The mind is a beautiful thing. We gain confidence, then we lose apprehension, which motivates us to do things we never thought possible. We increase our activity levels. Then we get more coordinated, stronger, and more mobile. It’s a process, but I promise there’s a light at the end of the tunnel. It takes hard work from you. But you can feel better and move better.
It's not normal to be in pain. And “I'm just getting older” isn’t a reason for you to be in pain either. If you’ve been struggling with pain for longer than 2 or 3 months, what are you waiting for?
Find the right professional for you. Give us a call and determine if we’re the right fit for you. If we’re not, we’ll help you find the right person to finally get on your way to a better quality of life.