Have you been living with pain for months? Maybe even years? Experiencing pain is a normal part of life, but living with chronic pain is not normal. Chronic pain is exhausting. It can affect a person’s ability to work, to go to social gatherings, and participate in the activities they enjoy. Is there any hope of ever finding relief from chronic pain? There are several things to consider that contribute to pain and how the body responds to pain when seeking relief from chronic pain. Thankfully, there are therapy options for chronic pain sufferers.
Often, individuals with chronic pain receive several explanations for their pain. They may have also tried several types of treatment and several pain medications. These efforts have likely helped manage pain for a short time or have taken the edge off the pain. This leaves individuals wondering if there is hope of ever truly healing and reducing pain. Understanding why this pain persists can help individuals find the best treatment to help them heal from their constant pain.
If you cut your finger, would you want to know about it? Of course! How would you know? The nerves in your body would tell you. There are more than 400 individual nerves in the body. These nerves are connected and create pathways to send information. The nervous system sends an alert to the brain saying ‘danger: you cut yourself.’ Once the threat (injury) is over, the nerves calm back down and slowly the pain from hurting yourself begins to fade away. This is normal, and it is difficult to survive without this process.
When the nervous system ramps up due to pain, it should calm back down once the threat has been acknowledged and the body begins to work on addressing It. Approximately 25% of individuals have an alert system that does not calm back down as it should, thus creating an extra sensitive alert system.
Prior to the onset of chronic pain, the body’s alert system tolerated activity at a normal pace. With an extra sensitive alert system, activity causes the alert system to ramp up much faster and pain is produced at a much quicker rate, giving individuals less room for activity before pain sets in. The individual can now only tolerate a 10-minute walk, rather than a 2-mile run.
What causes an individual’s alert system to remain extra sensitive? What most individuals don’t realize is that pain involves multiple systems in the body. It is not a simple matter of one system resetting and learning to function as normal. Instead, several systems must work together to regain homeostasis.
Did you know there is no place in the brain specifically designed just to house pain? In fact, there are eight different areas of the brain that light up with pain. The central nervous system is responsible for sending the pain alert to the brain, but once this occurs, it wakes up the other systems and when it remains extra sensitive the other systems to become affected. Every region of the brain that is affected by pain has a different primary function. During pain, the brain is having difficulty focusing on its primary job because it is sharing that same space with pain.
The eight important areas of the brain that light up when pain occurs:
- Premotor cortex–responsible for planning and executing body movement
- Cingulate cortex–responsible for focus and concentration
- Prefrontal cortex–responsible for memory and problem solving
- Amygdala–responsible for fear, addition, and emotion
- Sensory cortex–responsible for sensory discrimination
- Hypothalamus–responsible for regulation of body temperature and stress
- Cerebellum–responsible for balance and proprioception
- Hippocampus–responsible for spatial recognition
If you deal with ongoing pain you may have noticed it’s hard to think clearly, but didn’t understand why. These eight areas of the brain are thinking about pain while still trying to maintain homeostasis for the body. Because pain affects many parts of the brain, individuals will need to address multiple systems to calm the alert system back down.
The brain changes during pain experiences as it takes in information and data. Fear of movement, anxiety, ongoing pain, failed treatment, multiple explanations for pain, job issues, family concerns, and emotional trauma are just a few of the factors the brain is considering when determining to ramp up or calm down the alert system. Your brain is also considering temperature, blood flow, adequate sleep, and stress levels. This is why individuals may notice their pain is worse when one or more of these factors are amplified.
The good news is, there is hope for chronic pain. There are several things you can do to help reset the alert system and calm down the overactive signal being sent to the brain.
Education is key; understanding what is occurring in the brain when an individual feels pain is vital to reducing the overactive alert system. Pain is not “all in your head”—It is very real and is generated by the brain. It takes time to retrain the brain to reduce the alert system signal.
Working with a physical therapist who you can trust, that understands the neuroscience of pain and is able to teach you how to set proper goals and expectations to calm the alert system down, can retrain the body to move within normal limits again. Chronic pain therapy plans must be individualized to help manage what activity should be added each day and what goals will be important for each person to succeed.
Adding a movement component is very important to the treatment plan. Physical therapists are movement specialists and are best qualified to teach people how to move within limits that will not exacerbate their symptoms and can teach how to get out of the cycle of overdoing activity one day and paying for it in the days to follow.
Manual therapy plays a significant role in resetting the alert system and can help increase blood flow, loosen stiff joints, decrease soft tissue limitations, and help realign joints. This too is carried out by the physical therapist you trust.
Sleep deprivation makes it very difficult to overcome chronic pain and reset the alert system. Pain makes it very tough to sleep and a lack of sleep increases pain. So what is the solution? Creating a concrete sleep schedule is helpful. Get up and go to bed at the same time each day and resist the urge to take a nap. When discomfort at night plays a role in losing sleep, a physical therapist will be able to assist with positional changes that may be more comfortable to ease the pain.
And finally, an individual’s beliefs play a substantial role in resetting the overactive alert system. It is important to understand the pain and how it affects the body. There is hope in living with less pain and a purposeful lifestyle. Often, individuals start to believe they have had pain so long and have suffered so long that they are now beyond help. Small changes can make a big difference in the day-to-day routine. Individuals should not stop moving because they have pain. Instead, they should learn to move within their limitations through the guidance of a physical therapist. Through this guidance, they can start to restore normal movement patterns.
In conclusion, pain is a vital function of the nervous system that provides the body with a warning of a potential or actual threat. It is affected by past experiences, beliefs about pain, fear, and anxiety. An overactive alert system is easily ramped up based on the brain’s response to these factors. However, there is hope in resetting the overactive alert system. Medical professionals who are trained in understanding the neuroscience of pain can help. Visit a physical therapist at a Foothills Sports Medicine location near you to start a chronic pain therapy plan.
Foot pain is debilitating, making it difficult for sufferers to get through normal activities during the day. Sarah is a nurse who is required to be on her feet for a good part of her shift. When she began to feel sharp pain in the bottom of her heel, it was made worse by standing and walking for long periods of time. She tried taking Tylenol and Ibuprofen, she bought new shoes and over-the-counter orthotics—but nothing Sarah did took the pain away.
There are many individuals like Sarah who suffer from pain on the bottom of the foot, making it difficult to stand and walk through the activities of daily life. Most commonly, this pain is caused by a condition called plantar fasciitis. To manage the pain, we may try using pain relief medications and shoe inserts, or even some type of supportive tape to eliminate the pain. These are good suggestions for pain management, but without the guidance of a professional, it is difficult to figure out the root cause of the pain. Without diagnosing the underlying problem, it will be near impossible to figure out what type of treatment best fits your individual needs and will resolve your pain for good.
Sarah had plantar fasciitis, one of the primary causes of foot pain. Plantar fasciitis is the inflammation of the supportive tissue that connects the heel bone to the toes. Common signs of this condition include pain in the heel when you take your initial steps in the morning and when standing still. The cause of the irritation in the tissue is usually lack of necessary support of the feet. Plantar fasciitis is most common in individuals ages 40 to 70, patients who are obese, use an unsupportive shoe, and/or those who are required to be on their feet for many hours a day. Once this condition has developed, it is important to seek proper treatment to avoid it becoming a chronic issue. Sarah knew she needed to go to her physical therapist to see which helpful treatment options were available to resolve her pain.
Sarah attended physical therapy for about eight weeks at the Foothills Sports Medicine Phoenix Physical Therapy clinic in Litchfield Park. While in therapy, she was introduced to exercises, modalities, hands-on manual treatments, and useful information on how to care for her foot while it was healing. These are some of the key tools that were used in Sarah’s healing process:
Plantar fasciitis can cause a loss of ankle and toe range of motion due to tightness in the calf muscle and plantar fascia (the ligament that supports the arch in your foot.) Her physical therapist measured range of motion to determine loss had occurred, and then implemented a plan to regain mobility. A loss of mobility negatively affects the normal walking pattern, and this changed movement pattern can cause pain in the knee and hip. It is important to maintain normal motion to avoid permanent impairments, so Sarah’s therapist determined the best stretches to use to improve her range of motion.
- Strength of intrinsic foot muscles
Sarah’s PT completed manual muscle testing to determine whether a muscle imbalance was occurring, and then determined exercises to address her specific deficits. Plantar fasciitis often requires strengthening of the smaller intrinsic foot muscles to improve the natural support of the foot and to create a permanent physiological change to lessen the chance of re-injury.
- Proper support for the foot
One of the most important jobs your physical therapist does is ensuring the foot has proper support when walking, to prevent plantar fasciitis from reoccurring. Sarah’s PT examined her shoes to determine if additional support would help her. Her therapist also assessed her shoes to see if an orthotic (or shoe insert) was needed for arch support. Physical therapists are trained to apply supportive tape to determine if orthotics are necessary before they are purchased.
- Education and care instruction
Throughout treatment, Sarah’s PT has several conversations with her about how to improve the healing process. Her therapist suggested ice, supportive tape, and light activity modifications to encourage the rehab process. She also prescribed a home exercise plan, so Sarah could continue to make progress towards her goals while at home and once her therapy sessions were over.
By taking these steps, Sarah was able to get through a shift at work without pain after eight weeks, with no additional modifications to her lifestyle. If you are suffering from foot pain, your therapist will provide you with instructions and proper care for the best healing result. If you suffer from plantar fasciitis, you may need to seek treatment from a professional—so contact your local Foothills Sports Medicine Phoenix Physical Therapy clinic today!
Foothills Sports Medicine Physical Therapy provides AZ sports medicine and physical therapy to patients all over the Valley. We believe in the need for an individualized, hands-on approach to ensure our patients receive the best care possible. We offer a free assessment of your needs, which you can schedule online here today. For more information about AZ sports medicine and different physical therapy techniques, follow our blog!
Kristy Hartsock, PTA, is a dedicated member of the Foothills staff who utilizes her knowledge of sports medicine both in her work and at home with her four athletic boys. She is here today to talk about scoliosis and how physical therapy could help people of all ages with the condition achieve more active, pain-free lives.
Samuel, who is just 13 years old, was in constant distress due to the muscular restrictions and pain caused by scoliosis. Samuel is active in basketball, baseball and football, yet is limited by a constant tightness in his thoracic (upper to middle) spine. He was determined to remain active and achieve his athletic goals, so he turned to Foothills Sports Medicine in Litchfield Park for help.
Scoliosis is a condition in which an individual has an abnormal ‘c’ or ‘s’ shaped curve in their spine, which alters their overall upper-body alignment and posture. There are several types of scoliosis, including congenital, degenerative, neuromuscular, and idiopathic. Congenital scoliosis is present at birth, and is brought on by a deformity of the spine that develops in the womb. The cause of this is unknown. Degenerative scoliosis is caused by degeneration of the facet joints (the joints that allow your back to bend and twist) as a result of aging, and typically occurs in individuals who are 65 and older. Neuromuscular scoliosis is caused by an abnormal muscular nerve pathway in the body and is found in individuals with neuromuscular conditions, such as cerebral palsy or Duchenne muscular dystrophy. Samuel has idiopathic scoliosis, which typically develops in adolescents. The cause for this type of scoliosis is unknown.
Treatment of scoliosis is a team approach. It is managed best with the help of family, primary care physicians, surgeons, orthopedic doctors, and physical therapists working together to develop a plan of care for each individual patient. Your physical therapist at Foothills Sports Medicine will be able to evaluate the condition and determine how to restore and maintain function to allow patients to meet their greatest physical potential.
To treat scoliosis, your physical therapist will develop a plan of care specific to your individual needs. This may include, but is not limited to: hands-on manual therapy, range of motion exercises, functional movement training exercises, stretching, and a range of modalities. During this process, the therapist will closely monitor progress and determine when the plan of care requires modifications to ensure best results for the patient. At Foothills, we use our hands to guide and retrain movement patterns of joints and muscles that have been restricted by scoliosis.
In Samuel’s case, he developed a muscular imbalance as a result of the abnormal position of the spine. Scoliosis causes muscular imbalances, meaning the muscles on the involved side are being overworked and restricted, while the muscles on the uninvolved side are weakened by the changed position of the spine. This imbalance can be improved by strengthening the weaker muscles and inhibiting use of the overworked muscles.
Many patients with scoliosis, especially pediatric patients like Samuel, will benefit from modalities such as Kinesio tape to retrain the muscles affected by the abnormal position of the spine. Kinesio tape should be applied by a trained medical professional, as the technique used to apply is complex and requires extensive training. Kinesio tape can be applied to facilitate use of weaker muscles and inhibit muscles that are over-working. The Kinesio tape will continue to provide sensory input through the skin during the two or three days a patient is not in therapy, so messages are constantly being sent to the brain that retrain your body. This is one of the many tools used to improve Samuel’s movement patterns.
When movement restrictions are present, your physical therapist will implement range of motion exercises to help aid normal movement of the body. Foothills PTs are trained in assessing normal movement patterns, and will determine what exercises are best suited to retrain the body and achieve optimal results.
Samuel was discharged from therapy with results that allowed him to play active sports without pain. He was provided with a home exercise program to ensure he could maintain this newly gained motion, and he can now continue working towards his own personal goals.