Pain is one of the few common experiences we can all relate to. Everyone has experienced pain at one time or another in their lives. No one enjoys being in pain, but it is a necessary part of helping keep us alive. To gain a deeper understanding of pain we will look at the various parts of the brain that control pain.

Pain is defined as “an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage” which was developed by the International Association for the Study of Pain. Pain is an output from the brain when the brain thinks we are threatened. Tissues (muscles, joints, ligaments, and nerves) are just one input for the brain. The brain receives millions of inputs every second before it determines the output (pain or no pain) and processes them at an incredibly rapid rate, millions per second.

These inputs are messages sent to the spinal cord and brain, letting the brain know about temperature (so you know whether to wear a tank top or winter coat), blood flow (is it time to get up and move?), stress levels (hormones including adrenaline and cortisol), movement (your eyes are moving as you read this), and the immune system (such as when you have the flu). If the brain determines that something is a threat it can make you feel pain even in the absence of tissue damage. Processing pain is much more complicated than just a tissue being damaged, so let’s take a deeper look.

Scientists once thought that when tissues are damaged a special “pain center” in our brain lights up telling us we have pain and when tissues are healed this area turns off. We now know through brain scans that when we experience pain, nine areas of our brain light up, we call this our neuromatrix. Everyone experiences pain differently, my pain is different from your pain and your pain is different than your neighbor’s pain but we all have the same nine areas light up, they just light up differently. So what are the nine areas, what are they responsible for, and most importantly why does the neuromatrix matter?

  1. Premotor/Motor Cortex – organizes and prepares us for movement
  2. Cingulate Cortex – concentration and focus
  3. Prefrontal Cortex – problem solving and memory
  4. Amygdala – fear and addiction
  5. Sensory Cortex – sensory discrimination
  6. Hypothalamus/Thalamus – response to stress and motivation
  7. Cerebellum – movement and cognition
  8. Hippocampus – memory and fear conditioning
  9. Spinal Cord – first stop to process information from peripheral inputs (tissues) before sending the info up to the brain

Understanding that there are several areas of the brain that control pain is important. We now know that these nine areas do not just light up together when we experience pain but also communicate with each other when we experience other events such as memories and coordinating movement. This helps explain why when some people experience pain for prolonged periods they report difficulty concentrating at work, feel more stress, have a harder time completing physical activities, or can experience pain without tissue damage.

The good news: we can change the way that our brains light up through treatment interventions used in physical therapy. Education, manual therapy, trigger point dry needling, physical activity, and modalities are all ways that physical therapists can modify brain inputs to help people experience less pain and increase our ability to perform functional activities.

If you’re in pain, don’t wait any longer! Click here to make an appointment at your nearest clinic.

In Health,

Ted Carter, PT, DPT, OCS, TPS, CSCS, Cert. DN

Foothills Sports Medicine Physical Therapy

 

Let’s face it, no one likes to be in pain. However, people that do not experience pain usually pass away at an early age. This is because they are unable to protect themselves from substantial tissue injury that they are unaware of. Pain is the number one reason why people visit healthcare providers, especially physical therapists. The pain is a complex biopsychosocial experience which means that tissues (biology), cognitive beliefs (psychological), and context (social) of when an injury (or perceived injury) occurs all play a role together to determine if we will experience pain or not. This makes pain a much more complex process than most people, including healthcare providers, understand.

The most widely accepted definition of pain is “an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms” which was developed by the International Association for the Study of Pain. The purpose of this article is to educate people on pain experience and dispel some common myths about pain.

Myth 1: Pain only occurs when you are injured.

How many times have you finished yard work or gardening and gone inside to get something cold to drink? Have you noticed several cuts and scratches on your arms and legs? Have you ever woken up and noticed a bruise somewhere on your arm and don’t remember how it got there? These are both examples that your body had tissue damage yet you didn’t have any pain.

Let me take this one step further…there have been several studies where people who are asymptomatic (no pain or symptoms) have undergone medical imaging (X-rays, MRIs, CT Scans). A lot of the results would surprise you, such as 40% of people have a bulging disc on the MRI, low back degeneration starts in people’s ’20s, and one in four people had meniscus degeneration. When they were scanned five years later 90% had not changed. Remember, all these people with positive imaging findings had no pain or symptoms.

Myth 2: Chronic pain means that an injury hasn’t healed properly.

Almost every tissue in the body will heal within six to twelve months. There are no special pain fibers in your body contrary to popular belief and this has been studied extensively. More accurately, we have nociceptors, which are special nerve fibers that send information from tissues to the spinal cord and up to the brain if the spinal cord thinks the brain needs to made aware. Nociceptors can send messages in the absence of tissue damage which can be interpreted as danger messages by the spinal cord and brain which can give us the experience of pain even though the tissues are normal or have healed. Confusing right? This is one reason why long after tissues have healed people can still experience pain.

Myth 3: The body tells the brain when it is in pain.

Even though understanding the complexity of pain can be difficult, the one basic concept is that pain is simply an output by the brain which comes from thousands of various inputs. Just a few of these inputs include: movement, stress, thoughts, temperature, blood flow, and your immune system. Remember those nociceptors that we just talked about? Studies have shown that decreased blood flow to tissues will cause increased nociceptive activity. This doesn’t mean pain. Think about how long you’ve been sitting in your chair reading this article, have you shifted your body position at all? Leaned forward or backward in your chair? Crossed one leg over the other? The nociceptors in your body told you to move around because they weren’t getting enough blood flow, you probably didn’t even notice that you changed positions until right now.

Pain is complex and affects each of us differently.

The one constant is knowing more about pain can help decrease our experience of it. Pain is an output from the brain to protect us from actual or potential damage and can be modulated by our body based on the context of the situation when we experience it. This is why we can have tissue damage without feeling pain and we can feel pain when the tissues are completely normal. The nervous system is highly plastic which means that it can make adaptations, both positive and negative, extremely quickly. This means there is a lot of hope for people who experience chronic pain in the absence of tissue damage.

To end I want to leave you with a few fun facts about the nervous system.

  • The body has 45 miles of nerves
  • The brain uses 20% of the oxygen in our body
  • Your brain has about 100 billion neurons
  • The average number of thoughts by a person per day is 70,000 (so think happy thoughts!)

For further questions feel free to get in contact with a Foothills Sports Medicine physical therapist near you!

 

Starting a running program is a great way to ease into exercise and jump start your fitness. If done properly, you can prevent overuse injuries by slowly increasing your mileage. Here are five benefits of starting a running program:

 

1. Weight loss

We all know that to lose weight it’s important to exercise. By adding 30-60 mins of moderate exercise three times per week, you will boost your metabolism which will ultimately help get rid of that unwanted belly fat. To maximize weight loss, try reducing your caloric intake by 200-300 calories per day and make sure to eat plenty of vegetables and protein.

 

2. Increased energy

Running increases blood flow which carries oxygen to muscles. This allows them to produce more energy keeping you more alert throughout the day. It also stimulates chemicals in your body to keep you awake. Instead of drinking a cup of coffee, try going for a 20-30 min morning or lunchtime run to wake you up.

 

3. Improved mood

Besides giving you more confidence in the way you look, the U.S. Office of Disease Prevention and Health Promotion found that exercising 30-60 mins per day three times per week increases endorphins (Dopamine and Serotonin) in the body which helps make you feel happier. This can help reduce anxiety and depression.

 

4. Better sleep

There is nothing better than a good night’s sleep after a hard run. Research shows that people who perform 150 mins of exercise per week get a more restful night’s sleep. Rest is an extremely important, and often overlooked, component of a well-balanced exercise program. Eight hours of sleep will improve your metabolism and help your body recover from your training program so that you are refreshed and ready for your next run.

 

5. Progress to a more advanced exercise routine

If running a marathon seems like a daunting task, starting an easy running program of one to two miles a few times per week can help give you the confidence to increase your running frequency, speed and overall time running. Before you know it, that marathon that seemed impossible may just sound like your next bucket list item to tackle!

 

If you’re interested in easing into a new running program, the Foothills Running Group may be the place for you. Join us on Saturday, August 25th at 7 am at FAST Ahwatukee for an informational meeting and fun run. Learn more here.

As you’re training for the upcoming Mesa-PHX Marathon, you may develop overuse injuries, which are common for long-distance runners. These injuries can occur from muscle imbalances, increasing your training volume too quickly, and lack of stretching appropriately. Common overuse injuries from running include IT band syndrome, patellofemoral knee pain, Achilles tendinitis, and plantar fasciitis. One treatment physical therapists use to help you recover from overuse injuries, so that you stay on track for your marathon training program is cupping.

Cupping is an ancient practice that has been used in multiple settings to improve well-being. The process involves placing suction cups on the skin for several minutes. The cup sizes, cupping time, and movement of the cups can be manipulated in multiple different ways by physical therapist to address pain management, blood flow, muscle relaxation, and myofascial mobility.

The physical therapist will apply lotion on the target tissue and place a suction cup on it. The vacuum effect, in most cases, is created by a hand pump. The vacuum created in the cup draws blood flow to this target area for several minutes. After several minutes of cup manipulation, the cup is then removed by the physical therapist. By bringing blood flow to the area being cupped, it sends oxygen and nutrients to the area to promote tissue extensibility and relaxation. If you and your physical therapist decide that cupping is for you expect to have mild bruising after sessions. Bruising is expected to go away after several days but the long-term benefits make the short-term bruises well worth it.

If you’re interested in adding cupping to your marathon routine, contact any of our 22 Arizona locations today to set up an appointment. We understand what it takes to train for a marathon, and we’ll do our best to safely get you to the finish line.

Foothills Sports Medicine Physical Therapy is a proud sponsor of the 2018 Mesa-PHX Marathon. We’ll be set up the day of the marathon in the Runner Recovery tents to help ease any aches and pains after the race.

Ramping up your mileage as you train for the Mesa-PHX Marathon? As you progress through your training, you may begin to notice pain, weakness, or fatigue that’s limiting your workout. Overuse injuries are often ignored by athletes, marathon runners and even weekend warriors, but if you ignore them for too long, they can lead to a halt in your running—and even prevent you from completing your goal of running a marathon.

At Foothills Sports Medicine Physical Therapy, we treat an array of runners to assist with overuse injuries. One approach, that’s growing with popularity, is trigger point dry needling (TDN). This treatment is used to treat myofascial trigger points which are hypersensitive taut palpable bands of muscle tissue. In addition to these bands of tissue being painful, they also cause restricted range of motion and decreased muscle performance.

Dry needling is performed by inserting a thin, sterile, filiform needle through the surface of the skin into the muscle tissue. Once the needle is inserted the therapist may use a fanning technique (dynamic needling) or leave the needle in the same location for several minutes (static needling).

There are several mechanisms by which TDN provides pain relief. One way that TDN works is by causing a local twitch response (LTR) of the trigger point, promoting relaxation of the taut band. In addition to the LTR, the pin prick of the needle causes the body’s natural pain relievers to be released by the brain and spinal cord, it also stimulates deep blood flow to the muscle which promotes healing, and decreases local inflammatory mediators.

All of these mechanisms allow you to recover quickly from your overuse injury and continue your marathon training program. Interested in learning more about dry needling? Contact us today to set up a Rapid Recovery Free Injury Assessment where you’ll meet one-on-one to discuss your concerns with a licensed physical therapist. Many of our therapists are passionate about running, so we’ll do our part to get you safely to the Mesa-PHX Marathon race line. I’m currently training for the Mesa-PHX half marathon and it will be my 18th half marathon race.

Foothills Sports Medicine Physical Therapy is a proud sponsor of the 2018 Mesa-PHX Marathon. We’ll be set up the day of the marathon in the Runner Recovery tents to help ease any aches and pains after the race.

Pain is one of the few common experiences everyone can relate to. Everyone has experienced pain at least once in their lives. No one enjoys being in pain but it’s a necessary part of life that keeps us alive. Last year I wrote a blog article about common pain myths titled “Why Do I Hurt?

This time I will to explain the various parts of the brain that are involved during a painful experience in order to give you a deeper understanding of what happens when we experience pain.

To recap my first article, pain is defined as “An unpleasant sensory or emotional experience that is associated with actual or potential tissue damage,” which was developed by the International Association for the Study of Pain.

Pain is an output from the brain when the brain thinks we are threatened. Tissues (muscles, joints, ligaments, and nerves) are just one input for the brain. The brain receives millions of inputs every second before it determines the output (pain or no pain) and processes them at an incredibly rapid rate.

These inputs are messages sent to the spinal cord and brain, letting the brain know about temperature (so you know whether to wear a tank top or winter coat), blood flow (is it time to get up and move?), stress levels (hormones including adrenaline and cortisol), movement (your eyes are moving as you read this), and the immune system (such as when you have the flu).

If the brain determines that something is a threat it can make you to feel pain even in the absence of tissue damage. Processing pain is much more complicated than this, so let’s take a deeper look.

Scientists once thought that when tissue is damaged only the “pain center” in our brain lights up. We now know through brain scans that when we experience pain nine areas of our brain light up, we call this our neuromatrix. Everyone experiences pain differently, my pain is different from your pain, and your pain is different than your neighbor’s pain, but we all have the same nine areas light up, they just light up differently. So what are the nine areas, what are they responsible for, and why does the neuromatrix matter?

  1. Premotor/Motor Cortex: Organizes and prepares us for movement
  2. Cingulate Cortex: Concentration and focus
  3. Prefrontal Cortex: Problem solving and memory
  4. Amygdala: Fear and addiction
  5. Sensory Cortex: Sensory discrimination
  6. Hypothalamus/Thalamus: Response to stress and motivation
  7. Cerebellum: Movement and cognition
  8. Hippocampus: Memory and fear conditioning
  9. Spinal Cord: First stop to process information from peripheral inputs before sending the information up to the brain.

Understanding that there are several areas of the brain that light up when we experience pain is important. We now know that these nine areas do not just light up together when we experience pain, but also communicate with each other during other activities such as organizing memories and coordinating movement.

This helps explain why when some people experience pain for prolonged periods, they report difficulty concentrating at work, feel stressed, and have a hard time completing physical activities—all without injury.

The good news is that we can change the way our brains light up through physical therapy. Treatment includes education, manual therapy, physical activity, and modalities to modify brain inputs, which helps people experience less pain and increase our ability to perform functional activities.

Our goal at Foothills Sports Medicine Physical Therapy is for you to live a full and pain-free life. I have eight years of experience working in outpatient physical therapy, and I can’t wait to help get you back on track.

Let’s face it, no one likes to be in pain. However, people who do not experience pain usually pass away at an early age because they are unable to protect themselves from substantial tissue injury they are unaware of. Pain is the number one reason people visit healthcare providers, especially physical therapists.

The pain experience is a complex biopsychosocial experience—meaning the tissues (biology), cognitive beliefs (psychological), and context (social) involved in an injury (or perceived injury) all play a role together to determine if we will experience pain or not. This makes pain a much more complex process than most people, including many healthcare providers, understand.

The most widely accepted definition of pain is: “an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms,” a definition which was developed by the International Association for the Study of Pain. The purpose of this article is to educate people on the pain experience and dispel some common myths about pain.

Myth 1: Pain always occurs when you are injured.

How many times have you finished yardwork or gardening and gone inside to get something cold to drink and noticed several cuts and scratches on your arms and legs? Have you ever woken up and noticed a bruise somewhere on your arm and didn’t remember how it got there? These are both examples that your body had tissue damage yet you didn’t feel any pain.

To give a more extreme example, there have been several studies involving people who are asymptomatic (have no pain or symptoms) but have undergone medical imaging (X-rays, MRIs, CT Scans, etc.). A lot of the results would surprise you. For example, 40% of individuals had a bulging disc on an MRI, low back degeneration starts occurring when many patients are in their 20’s, and one in four people had meniscus degeneration. When they were scanned five years later, 90% had not improved. Remember, NONE of these patients had any pain or symptoms, despite the issues found on their scans.

Myth 2: Chronic pain means that an injury hasn’t healed properly.

Almost every tissue in the body will heal within six to twelve months from the time of injury. Contrary to popular belief, extensive studies have shown there are no special pain fibers in your body. More accurately, we have nociceptors, which are special nerve fibers that send information from tissues to the spinal cord and up to the brain if the spinal cord thinks the brain needs to made aware of something. Nociceptors can send messages even in the absence of tissue damage, which can be interpreted as danger messages by the spinal cord and brain. This can give us the experience of pain even though the tissues are normal and have already healed. Confusing right? This is one reason why long after tissues have healed people can still experience pain.

Myth 3: The body tells the brain when it is in pain.

Even though understanding the complexity of pain can be difficult, the basic concept of pain is simply an output of the brain that is the result of thousands of inputs. Just a few of these inputs include: movement, stress, thoughts, temperature, blood flow, and your immune system.

Remember those nociceptors that we just talked about? Studies have shown that decreased blood flow to tissues will cause increased nociceptive activity. This doesn’t mean pain. Think about how long you’ve been sitting in your chair while reading this article—have you shifted your body position at all? Leaned forward or backward in your chair? Crossed one leg over the other? The nociceptors in your body told you to move around because they weren’t getting enough blood flow, you probably didn’t even notice that you changed positions until right now.

To summarize, pain is complex and effects each of us differently. The one constant among everyone is that knowing more about pain can help decrease our experience of it. Pain is an output from the brain meant to protect us from actual or potential damage, and it can be modulated by our body based on the context of the situation when we experience it. This is why we can have tissue damage without feeling pain, and why we can feel pain when the tissues are completely normal. The nervous system is highly plastic, which means that it can make adaptations, both positive and negative, extremely quickly. As a result, there is a lot of hope for people who experience chronic pain in the absence of tissue damage.

Finally, I want to leave you with a few fun facts about the nervous system:

  • The body has 45 miles of nerves
  • The brain uses 20% of the oxygen in our body
  • Your brain has about 100 billion neurons
  • The average number of thoughts by a person per day is 70,000 (so think happy thoughts!)

If you have any questions about pain, or if you have an injury a physical therapist could help you with, please contact your local Foothills clinic today!

Ted Carter, PT, DPT, is a Phoenix sports medicine expert and has over five years of experience working in outpatient physical therapy. He currently treats at the Foothills Sports Medicine Physical Therapy Ahwatukee location in Phoenix, Arizona, and is a certified Orthopaedic Clinical Specialist (OCS) and Certified Strength and Conditioning Specialist (CSCS). Today, Ted shares his professional knowledge on how to get a more therapeutic sleep to enhance recovery.

Most of us can agree that we enjoy sleeping and would like to get more of it. The majority of patients I treat come to me because they are in pain, but do not fully realize the profound effect that sleep has on our body— especially when it comes to healing. Sleep is when our body has the best chance to repair itself, which can jumpstart your recovery following an injury.

Recent studies have shown Americans are getting insufficient sleep across the board. In an article by Lauderdale, Knutson et al., they found Americans only sleep six hours per night on average. This is significantly less than the six to nine hours a night recommended by the National Sleep Foundation. It’s no surprise that busy schedules and unlimited digital distractions make sleep the last item on our daily checklist. But adequate sleep is crucial as it has been shown to decrease inflammation, lower pain levels, increase fat metabolism and muscle growth, improve productivity at work, and elevate our mood. For our bodies to function optimally, it is important to get enough restful, uninterrupted sleep.

These 10 tips will help you have a more restful and therapeutic sleep to maximize your recovery, and expedite your results during physical therapy.

  1. Turn off the lights and electronic devices— Bright lights and electronics with LED screens keep the nervous system active. Turning off overhead lights and electronics one hour prior to bedtime will help your nervous system ramp down and prepare for a night of restful sleep.
  1. No naps— Naps may seem like a good idea, but they also make it difficult for your body to get to sleep earlier and stay asleep longer. Omitting naps can help you get to sleep faster.
  1. Limit caffeine intake to only the morning and early afternoon— Caffeine is a central nervous system stimulant that helps us stay alert. Consuming too much caffeine or taking it late in the day will keep it active in your system. Avoid any products that have caffeine in the late afternoon or evening.
  1. Table your thoughts for tomorrow— When the day is winding down, we can find ourselves planning the upcoming day or week. However, planning keeps your brain engaged when it should be shutting down for the night.
  1. Darken and cool your room— Melatonin is the hormone released around bedtime which helps us fall asleep. It is released in higher doses when the room is dark and cool.
  1. No kids or animals in bed— Having kids or animals in the bed can create extra movement and heat which can cause you to wake up several times a night instead of a staying asleep. Interrupted sleep disrupts our body’s sleep cycles leading to a less restful night’s sleep.
  1. Limit alcohol consumption— Alcohol can cause relaxation and reduce stress, but in excess can affect our normal sleep cycles and cause extra trips to the restroom when we should be sleeping.
  1. Limit fluid intake in the evenings— Drinking water is important but consuming large amounts in the evening prior to bed can cause you to wake up to use the restroom when you should be sleeping.
  1. Stay in bed— Pick a bedtime and stick to it. If you are unable to fall asleep quickly, stay in bed and close your eyes while thinking of relaxing thoughts. After a few nights of this routine your body will adjust to your new bedtime.
  1. Exercise— Regular exercise helps clear toxins and stimulants in the bloodstream, which will help you fall asleep faster.

The best way to start is to pick a few items to begin incorporating tonight. Try to add one item from the checklist each night until you have all the items covered. Remember this is a process and it can take time to see results. A few simple daily changes will help you sleep better and recover faster.

Ted and all of our physical therapy experts at Foothills Sports Medicine Physical Therapy have extensive knowledge about injuries, physical rehabilitation, sport performance and recovery. If you have questions about your injury or recovery, make an appointment for a physical therapy consultation today! To learn more about what our certified specialists can do for you, check out the Foothills blog.