Tag Archives: pain treatment

Let’s Talk About the Complexity of Pain

What is Pain?

Pain is an unpleasant complex experience that occurs in response to a potential threat to our body’s tissues. No one really wants to have pain and if you do get pain you typically want to get rid of if ASAP. What we need to remember is that pain is normal and necessary to our survival as it is our body’s alarm system. The alarm system is there to help bring our attention to potential threats and to change our behaviour to avoid the threats if necessary. 

Everyone experiences pain differently. The way we experience pain depends on many factors such as the following: the severity of tissue injury, our emotional responses, previous experiences with pain, cultural experiences, the social and physical environment, our sensory inputs from receptors in our body, beliefs and knowledge about pain and our expectations about the consequences of pain.

For example: A person who is a major league soccer player that fractures their ankle will feel the pain very differently compared to a 65 year old person who is relatively sedentary because the soccer player may feel anxious about how is he going to make money if he can’t play soccer, whereas the 65 year old who generally is not very active will not have much change in their day. 

How Do We Experience Pain?  

When your body is injured in some way whether it be from stubbing your toe, repetitive use of you shoulder or appendicitis, the receptors and nerves in your body send this information to your brain and it is your brain that decides whether or not you feel pain. These receptors in your body are called nociceptors and they respond to thermal, chemical or mechanical changes on the tissues. For example, when you place your hand on a hot stove top the receptors in your fingers and hand sense that the temperature has changed. They then send messages to your brain about the temperature change and your brain decides if this change in temperature is a threat and if you should feel pain to make you take your hand away from the potential threat of a burn.

The signals from the nociceptors do not create pain. It is the brain decides that receives the signals from the nociceptors and other information such as your memories of pain, your beliefs about pain, your emotions at the time of the signal, your expectations and the information about the environment and uses all the information to decide whether or not there is a threat of damage and whether we should feel pain. The brain may decide that a nociception signal is not important and that we do not need to feel pain, so we ignore it. An example of this is when we are sitting in a chair the receptors in our bottom notice the change in pressure an send this signal to the brain. The brain then takes the information from the signal, and the environment and decides that sitting in the chair is not harmful so therefore we do not feel pain.

An analogy that can be helpful understand pain is to think of pain like a ship that is sailing in the ocean. The receptors are the lookouts on the ship, and they notice lights in the distance (these are the potential danger signals). The brain is the captain of the ship and makes all the decisions about how to sail.

The lookouts notice lights in the distance and tell the captain about them. The captain then considers his memories about these waters and takes in information about the environment. Maybe the captain knows these waters well and knows that these waters are safe and pirate free. He would then decide that the information was good to know but not very important, he may tell the crew members not to worry about it and they continue to sail as normal. This is like the when you sit in the chair and the brain decides that it is not a threat, so you continue sitting as normal without pain.

But if the captain is concerned by the information because he has never sailed these waters before and thinks that the lights may be pirates coming to rob the ship, he may tell the other crew members to stay on high alert. This is like when you place your hand on the hot burner and the brain creates a pain experience to make sure you are aware of the potential threat. He may even change the way he was sailing to avoid the pirates. This is like when pull your hand away from the burner because of the pain to avoid the threat of a burn.

Types of Pain

Pain can be either acute or chronic.

We tend to consider acute pain as pain that has a “mechanism of injury” such as a fall, motor vehicle accident, slamming your finger in a door etc. Acute pain typically is short lived, most times is not present past 3 months (BUT not always) and usually follows the stages of tissue healing (which are outlined in the picture below).

Chronic pain is when the pain is occurring for a longer period of time. It is often disproportionate to the stages of tissue healing and may or may not have a mechanism of injury that explains why the pain is there. Chronic pain can be very complex and is not fully understood. Chronic pain is usually pain that is present past the usual tissue healing process. Meaning that the tissues have likely healed, and no more damage is likely being done. But a reason we may still get pain is because our tissues have become more sensitized. If you think of the body as a ship again. Sometimes even through the ship has long since cleared the pirate-infested waters the captain and the crew remain hypervigilant to be sure they are safe. This means that now, even normal and helpful signals such as lighthouses, and ship horns may be perceived as threats. This can be the same as if we are in pain for a long time the entire system including the nociceptors and the brain become hypersensitive to all the information that even the normal signals that the brain usually ignores will be considered threats and you feel pain even though there is no tissue damage occurring.

Management of Pain

Management of pain can be complex because of all the factors that contribute to pain. Therefore, management of pain may have to be individualized. Pain management can include many things such as resting the area of injury, use of modalities such as ice or heat, education by a health professional about exercises, work or activity modifications, education about what to expect, healing duration as well as management strategies of stress or anxiety.

BodyTech Physiotherapy

Acupuncture

Acupuncture is a form of treatment which involves the insertion of tiny needles into the skin at very precise points throughout the body. The needles are solid, sterile, and single-use. No medication is injected. The presence of the needles creates a therapeutic effect by encouraging healing, reducing pain, and promoting energy.

Acupuncture

How does acupuncture work?
There are two approaches to acupuncture: classical acupuncture and anatomical acupuncture.

Classical acupuncture is rooted in Traditional Chinese Medicine (TCM). In TCM theory, energy flows through the body in predictable channels, called meridians. Pain and dysfunction occur when the flow of energy is deficient or out of balance. TCM theory proposes that acupuncture relieves pain and promotes good health by restoring the body’s energy balance. The acupuncture points are located along the meridians. Needles are inserted to correct energy imbalance and restore energy flow throughout the meridian. Therefore, pain and dysfunction in one part of the body can be treated with acupuncture points at a distant location in the body.

Anatomical acupuncture was developed based on Western anatomical and physiological concepts. In this theory, acupuncture has both local and distant effects:

  • Locally, acupuncture needles stimulate the release of endogenous opioids at the site of the needle. Endogenous opioids are natural painkiller molecules that are synthesized in the body and released to decrease pain. Blood supply to the area is increased, which promotes healing by improving the delivery of oxygen and immune cells to the injured tissue. Immune cells, such as mast cells, macrophages, and fibroblasts aid the natural process of tissue healing. The needles also suppress the local inflammatory response, which further helps to decrease swelling and pain.
  • Distal to the needle site, acupuncture stimulates peripheral afferent nerves. Afferent nerves carry sensation signals from nerve endings to the brain (such as sensations of touch, temperature, and pain). The acupuncture needle interacts with the afferent nerves to modulate and suppress the transmission of pain to the brain. This reduces the perception of pain.

What are the benefits of acupuncture?
Acupuncture is effective in treating a wide variety of neurological and musculoskeletal disorders, including:

  • Tendonitis and tendinopathy
  • Ligament sprains
  • Muscle strains
  • Myofascial pain and inflammation
  • Osteoarthritis
  • Nerve pain, such as sciatic pain
  • Low back pain and disc bulges
  • Whiplash and other neck pain
  • Muscle tension headache and suboccipital headache
  • Bell’s palsy and trigeminal neuralgia
  • Fibromyalgia

In Traditional Chinese Medicine (TCM), acupuncture is used to treat many other conditions:

  • Digestive problems (nausea, vomiting, constipation)
  • Respiratory problems (sinusitis, congestion, bronchitis)
  • Urinary problems
  • Menstrual pain
  • Insomnia
  • Anxiety and stress

What can I expect from acupuncture treatment?
The reaction to treatment is unique to each person. Some people feel relief immediately, while others notice improvement after hours or days. Some people require several treatments before noticing improvement. Some people do not respond at all. The number of treatments required varies for each patient and condition. Similar to most types of treatment, acupuncture works best if it is repeated a few times.

Are there any side effects?
There are usually no side effects to acupuncture treatment. The most common side effects are tenderness or slight bruising/bleeding at the needle site, but these only occur approximately 6% of the time. Occasionally, someone may feel nauseous, faint, or dizzy. This occurs less than 1% of the time.

Your physiotherapist will assess you thoroughly to ensure that you are a safe and appropriate candidate for acupuncture treatment.

Preparing for acupuncture treatment
Prior to treatment, have a light meal and be well-rested. Avoid alcohol or sedative medications for 4 hours before treatment, and avoid smoking tobacco for 1 hour before treatment. Continue to take medication as prescribed by your doctor.

After acupuncture treatment avoid alcohol, caffeine, and smoking tobacco for 1-2 hours. If you are being treated for pain relief, avoid strenuous activity for 1-2 days after treatment, even if you feel pain-free.

Conclusion
Acupuncture is a useful adjunct treatment to physiotherapy. It is effective for treating a wide variety of musculoskeletal and neurological problems, including acute and chronic conditions. Your physiotherapist will assess you thoroughly and create a treatment plan to address your unique needs.

BodyTech Physiotherapy

References
ZQ Zhao. Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology. (2008)

ZJ Zhang, XM Wang, GM McAlonan. Neural acupuncture unit: A new concept for interpreting effects and mechanisms of acupuncture. Evidence-Based Complementary and Alternative Medicine (2012)

SM Wang, ZN Kain, P White. Acupuncture analgesia: I. The scientific basis. Anesthesia and Analgesia (2008).

 

Physiotherapy Treatment for Headaches

headacheMost of us have experienced a headache at some point in our life. For some people they are a more frequent occurrence and can have a significant impact on their daily lives. Over the counter medication is the most popular choice for immediate symptom relief, however for certain types of headaches, while medication may help to relieve the symptoms, the underlying cause of the headaches is not being treated, and symptoms are likely to return. What most people don’t realize is that Physiotherapists can treat the root cause of most headaches, not only relieving the immediate pain, but prevent it from reoccurring. Headaches can typically be grouped into three main types, tension, cervicogenic, and migraine. Each type is characterized by different causes of headache pain.

Tension Type Headache

Tension headaches are the most common. Pain from a tension headache is usually described as a dull pressure or tightening sensation. The pain is typically felt in the forehead, both temples and the back of the head. A tension headache can last anywhere from thirty minutes to seven days. A tension headache will not cause nausea but it may cause either increased sensitivity to light or sound. There are numerous causes or risk factors that can contribute to a headache. The most common triggers include muscle tension in the neck and shoulders, poor posture or sustained postures for an extended period of time, and eye strain. Stress, dehydration, hunger, and hormonal changes are additional factors that may contribute to tension headaches.

Cervicogenic Headache

Another common type of headache is a cervicogenic headache. Approximately 1 out of 100 people experience this type of headache. A cervicogenic headache, as the name implies, is cervical in origin. The headache pain is perceived as occurring in the head but the actual cause is in the neck. The pain is usually a dull, one sided ache that starts in the back of the head and spreads to the forehead, temples and behind the eyes. The person may experience pain in the neck, and possibly difficulty turning the head. This type of headache can last days or even months and can be constant or reoccurring. The most significant causes or contributing factors are stiff joints in the neck, temporomandibular joint dysfunction (TMJ), poor posture, upper back pain or stiffness, muscle weakness or tightness in the neck shoulder and back area, whiplash or other neck injury, and poor sleep positions. Additionally, cervicogenic headaches can develop months after a concussion or head injury indicating dysfunction in the joints of the neck.

Migraine

Migraine headaches, according to the international headache society, are a genetic neurological disease. Migraines can be categorized as being with or without an aura. An aura is described as visual or sensory symptoms or speech disturbance. Visual symptoms can be flickering lights, seeing spots or loss of vision. Sensory symptoms can include pins and needles, and numbness. The diagnostic criteria for a migraine states the aura must last longer than five minutes but less than one hour. A migraine headache can last from four to seventy-two hours. It is usually described as a one sided, pulsing type of pain. The pain is usually moderate to severe and aggravated with activity. A migraine may cause nausea, vomiting and sensitivity to light and sound. The sufferer may experience pre-headache symptoms such as food cravings, mood changes, and fatigue or muscle stiffness.

How Physio Can Help:

There are many other sub-categories of headaches, and although we have categorized them, it is possible for one type of headache to cause another type of headache. For example, a tension headache if left untreated can trigger a migraine for some people, making it more complex to diagnose what type of headache you have. Migraines are generally not treated by a physiotherapist, however if the you have pre-headache symptoms such as muscle tightness, pain or joint stiffness in the jaw, neck, upper back or shoulders these can often be the factor that trigger the migraine. The approach with physiotherapy in this case is to eliminate the muscle and joint issues to diminish the number of triggers.

Tension type headaches and cervicogenic headaches are the two main types that can be treated by physiotherapy. The most common contributing factors to these two types of headaches are poor posture, a combination of weak or tight muscles known as muscle imbalances, or joint stiffness which can be in the neck, jaw, back or shoulders. An issue in one or more of these areas is often the cause of re-occurring headaches because all of these areas are closely connected. If someone is experiencing headaches, but also has a shoulder problem, the two issues are not always considered in combination however, when it comes to treating headaches they should be linked as the muscles in the neck also help with movement or stability in the shoulder. In order to treat tension and cervicogenic headache a detailed assessment of the neck, shoulders, and upper and lower back would be required. The assessment should identify postural discrepancies, muscle dysfunctions such as weak, tight or overactive muscles, and joint mobility issues such as too much or too little movement.

Once specific areas of dysfunction have been identified, an individualized treatment approach can be developed. Treatment should include postural education and correction for specific postural positions. Postural awareness training on how to activate the correct group of muscles to achieve optimal posture is crucial in decreasing this contributing factor. Posture can also be corrected with specific taping techniques that can either help you turn on certain muscles or prevent you from falling into a poor posture. Taping can provide quick relief of discomfort but is only used temporarily until you are able to stretch and strengthen to achieve a good posture actively.

The next step in treatment is usually specific active and passive stretching of the shortened and tight neck and shoulder muscles. Stretching improves the muscle balance in the neck and will reduce the tension in the muscles surrounding the joint and thereby relieve pain. Stretches should be specific to isolate one muscles instead of general neck stretches which can further aggravate a headache.

Once the muscle tension has been reduced, strengthening of the weak neck, back and shoulder muscles should be started. Strengthening is important to help correct posture and eliminate strain of the muscles and joints when in certain positions. Weakness in certain muscles is often the cause of ongoing pain and inability to maintain good postural alignment. The focus with strengthening should start with the deep stabilizing muscles of the neck and back; these muscle require a combination of strength and endurance to support our upright postures throughout the day.

For tension and cervicogenic headaches, stretching and strengthening exercises alone are not enough to reduce the occurrence of a headache. Underlying the muscle tightness and weakness is usually cervical spine joint stiffness or lack of movement. This lack of movement in the neck joints needs to addressed in order to decrease the strain in the neck. Physiotherapists that are trained in manual therapy can help to loosen a stiff or locked joint through a technique called joint mobilization. Joint mobilization is a specific technique used to improve movement in a joint to restore range of motion and decrease the tension in the muscles around the area as well as reduce pain.

In addition to manual therapy and exercise there are other modalities a physiotherapist can use to help relieve pain. The application of a heating pad to the neck, shoulders and back can help to reduce muscle tension by increasing circulation in the area. The reduction in muscle tension provides relief of pain. Interferential current (IFC) can be used to provide immediate pain relief. IFC is the application of mild electrical stimulation to the muscle and nerve endings that cause pain. This blocks the pain receptors and decreases the pain, which in return helps to relax the muscles in the area.

Acupuncture is a common modality used to help relieve headaches and muscle tension. Acupuncture stimulates an increase in blood flow, which relieves muscle tension and thus relieves the pain in the surrounding area. It also helps in stimulating the production of our natural pain killers and anti-inflammatories. Often patients are too sore or tender to tolerate stretching or massage in the affected area; acupuncture is a great option to decrease the local soreness and allow treatment to continue.

To effectively treat headaches all of the contributing factors must be considered and addressed. Active participation from the patient is a necessity to be successful. Just as important is correcting or modifying aggravating activities or postures to decrease the severity and occurrence of pain. Additionally, continual prevention is an important step, if you are aware of stressors that contribute to your headaches you should try to modify or change these factors.

Prevention

It is important to follow through with a prevention or maintenance program to reduce reoccurrence of future headaches. There are many options when it comes to preventative measures including massage therapy, relaxation and stress management techniques, postural awareness, workplace ergonomics, stretching and strengthening programs, regular aerobic exercise, and a headache diary.

A massage every couple of months can aid in reducing tension in the muscles, will help to maintain good posture and will also provide relaxation and stress relief. Regular massages can also help to point out problem areas before they become a pain causing structure. This will help with headache management as it may signify the need to restart certain exercises or visit your physiotherapist.

The ability to de-stress and relax is very important for headache sufferers as stress can affect blood flow and cause muscle tension. For some people stress may be one of the main contributing factors of their headaches. Yoga is an effective method to relax, stretch and de-stress the mind and body. Regular aerobic exercise is another effective method to help increase blood flow to the muscles which will help to reduce tension. When it comes to relaxation it is an individualized approach, and each person should strive to find what works for them.

If posture was identified as a main contributing factor for headache pain, steps should be taken to ensure your workplace station or home office is set up ergonomically for your body. An individualized ergonomic set-up will aid in maintaining good posture throughout the work day and decrease the stress and strain on your muscles and joints. Stretching frequently throughout the day will also reduce tension, as well as avoiding prolonged sustained positions will help to decrease stiffness and strain. Stretches should be held at a comfortable position, not into pain, for a minimum of 30 seconds and repeated throughout the day as necessary.

A headache diary can help to identify triggers or contributing factors. If you know what these factors are it is easier to avoid or modify them and will help reduce or eliminate your headaches.

A detailed physiotherapy assessment and complete physiotherapy treatment approach are necessary to address all of the contributing factors and therefore the root cause of a headache. Over the counter medications only treat the symptoms of the headache and not the pain. If headaches have become a normal part of life for you or someone you know, a physiotherapy assessment with a trained manual therapist should be considered to help solve the underlying issues.

BodyTech Physiotherapy

BodyTech Physiotherapy
519-954-6000