All Pain is Not The Same

What is it about pain that makes it so difficult to cure in certain cases?  

Normal Pain

Normal pain is helpful. It is protective. By causing an unpleasant feeling, normal pain changes our behavior. It teaches us how to avoid things that lead to injury or illness. It motivates us to avoid using an injured body part, to give it enough time to heal. Normal pain can be intense at the onset and should gradually decline over time, as healing occurs and we can gradually get back to normal life again. 

Sometimes pain is not helpful. Phantom limb pain is a perfect example. This type of pain is sometimes experienced after an amputation. Intense pain is felt in an area of the body that is not even there anymore. 

Why does this happen? Why does the body produce pain in this way? 

Pain is very complicated. Top researchers are just starting to understand it. Pain involves complicated biochemistry and a very complex nervous system. 

Abnormal Pain

Abnormal pain evolves due to over-sensitivity of our nervous system. There is a long list of reasons for this sensitization. Generally, the longer we have pain, the more likely it will cause nervous system sensitization. 3-months is typically the limit of what is considered normal or acute pain, after that, it is considered Chronic Pain. In this stage, pain becomes more of a problem than the actual physical injury itself. The pain is very real, but it does not have as much of a useful purpose and it becomes very stubborn and difficult to treat.  

Living with abnormal or chronic pain can cause things to spiral. Pain will discourage you from moving and this may prevent you from participating in normal family life, work and social activities. Your experience with normal pain tells you that it will fade away with healing. This may not be the case with chronic pain. So, while you wait for your pain to go away, the stress keeps adding up. Your friends and family start getting frustrated with you. Your doctor may run out of ideas to treat your pain when normal treatments don’t work. The typical medications for pain aren’t working because this is Abnormal Pain and it doesn’t respond to the typical medication the way that normal pain does. You may feel there is no option other than surgery or you may have already had surgery with limited or no benefit. You might become convinced there must be something else wrong with you that just hasn’t been discovered yet. 

The good news is that research is improving our understanding of how abnormal pain works and how to manage it. 

Get moving: When movement hurts, it becomes hard to get motivated to move. Even when you do get motivated, you may start too fast or do the wrong exercises and cause a setback, making it even harder to get motivated to move. This is when you really need professional guidance. Physical therapists and Occupational therapists are well suited to guide you through this difficult process.  

Guided Imagery: In the beginning, you may not be in a proper condition for movement. Therapists, in extreme cases, may decide to start you with Guided Imagery to prepare your brain and nervous system for movement.  

Measured Exercise: In less extreme cases, therapists will guide you through a very closely monitored and measured amount of very specific types of exercise. Once your brain starts to experience movement again without the associated pain, the nervous system will start to turn down the sensitivity. By using measured exercise, you can set and achieve specific movement goals. Achieving goals has a positive effect on your nervous system and causes the release of Dopamine, a reward and feel-good chemical working in your nervous system. This in-turn allows for further movement to occur. Again, this must be carefully measured to avoid painful setbacks. By taking small steps like this and achieving small goals in a progressive manner, you can get back to moving without pain. 

Get sleep: Chronic pain causes disturbance in your sleep patterns, which winds-up the nervous system, making it more sensitive. Movement causes the release of neurochemicals that aid in sleep. Getting better sleep soothes the nervous system. 

Get good nutrition: A very large topic for a future discussion. Just know that certain food types are inflammatory and others have the opposite effect, reducing inflammation in the body. Stay tuned for future discussions on this topic. 

Cognitive Behavioral Therapy: Pain causes negative thoughts and emotions. These negative thoughts have a negative effect on your nervous system and increase nerve sensitivity. With guidance, you can learn to recognize these negative thoughts when they occur and develop new strategies to reverse them.   

This whole process takes time and requires guidance along the way. 

Work Conditioning: For injured workers, this is a program that goes beyond traditional therapy, giving you more time and more guidance to deal with your chronic pain. Work Conditioning gives you 2-3 hours for 3-4 days per week, giving you more time to get moving than traditional physical therapy visits. If you do well with this, you can keep it going by progressing to Work Hardening which progresses even further and focuses on getting you prepared to return to work. 

If you’re ready to get started on a work hardening and conditioning regimen, contact the team at REHAB AT WORK today.

Article by Guy Seeley, PT


Who Knew Physical Therapy Can Treat Dizziness?

The vestibular system plays a critical role in maintaining the sense of balance and equilibrium. The structures within the inner ear are considered part of the peripheral vestibular system and are full of motion sensors that detect motion and send that information to the brain. The brain interprets the information and determines the position of the head in space. This blog will discuss two different pathologies that can occur in the inner ear that can cause significant dizziness and how Physical Therapists can be equipped to treat them. 

Benign Paroxysmal Positional Vertigo

BPPV is the most common disorder of the peripheral vestibular system. It happens when the otoconia, that are usually in the utricle, are forcefully displaced into one of the three semicircular canals confusing the motion sensors in the ear leading to extreme and sudden vertigo. BBPV often occurs after a traumatic event, but can also happen idiopathically or with specific head movements

“Every time I roll over in bed, I feel like the room immediately begins to spin

*Note that these patients will use the term “spinning” or “spin” to describe their dizziness.

Can Physical Therapists Treat BPPV?

Yes! A Physical Therapist might ask a few questions and conduct a few tests to establish BPPV as a diagnosis. For treatment, the therapist will guide you through a series of positions to allow the displaced otoconia to return to their correct position within the inner ear. It is usually a relatively easy and quick fix if the positional maneuver is done correctly. Only two or three additional visits may be required to ensure that all otoconia are back where they belong.

Vestibular Hypofunction

Vestibular hypofunction encompasses peripheral vestibular disorders such as neuritis, and labyrinthitis and are usually caused by infections to the inner ear or traumatic events. In this case, dizziness is usually exacerbated with head movement. The main culprit is often a malfunctioning vestibulo-ocular reflex (VOR). The VOR is crucial in stabilizing the eyes while the head is moving, and can be problematic if it is impaired. If the eyes cannot keep up with the head as it moves, it can lead to significant dizziness, and can have a detrimental effect on daily activities such as driving, reading, crossing a busy street, etc. 

“I get off balance and very dizzy every time I turn to the left, so I avoid doing so” 

*Note these patients will not use the word “spinning” or “spin” to describe their dizziness. 

Can Physical Therapists Treat Vestibular Hypofunction Too?

For the most part, yes. For treatment, the therapist will walk the patient through a series of exercises aimed at stabilizing their gaze. The goal of the exercises is to essentially re-train the brain to not get dizzy with head movements. Treatment for a vestibular hypofunction is usually longer (6-12 weeks), as it takes time for the patient to progress from simple to more complex gaze stabilization exercises. 

Final Thoughts

Dizziness can be truly debilitating and affect virtually every facet of life. It is not well known, even to fellow health care providers, that physical therapy can effectively treat vestibular disorders, yet it is well within the Physical Therapy scope of practice.  

If you’re suffering from dizziness, contact REHAB AT WORK today to see if physical therapy and rehabilitation might be a good option for you!

Article by Rebecca White, PT, DPT