Pain in the Brain

By: Partiba Jassal MPT

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Most people will experience pain at some point in their life. And you have probably heard something along the lines of ‘the pain is in your brain.’ What does that saying really mean? Let’s understand pain a little bit better…

How does the pain process occur?

Our nervous system has millions of sensors throughout our body. It is constantly telling our brain about the changes that occur in our body tissues. One part of our nervous system is able to detect ‘danger’ to our body tissues, warning the brain about the amount, location, and extent of danger. The brain almost always responds to this information without us ever having to think about it consciously and decides if it we experience pain or not.

If you have pain, can movement make the pain worse?

Whether you’ve strained a muscle, sprained a ligament, broken a bone, or damaged a nerve, the correct movement patterns will always be beneficial in minimizing your pain. Here are a few reasons why movement can help:

  • A lack of movement leads to a build up of fluid in your muscles and joints, and this build up can cause or increase your sensations of pain
  • Bones are living and healing structures which benefit from movement and regular compression through activity
  • There are hundreds of meters of peripheral nerves in your body and these slide as you move; injury or diseases which alter this movement cause result in pain

An interesting fact is that changes that appear on X-ray and other imaging reports do not always necessarily correlate to pain. Why is this? As we age, normal changes occur within our body structures, and this is usually a painless process. However, when pathology is introduced the brain’s danger alarm system becomes alerted, and we then experience pain as result. This pain is our signal to seek help and fix the problem.

How can physiotherapy help me with my pain?

Whether you have acute pain or chronic pain, understanding and becoming educated on your pain will help you to manage it better. You can learn to minimize your pain by understanding the injury, the healing process, correct movement patterns, and the do’s and don’ts. This is where physiotherapists can help, because they are trained professionals with the ability to guide you through pain management techniques.

Reference:
Butler, David S, and G L. Moseley. Explain Pain. Adelaide: Noigroup Publications, 2003. Print.

Image: Science Photo Library/Getty Images

Knee Osteoarthritis

By: Mitchell Laidler BScPT

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Osteoarthritis is one of the most common joint disorders and is primarily seen in older populations over the age of 65 years old.

It is characterized by the changes in the joint itself, a decrease in cartilage thickness and formation of new bone (known as osteophytes) at the joint borders, causing the bone to lose its smooth ending, forming ‘jagged edges’.

Some symptoms you may experience include pain, swelling, reduced range of motion, and intermittent crepitus.

There are many variable factors that can influence these degenerative changes, such as age, weight, joint instability and muscle weakness. 

In a recent study, some physical interventions that had the best evidence for treating knee osteoarthritis were:

  • Biomechanical interventions (e.g. knee alignment, foot arch support)
  • The use of a cane or walking stick (for single knee osteoarthritis)
  • Land and water based aerobic activity
  • Strength training
  • Weight management strategies

Although there are some pharmacological interventions for knee osteoarthritis, the best evidence still points towards the use of physical interventions to reduce pain and increase function in those with osteoarthritis.

This is where physiotherapy can step in and assist with creating a personalized rehab plan. Speak to your local therapist about how they can help you manage your symptoms.

References

Goldring, S. R., & Goldring, M. B. (2006). Clinical aspects, pathology and pathophysiology of osteoarthritis. Journal of Musculoskeletal and Neuronal Interactions6(4), 376.

BA, M. S., Arden, N. K., & Kwoh, M. D. OARSI Guidelines for the Non-‐Surgical Management of Knee Osteoarthritis.

Non-Specific Low Back Pain

By: Michael Lam, MPT IMS

What is non-specific low back pain and why do I have it?

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Low back pain generally falls into two categories: Acute & Chronic.

Acute low back pain usually stems from some sort of recent traumatic event, or a series of repetitive micro traumas to the low back that happen over time. Chronic low back pain is loosely defined as pain that persists greater than 3-6 months.
Non-specific low back pain is defined as "low back pain not attributable to a recognizable, known specific pathology e.g. osteoporosis“ (1).

Why am I getting low back pain?

Well, chances are that if your low back pain occurred while lifting incorrectly, it’s likely acute. If it’s pain that has been a long-standing issue (e.g. “I’ve always had a bad back, but didn’t really do much for it when I was younger because I could get by”), then it’s likely a chronic issue. 

The literature has shown that the longer your low back pain persists, your deep core stabilizers, namely your transverse abdominis, begin to alter in terms of their firing (2), muscle tone/thickness and movement (3). At a younger age, we tend to be more active, stronger, and have better ways to compensate for the pain so we can continue with our daily activities (sports, work etc). At a certain point in time, those compensatory strategies begin to break down and that is likely why the intensity of the low back pain may spike.

So what can you do about low back pain?

You’ve probably tried a lot of painkillers, muscle relaxants and other pharmaceuticals but have found that they, only temporarily numb/alleviate the pain for several hours before its return. Studies have found the best way to manage low back pain is to retrain and jump-start your deep core muscles/stabilizers. Not just your abs though, the muscles more directly linked to your low back pain – the transverse abdominis. (4,5,6). In a study, working on stabilization exercises was found to decrease pain and levels of disability over a number of weeks.

So what now?

If you’re reading this and fed up with your low back pain, pop by and talk to one of our physiotherapists to see how he/she can help decrease your pain and improve your overall quality of life.

(References:

  1. Balagué, Federico, et al. "Non-specific low back pain." The Lancet 379.9814 (2012): 482-491. Level of evidence 1A
  2. HodgesPW, Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain. Exp Brain Res 2001;141:261–6.
  3. HidesJ, StantonW, FrekeM, et al.  MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain. Br J Sports Med 2008;42:809–13
  4. Ferreira PH, Ferreira ML, Maher CG, et al, Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain, British Journal of Sports Medicine  Published Online First: 26 May 2009. doi: 10.1136/bjsm.2009.061515
  5. Yen-Hua Chen, Huei-Ming Chai, Yio-Wha Shau, Chung-Li Wang, Shwu-Fen Wang, Increased sliding of transverse abdominis during contraction after myofascial release in patients with chronic low back pain, Manual Therapy, Volume 23, 2016, Pages 69-75, ISSN 1356-689X, http://dx.doi.org/10.1016/j.math.2015.10.004. (http://www.sciencedirect.com/science/article/pii/S1356689X15001940)
  6. Hosseinifar, M., Akbari, M., Behtash, H., Amiri, M., & Sarrafzadeh, J. (2013). The effects of stabilization and mckenzie exercises on transverse abdominis and multifidus muscle thickness, pain, and disability: A randomized controlled trial in NonSpecific chronic low back pain. Journal of Physical Therapy Science, 25(12), 1541-1545. doi:10.1589/jpts.25.1541)