It’s Ok to Move!
As long as it’s measured…
Your complete guide to understanding persistent pain, and overcoming it in 4 simple steps when:
– Suffering from pain?
– Treatment isn’t working?
– Rest and avoiding everything doesn’t help?
If you answered yes to any of these questions then you must read this report to improve your understanding of persistent pain, or pain lasting longer than 3 months.
It’s incredible how profoundly this disorder can impact someone, and their subsequent healthcare and lifestyle journey.
The purpose of this report is to summarise how to understand and develop these skills, of which we as clinician’s at Core have refined over the past 20 years of experience with our patients.
Patients’ suffering from chronic back pain often think that:
1. Resting pain must mean there is something physically wrong with their neck, back or other body part;
2. Increased pain or spasm with certain activities must mean you should avoid these activities entirely; or in some cases rest from all activity and take it easy for a while.
3. “Cure-searching” and “relief” is the first goals in their recovery, before commencing any type of active rehabilitation.
More often than not, these beliefs lead to family and various medical and allied health professionals (either knowingly or inadvertently) trying to facilitate “fixes”, and enable disability – thus unfortunately dis-empowering their patients or loved ones further as a consequence.
It’s Ok to Move! As long as it’s measured!!
For this very reason, chronic pain is often referred to as the “invisible” disorder – as in because there is no plaster cast or crutch visible that it’s impossible to determine to what degree someone is actually suffering from pain!
What we know now though is that persistent pain is poorly understood at both the medical and community level, and unfortunately is predominately poorly managed.
There are 3 key impacts on the individual suffering from persistent pain:
1. Significant physical injury and associated functional disability.
2. Elevated psychological influences including increased stress, depression and anxiety levels.
3. Considerable social impact on family, lifestyle and work-related interests.
What patients, healthcare providers, insurance companies, and society in general must understand is that persistent pain may not be “cured” by treatment, medications, procedures or surgeries; that “answers” lie not in “finding relief”, but rather in developing and understanding and effective pain management schemas; and that the patient’s understanding and involvement is central to achieving effective and sustainable outcomes.
Quite simply, patients with persistent pain need to be managed as people, and not diagnoses.
When this is done effectively, pain sufferers benefit in 4 ways:
1. Greater understanding of the impact pain can have on one’s nervous system, and that by simply treating their diagnosed injuries won’t necessarily lead to reduced pain and improved activity levels.
2. Less stress and anxiety towards one’s pain experiences – allowing the person to feel more confidence to start moving with pain, rather than trying to avoid increasing it.
3. Improved physical mobility, strength, flexibility and stability. It’s Ok to Move! As long as it’s measured!!
4. Restored independence with activities of daily living by learning how to live life (at least initially) with pain, as opposed to not living life because of it!
Our goal is to help pain sufferers develop a simple 4 Step “tool-box” of effective pain management strategies to improve physical activity and overcome pain, thus ensuring fantastic outcomes!!
Step 1: Pain Education
When we talk about Pain Education, this means gaining a detailed knowledge of what you’ve actually done to yourself, and how this can be a perfectly normal experience with standard time-frames for physiologically healing.
As an example, most back injuries heal as best they will within 3 to 6 months post incident, so once red flags have been ruled out and the relative time periods have passed, the skill here is to actively return to normal things as quickly as possible, whilst mastering reassurance regarding hurt vs harm.
Understanding hurt vs harm means that just because things may seem painful at first when initially getting going, this doesn’t mean they are actually causing you harm, or your “problem” is getting worse. Most of the time these types of symptoms are reflective of your nervous system de-sensitising and adjusting to you moving once again. It’s Ok to Move! As long as it’s measured!!
Step 2: Mindfulness
Once you have this skill mastered, the next step here is working on your mindset and attitudes towards pain. By this we mean that the associated mood and stress impact from persistent pain is completely normal, and unless channeled, can become as equally unhelpful to your ongoing pain experience to that of your initial physical injury.
So, by using relaxation and other psychological techniques such as mindfulness, one can actively learn to take control of their natural thoughts around apprehension from pain, and simply increase their function in progressive bursts knowing they are on the road to recovery. Working with a counsellor or psychologist can be particularly helpful here when initially trying to develop these skills.
Step 3: Tailored Exercise Programs
When considering the role of Tailored Exercise Programs, it’s highly likely a person with pain has attempted stretches or exercises before as part of an initial treatment program. There are many types of back exercise programs, these range from aquatic or hydrotherapy, core exercises, clinical pilates and yoga, resistance/weights programs, and cardiovascular exercise (step count walking, swimming etc).
From a patient’s experience, these techniques may or may not have been helpful initially, or simply weren’t as effective as time went on. The usefulness of any exercise for pain can be attributed to what type is prescribed at which part of the patent’s treatment journey, and how consistent the patient is at completing same as part of their daily regime.
Current evidence shows that movement really is medicine – however there is “no one size fits all” recipe. With chronic back pain rehabilitation there is an individualised need to balance exercise protocols to each back pain sufferer, to ensure maximum effect for one’s strength, flexibility or mobility, whilst minimising the risk of flare-up from “over-doing it”.
It’s Ok to move! As long as it’s measured!!
Progressing exercises to ultimately those which are simulating activities of daily living for each person is best practice. Our Core Physiotherapists’ role is to individualise each patient’s exercise program to ensure maximum results, in the most rapid time-frame.
Step 4. Modifying Lifestyles
The fourth and final piece of solving the persistent pain puzzle is the need to understand and refine ergonomic and lifestyle strategies when moving – because prevention really is better than cure!
Considerations to one’s diet and medication regime is important to ensure there are no unknowing contributing influences to one’s pain experience. Some medications may no longer be appropriate for pain management, and ironically can be part of the problem, contributing to one’s pain experience.
Excess alcohol and smoking can also influence pain levels. Discussing this with each patient’s healthcare providers is vital to ensure all adjuncts are complimenting and not conflicting one another for assisting the goal of improved function for pain sufferers.
One of the most important ergonomic skills in back pain management is “Pacing” – either planned or reflective in nature. Understanding the need to focus on the quality of what you are doing, and not necessarily the quantity is vital. The cliche “slow and steady wins the race” summarises pacing skills nicely for tackling persistent pain.
When one is trying to upgrade their daily activities, pacing can simply be the skill of forward planning how they can do this in progressive steps, to increase the likelihood of achieving such goals, at minimal risk of flare-ups. Pacing is also post activity success or failure reflection in the event of flare-up of symptoms. This means taking the time to breakdown exactly how you went about doing something – ie: sit, squat, bend, lift or twist over time – to try and understand what could have been done differently to change your post-activity pain levels.
In this space, the persistent pain sufferer must become the expert in knowing and understanding their current capacity limitations – to ensure control over building these over time through pacing strategies.
This is why we preach that it’s Ok to move! As long as it’s measured!!
In summary, from our 20 years of experience working in this space, honed through our expert team at Core we’ve found that simply focusing on achieving our 4 step process is the key to success for overcoming persistent pain.
Often shifting your focus to what you can do with pain, as opposed to what you can’t do because of pain is a very helpful starting point to begin your pain management strategy.
If you are, or know of anyone who might currently be losing the battle with persistent pain, and they are currently undertaking some of the previously mentioned medical approaches in hope of change, please make them aware that current evidence suggests these interventions will more likely than not, lead to poor outcomes.
Our program is available across all our Gold Coast and Brisbane clinics. For more information on the components and research behind same visit www.painconsultant.com.au
Thanks for taking the time to learn the 4 simple steps of how to beat pain forever; and always remember that it’s Ok to move! As long as it’s measured!!
Principal | APA Pain Physiotherapist
Core Physiotherapy & Exercise Programs.