Break Through Your Limitations with Strength Training as an Older Adult

By: admin Published: October 7, 2020

The Secret to Aging Well

Have you heard this phrase before, or maybe even said it to yourself: “You will understand when you are my age that your body just can’t do what it used to do.”

What if I told you that I knew of a secret that would let you change what your body can do, no matter what your age?

people exercising in a group

So what is this secret that holds the key to aging well? Strength training! What do I mean by strength training? Strength training is any kind of exercise directed at making you stronger and it is a science-proven solution for helping you improve your ability to do what you want while you age.

Why Strength Matters as You Age

Strength training is about so much more than growing big muscles. Strength training can help you:

→Increase your bone density (which means you are less likely to have a bone fracture)

→Decrease your risk of falling

→Improve your ability to manage diabetes, high blood pressure, heart conditions, and many more health conditions

→Increase your independence

→Improve how fast you walk

→Decrease your symptoms related to arthritis

→Lose weight

Can I Strength Train if I have Pain?

get your muscles on!

Yes! This is where a visit with a physical therapist will be particularly helpful for you. A physical therapist can design a program that allows you to build strength without increasing your pain, so you can get back to doing what you want to do faster.

How your PT Can Help

Physical therapists are well trained in how to safely create strength training programs that can target your specific needs to help you get stronger and reach your goals.

→These programs can be designed to be complete at home or in the gym.

→We are equipped to design programs that can include bodyweight, resistance bands, dumbbells, barbells, and low vs. high impacts exercises and much more!

Call CoreBalance Therapy Today to Discuss How a PT can Design a Strength Training Program for You!

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Vertigo, Dizzy, BPPV? Time to See your Physical Therapist

By: admin Published: September 7, 2020

 

by Deborah Bodin, PT

Wake Up Spinning?

Did you wake up one morning and feel like the room was spinning when you tried to get out of bed? Did this make you feel like you might throw up? Unfortunately, you’re not alone. This sensation is called vertigo and it is very common–it is experienced by 40% of US adults in their lifetime.

dizzy person

It is likely that you have Benign Paroxysmal Positional Vertigo (a.k.a. BPPV) as it is the most common cause of vertigo.  Almost 1 in every 10 older adults (75 or older) has BPPV.  This is important because BPPV increases your chance of experiencing a dangerous fall up to 12 times.

Now for some good news! BPPV is very treatable with physical therapy. Many times your current symptoms can be resolved in one or two physical therapy sessions.

What is BPPV?

 

anatomy of inner ear

There are 3 semicircular canals and 2 balance organs in each ear.

  • Benign: not life-threatening
  • Paroxysmal: recurrent, sudden, intense symptoms
  • Positional: related to a change in the position of the ear
  • Vertigo: sensation of rotation or spinning

BPPV is a problem where “crystals” (actually small pieces of calcium carbonate) break loose from where they normally belong in your inner ear. They get stuck in a part of your inner ear where they are not supposed to be. This can be related to a blow to the head, recent illness, or, more commonly, no reason at all.

When the crystals are in the wrong place, a short, often intense, sensation of dizziness called vertigo can occur with a change in your body’s position. The most common activities that cause vertigo are: rolling over in bed, getting out of bed, bending forward, or looking up.

What are the symptoms of BPPV?

 

Symptoms of BPPV include:

  • Dizziness
  • Vertigo – the sense that you or the room is spinning
  • Loss of balance or unsteadiness
  • Nausea
  • Vomiting

What can physical therapists do?

The physical therapists at CoreBalance Therapy have specialized training in the assessment and treatment of dizziness.  They will take a detailed history of your symptoms that may include:

  • when they started
  • what you were doing when they began
  • how long your dizziness lasts
  • what makes it worse/better
  • other recent illnesses or injuries that may be contributing to your symptoms

To evaluate for BPPV your therapist will be looking at how your eyes move when you are both sitting still and when your head is moving or you are changing position.  Special video goggles may be used to record how your eyes move.  The testing involving putting you in a variety of positions is designed to recreate your symptoms to help your therapist decide what maneuver is appropriate for treatment of your BPPV.

Physical therapy evaluation is also checking for other possible causes of your symptoms. Dizziness can be caused by many other issues and if your therapist does not think that BPPV is your problem, they may offer you different physical therapy treatment exercises or refer you to another medical specialist.

How long does it take to feel better?

BPPV is treated by a series of maneuvers designed to put the crystals back where they belong.  This is usually effective in a few treatment sessions. As the crystals move back to where they belong, you may experience your familiar symptoms. Your therapist expects this and will help you get through them.

What happens if I don’t do anything?

If you do nothing, the symptoms of BPPV can sometimes decrease or resolve without any treatment; this can take only a few days or up to several months. In general, it is not recommended to leave this condition untreated. Falls, imbalance and depression are more common in individuals with untreated BPPV.  There are some medications that may decrease your acute dizziness symptoms, but they don’t fix the problem and may lead to worsening of your symptoms if taken long term.

How effective is treatment?

Physical Therapy maneuvers are very effective at eliminating your current episode of BPPV and, many times, it only takes a few treatment visits.  Your therapist can also teach you how to self-manage any future episodes if your BPPV returns. We understand how frustrating it is when vertigo occurs and we want to get you back to your life as quickly as possible!

Call CoreBalance Therapy to Schedule Your Visit with your PT to Treat Your BPPV Today!

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Do you leak when you lift?

By: admin Published: July 14, 2017

Here is an article written by our former student, recently graduated: Erin Brunelle, PT, DPT

CrossFit has developed a loyal following of fitness enthusiasts. An often-cited benefit of CrossFIt is that it develops functional fitness skills, meaning that what you learn to do in CrossFit (e.g. lift weights) helps you perform better in everyday life (e.g. lifting boxes when you clean your garage). However, CrossFit seems to miss the mark on training a very important yet rarely-discussed component of the core – the pelvic floor.

Realistically, most fitness regimens don’t address the pelvic floor. Most people think only of the abdominals when someone refers to their “core”. But the core is actually a cylinder of muscles that includes the pelvic floor. The abdominals make up the front of the cylinder, the deep back muscles are the back of the cylinder, the top of the cylinder is the respiratory diaphragm, and the bottom is the pelvic floor. See this video of Amy Flory, PT, giving a short explanation of this concept HERE.

Because this cylinder is pressurized, it is often compared to a soda can (see diagram).

Core=soda can

The “core” is a pressurized cylinder

So think about this: if the inside of the cylinder is pressurized (what we would call intra-abdominal pressure) and the only way out is through the pelvic floor, what is likely to happen in instances of increased intra-abdominal pressure, such as when we lift heavy objects? That’s right. Urine leakage, or what we would technically refer to as stress incontinence (not psychological stress, but mechanical stress).  Sometimes, that increased pressure can also result in dropping or bulging of the pelvic organs.

And here’s the thing: stress incontinence should not happen, even when you’re setting a new personal record in the power clean! The pelvic floor muscles are skeletal muscles, meaning that they can be trained and strengthened like your quads or biceps. You just have to learn how to contract them (think Kegels) and get in the habit of engaging them when you’re lifting or jumping. For help on training your pelvic floor muscles and reducing long-term tissue damage that result in stress incontinence and pelvic organ prolapse, make an appointment with a pelvic floor physical therapist.  There are two of them at CoreBalance: Amy Flory, PT, and Colleen Gest, PT.  If you live outside of northern Arizona, they can help you find a specialist close to you as well!

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CoreBalance Therapy welcomes Tiana Tallant, MA, PT, DPT

By: admin Published: June 22, 2017

CoreBalance Therapy is delighted to announce the addition of Tiana Tallant, MA, PT, DPT to our staff!

We’ve known Tiana for years, as she was an employee prior to completing her doctorate in physical therapy, and we could not be happier that she has decided to come back and work with us now that she holds her physical therapy license. She brings a wealth of knowledge and skills as well as a delightful and empowering personality to our clinic.

Tiana holds a Master’s degree in Health Psychology, which helps her to better understand how people’s behavior interacts with their health conditions. That background fits perfectly into her interest in the management of persistent pain conditions, where treatments such as behavioral modification, meditation and cognitive therapies offer great potential for improved management and function. Tiana also has been a registered yoga therapist (RYT) for years, teaching in the community, and brings that expertise to exercise programming and design of home exercise programs for her patients. Finally, Tiana is an accomplished athlete, competing in CrossFit competitions and distance running events at a statewide level.

We asked Tiana to write something about herself, so you can all see why we’re so excited about having her:

“We are not a singular thing-we are built to change.” -unknown

This is one of the fundamental principles that I operate from in my everyday life and in how I treat patients. My name is Tiana Tallant and I am the newest physical therapist at CoreBalance. I graduated from the NAU DPT program earlier this year and am incredibly grateful for the opportunity to begin my career at CoreBalance. Before entering PT school, I completed my MA in Clinical Health Psychology which allowed me to dedicate time and effort into understanding the human relationship with change- what drives us to change, what barriers we have to overcome, and how we use our environment and/ or relationships to create those changes. In my perspective, coming into the clinic for Physical Therapy is another scenario that asks us to change. It takes us out of our normal routine and for the short term or the long term asks us to do some things differently. Whether you are seeking therapy for an acute or chronic condition, I will ask you for a commitment to try something different- maybe completing exercises at home, being more active, or trying to engage in a certain movement pattern differently. Whatever it is, you will have the opportunity to create meaningful change through your experience with Physical Therapy. I so look forward to being by your side throughout the process!!

Tiana is seeing patients at our University location. Her areas of particular clinical interest are musculoskeletal injuries of all types, patients with persistent ongoing pain conditions, and patients who are experiencing difficulty developing an exercise routine for the management of chronic health conditions such as diabetes, high blood pressure, or long-term weight management.  You can learn more about Tiana and the rest of our provider team by clicking here, or call us at 928-556-9935 to make an appointment to see any of us.

Graston Technique

By: admin Published: May 6, 2014

by Holly Nester, PT, MPT

What is Graston Technique?

Graston is a respected form of instrument-assisted soft tissue mobilization used to effectively treat pain and restricted mobility.   Therapists specially trained in the Graston techniques utilize uniquely designed stainless steel instruments to break down fascial restrictions and scar tissue that impair normal movement.

Graston

 

What are the benefits? 

  • Assists with faster recovery by addressing the restricted tissues that are causing dysfunction
  • May reduce need for anti-inflammatory medications
  • Is effective for both acute and chronic conditions
  • Increases tissue mobility resulting in less pain and stiffness

What types of patients are treated with Graston?

Graston is appropriate for those who would benefit from manual therapy and lengthening of restricted tissue.  While I continue to have great results with direct hands-on treatment, Graston techniques offer an alternative approach that is especially beneficial for deeper or long standing restricted areas where fibrotic tissue is contributing to injury and/or pain.  Diagnoses that I have successfully treated with Graston include:

  • Neck/back pain
  • Carpal tunnel syndrome
  • Tendinitis/epicondylitis
  • Hip/knee disorders
  • Plantar fasciitis
  • Scar tissue

What to expect?

The internet has pictures of people horribly bruised following Graston techniques, but this is not the norm.  While Graston is used for professional and Olympic athletes who may tolerate that type of extremely deep work, most people treated in our physical therapy clinic can anticipate a much less severe response.  Typically we warm up the tissues so that they are less tender and more responsive to lengthening.  Hands on techniques may be used in conjunction with Graston instruments to lengthen the injured tissue and allow for more normal movement patterns and reduced pain.  There may be reddening of the skin, tenderness, and some light bruising depending on the individual and depth of pressure used.  It is always done to the patients’ tolerance and with their consent.  Exercise and ice are often included as part of treatment following Graston techniques.

Click here for a printable information sheet on Graston technique.

What research is available?

If you are interested in reading available research articles, please visit www.grastontechnique.com for more information.

What Do Patients Say?

“Before receiving Graston, I had repeated injuries of various sorts (e.g. pulled hamstring and chronic tension).  With Graston, Holly was able to get to areas connected to the “tight spots” that ultimately got to the root of the issues.  I am so grateful for her wisdom and the Graston technique!  Now I know that what was once chronic pain does not have to be normal for me any longer.”

 

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Staying Active While Injured

By: admin Published: November 24, 2013

by Katie Pierce, PT, DPT

Has being laid up with an injury gotten you down?dog play and knee scooter 073 (956x1280)

Dealing with a physical injury, chronic pain, or other health condition can be a real game-changer. Activities which used to be easy (like walking across a room, let alone taking your dog out for a run), now seem almost impossible.  Even if the condition is short-lived (such as I faced this fall when I injured my ankle while running, and had to wear a cast and use crutches for several weeks), plummeting physical activity levels can be a real downer. But with a little determination and some creativity, an injury or health condition doesn’t have to be a sentence for house-arrest. Here are some tips to help you find ways to safely engage in physical activity while dealing with an injury or other health condition:

Alter your workout: Change mode, intensity, frequency, or duration:

The mode (how you are exercising) may be the first thing that needs to change while you’re recovering from injury. No matter how much I would love to deny the fact, I was NOT going to be able to run while my leg was in a fiberglass cast and I was non-weight-bearing on crutches. Arghh… But I could don my water-proof cast cover and get in the pool.  Or ride a “New Step” seated stepper machine at my local community center  by peddling with both arms and my left leg only.

Your favorite activities may be out-of-reach for awhile, but there are other creative ways to keep your activity level up. And “New Stepping” with the folks at the local senior center, I learned, no matter how much it’s NOT running, is much better than staying home and skipping the day’s exercise altogether. Why? Because I crave those exercise-induced endorphins! Any exercise which gets the heart rate up and keeps it there for a period of time, can effectively boost feel-good neurotransmitter levels in the brain, such as serotonin and epinephrine  (DG Amen, 2010).

Other, more subtle changes to your exercise routine may do the trick. Reducing intensity, for example , may be all it takes to allow a less serious injury to heal. Or reduce frequency of the offending activity (e.g. biking 5 times a week was nagging at your knee, so you reduce to twice a week), while choosing a different mode of exercise on the days off. Or duration: simply do the activity for less time. Your Physical therapist can help you decide which changes need to be made to your typical exercise program to help you heal, while still meeting your needs for physical activity.

winter crutch outings

Disclaimer: Special equipment is being used to keep me safe in this photo (Yak Trax on the boots, metal spikes on the crutches… Don’t try this without proper gear! See next section, below)

Nature has been called “Vitamin N,” because outdoor time is so essential to our well being as homo sapiens (Louv, 2012). Getting outside can be key to boosting mood, especially if your primary mode(s) of physical activity before your injury involved the out-of-doors.

Meeting your cardiovascular exercise needs outdoors may not  be possible, depending on your injury or health condition. But just “being” outside can still provide a needed lift to your spirits.  Earlier this fall, while non weight-bearing on crutches, and nursing a sore shoulder, I could literally only propel myself a few hundred feet at a time.  But I still made plans to drive up with a friend to the edge of the National Forest almost daily. We’d park, and I’d crutch out several yards and sit on rock, listening to the sounds of Nature and feeling the warmth of the sun on my skin. I couldn’t exercise outdoors, but I could still enjoy the gifts of beauty of it.  And then I’d go to the pool for my aerobic exercise. It took some planning and extra time, yet I could feel the mental boost it gave me to spend time outdoors every day.

Be creative:  Special tools and equipment can help you do what you love

Sometimes the limitations of an injury make certain forms of exercise unsafe (think rubber crutch tips on snow and ice) or impractical (a fiberglass cast in the swimming pool?).  My clients with dizziness and imbalance, for example, just can’t safely ride their bikes when dealing with a flare in their symptoms.

But a little creativity – and some special products – can help solve problems like these. “Crutch tips for snow and ice,” (my actual Google search terms) for example, were my best friends last winter, and turned seemingly treacherous situations into an easy crutch-walk. Can’t get a cast wet? No problem: Waterproof vacuum-sealed cast covers are at your service. Just search online, you’ll be surprised at what’s for sale.

jog belt

Ask to borrow a blue “aqua jogging belt” at a local aquatic facility – You can use it in deep water, or if you can bear some weight, in chest-high water with your feet touching bottom…

But what about more complicated conditions, like spine pain or dizziness? Spine pain can be a tricky injury for those wanting cardiovascular exercise, because many motions can trigger pain – twisting, flexing, bouncing, etc.  But what about deep water jogging?  Aqua Jogging belts are designed to allow you to move in deep water without sinking, and allow you to maintain good postural alignment while moving your limbs and raising your heart rate. Here in Flagstaff, you can borrow an “Aqua Jogger” at no extra charge with your day pass to both the Aquaplex or NAU’s Wall Aquatic Center.

Dizziness and imbalance can be tricky, too. A few of my clients have returned to their love of biking while still healing from vestibular disorders, by setting up a stationary bike trainer and getting those wheels turning, safely.

Rental products for mobility can help with leg injuries: my “knee scooter” and I, below, had a great time participating in a “Splash 2 Dash” race at NAU.  So what if I didn’t finish the 5K run (OK, so I scooted about 400 meters then called it a day)? I still had a blast, and I rocked the swim portion, waterproof cast protector and all.

 So the moral of the story?  Exercise is good for the body, and for your spirits, too. Your Physical Therapist can help you design an exercise program to keep you as fit [and happy] as possible while you let your body heal.

Contact the expert physical therapists at CoreBalance Therapy, for evaluation for an injury or mobility condition, and learn how to stay active while you recover.

You just might see this active P.T. crutching around the clinic, for a few more weeks…

Yours,

Katie

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Iliotibial Band Syndrome

By: admin Published: September 2, 2013

Well, it’s ITB season, that time every year in Flagstaff when runners have ramped up their hill work to compete in the Imogene Pass Run, a 17.1 mile race up and over the Imogene Pass in Colorado.

Iliotibial Band Syndrome is characterized by pain and focal tenderness in the lateral knee. Specific aggravating activities include sprinting, running down hills or stairs, cycling up hills, and walking or hiking two or more miles. Usually discomfort increases as subjects continue to perform the implicated activity and pain usually stops with cessation of activity. Though runners and cyclists are the most affected by this condition, it can also rear its head with other high volume activities such as aggressive walking, hiking and any activity involving repetitive flexion and extension of the knee.

Anatomy:ITBS

The iliotibial band (ITB) is a thick band of fascial tissue taking its fibers from the gluteus maximus in the back of the hip, and tensor fascia lata muscle on the outside of the hip. The ITB then travels down the outside of the thigh and knee and inserts into the lower leg. Biomechanically, bending and straightening the knee causes the ITB to move over the bones at the outside of knee.

Cause of injury:

Functionally, high mileage, quick ramping up of training and repetitive flexion and extension about the knee predispose a susceptible individual to this injury. Genu varum (“knock-knees”), greater body mass and height and ITB tightness have been implicated as possible anatomical causes of ITB syndrome. Some sources also implicate excessive mid-foot mobility (sometimes referred to as over-pronation) and hip abductor or rotator weakness as predisposing factors. It has also been suggested that leg length discrepancy, either structural or related to muscular imbalance in the pelvis or lower extremity, might create a pelvic tilt that puts excess stretch on the band of the longer leg.  In addition, weakness of the large gluteus maximus muscle may allow the ITB to migrate forward on the outside of the thigh; this migration leads to shortening of the ITB and increased compression or friction at the knee or hip bones.

Treatment:

In the acute phase of injury, activity modification is advised and includes decreasing mileage/activity and resting, local ice massage, anti-inflammatory medication, and corticosteroid injection have proven effective in reducing symptoms. In the subacute phase, stretching and myofascial release are helpful to increase tissue length and decrease muscle tension. There is a small study of Graston Technique (using metal instruments to treat limited soft tissue mobility) that showed immediate improvement in symptoms.  Holly Nester, PT, at our east clinic, is one of the few certified Graston practitioners in Flagstaff.  During the recovery phase, it is advised that the subject introduce progressive strengthening exercises for the hips and core stabilization exercises to improve coordination and control about the hip, knee and trunk. Return to activity includes easy sprints and gradual increase in distance and frequency. Recovery may take 6-8 weeks, if symptoms are suppressed well enough in the beginning, so be patient and understand that too-rapid return may cause recurrence of symptoms. Return to activity may also be facilitated by orthotic consultation and implementation if structural or anatomical contributions are a factor predisposing some individuals to this condition.

If you want to read more about Iliotibial Band Syndrome, have a look at this article published in 2011.  It gives a lot of detail about the condition and treatment, but really it says the same this this blog post does – treatment requires a careful examination to identify the biomechanical cause of the condition and correct it.  If you are looking for a physical therapist with the time and expertise to perform that kind of assessment, please contact us!

CoreBalance and Personal Care PT merger

By: admin Published: August 10, 2013

The direction healthcare delivery is taking in order to provide more affordable care is also a direction that makes it more difficult for small healthcare practices to survive.  The physical therapists at Personal Care Physical Therapy and CoreBalance Therapy take pride in providing quality care designed for each individual in a comfortable and friendly environment.  In order to foster this endeavor, and to provide more support for our awesome therapists, we are thrilled to announce that the two outpatient clinics are merging resources and operations.

Both of the existing clinic locations will remain open and will operate under the name, “CoreBalance Therapy”.  Contact information for each clinic site will remain unchanged.  For your convenience, we will be extending most of our specialized programs to both locations. These include:

Some services will remain at one clinic location. For example, Tai Chi classes and one-on-one Yoga therapy will continue at the University location, and Functional Capacity Evaluations will continue at the Cedar location.

We are all excited about the future and are happy to talk with you about it!  See you in the clinic soon!

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NeuroScience of Chronic Pain Part III

By: admin Published: April 18, 2013

by Jay McCallum, PT, DPT, OCS

How Does Chronic Pain Change the Sensory System?

In my last post I tried to outline the super-complex process that the brain goes through to generate the experience of pain, and what I want to try to do today is talk about what changes when the nervous system is bombarded by pain impulses over a long period of time.  This can be a challenging idea to transmit to people who have had pain for may years – they have nearly all heard some refrain on the idea that ‘your pain is in your head,’ with the subtext being ‘your pain is not real’ or, worse yet, ‘you’re faking it.’  I have had patients become angry and leave care, or become tearful or defensive when I try to bring this topic up, which is why I wanted to spend the time writing in my last post about how the experience of pain is generated by the brain.  What we are talking about here is not ‘the subconscious’ or anything like that – it’s about structural changes in the parts of the brain responsible for processing various inputs and generating the output or experience of pain.

There are several ways that the nervous system adapts over time to pain, and unfortunately the idea that we get tougher or desensitized is not at all accurate.  Remember that our nervous system is “plastic”, that it, it changes its structure in response to stimulus.  Generally, the more of a stimulus you give the nervous system, the more ‘resources’  it devotes to that stimulus.  Think of practicing a skill like hitting a golf ball – to break down the details of that, we improve our skill at that because with practice we devote more neurons to the motor program.  Or think of a sommelier who can identify many nuances of a wine — again, more neurons devoted to that process.  With pain, what we see is that the spinal cord itself ‘turns up the gain’ on its pain pathways, devoting more neurons to nociception (pain stimulation) than ‘normal.’  It looks a bit like this diagram, if you think of the vertical axis as being basically loading to a tissue, with the peak being the point at which injury would occur:

Normal Protective Pain

Normal Protective Pain

This is how pain is supposed to work – the person feels pain just a little before the point at which tissue damage occurs.  But when the spinal cord is turning up the gain, it looks more like this:

Abnormally early onset of pain in relation to tissue load

Abnormally early onset of pain in relation to tissue load

In this diagram you see that there has been a change in true tissue tolerance related to the original injury but the nervous system begins to generate pain far before any tissue damage begins to occur.  Let me emphasize here for a minute again that this is TOTALLY REAL PAIN, it just isn’t calibrated well to tissue damage anymore.  This change appears to happen primarily in the spinal cord, and as such is often referred to as “central sensitization.”

Central Facilitation

As if this isn’t enough, the brain itself has to get into the act.  As with other things I’ve described with this series of posts, the changes are complex, but there are two main themes – loss of precision and a process called facilitation.  We’ll start with the loss of precision.  As neurons in the sensory cortex of the brain are continuously bombarded with stimulation the stimulation basically starts to bleed over to neighboring neurons, to the point that brain imaging scans show overlap between areas of activation in the brain with stimulation of different parts of the painful region.  Patients experience a sense that their pain is spreading over time, sometimes even spreading to the opposite side of the body, and simultaneously becoming more difficult to describe.  Rather than pointing at the pain with a finger they wave at a whole area of their body, and they describe a sensation that the pain is ‘moving around.’  This loss of precision is easiest to ‘see’ experimentally in people who have a single extremity involved, say a very painful right arm.   We use our sensory cortex to help us identify whether we are looking a picture of a right arm or a left arm, basically sort of superimposing that picture onto our sensory cortex to see which side it ‘fits.’  Those patients with painful right arms, for example, are significantly slower to identify pictures of right arms than left arms, which tells us that their sensory cortex is not processing information quickly or accurately.

Facilitation basically means ‘priming’, and to understand this remember that the brain is absorbing information about many different things as it creates the experience of pain, and over time it no longer needs the entire set of stimuli to create the experience.  In our course, the analogy was to ask a group of attendees to stand up, then sit, then stand, then sit, etc.  Each time the speaker gestured along with giving a verbal command, until the last time when all he did was gesture.  And everyone stood.  A partial stimulus – had he just walked up to them and gestured initially they would have just stared at him – leading to the output of standing.  With pain, it might be the stimulus of an environment or activity that has historically provoked pain.  A case study of a bicyclist who had chronic pain with hill climbing was presented – she was placed in a setting where screens to either side of her could be tilted to make it look and feel like she was climbing a hill, and her pain could be brought on (and relieved) simply by tilting those screens, with no change in the actual intensity of her riding.  A partial stimulus of hill climbing leading to the experience of pain.  (You can read more about her here).

So…to recap:  Nociception (remember, that’s the name we use for nerves in the body that carry a painful stimulus to the brain) gets amplified by the spinal cord over time.  The sensory cortex of the brain that is responsible for generating the sensation of pain and sending it to our consciousness becomes somewhat sloppy (very like what happens with the motor cortex as I described in my first post on this subject).  And the pain system begins to leap to conclusions based on incomplete data.  Finally, just because I can’t say it enough times, the pain is REAL.  It’s just no longer accurately representing tissue damage like it is supposed to.

I have one more post in the pipeline, which will deal with what we can do in physical therapy to address this process, but the short version is that it is very much a thing that physical therapy can impact because it’s about retraining the brain, and PTs work with changing brain function every day.  Lots of things can change the way the brain functions, including everything from trauma (a head injury or a stroke) to what might amount to an overuse injury to part of the brain (chronic pain), and PTs treat all those things.  So if you have a history of longstanding pain that has not always ‘made sense’ to your medical providers, then consider giving us a call at 928-556-9935 or an email at [email protected].

 

 

Neuroscience of Chronic Pain Part II

By: admin Published: April 2, 2013

by Jay McCallum, PT, DPT, OCS

 

The Sensory System

In the first post of this series I focused on how the motor system changes in response to longstanding pain, basically with a shift in strategies towards more of a mass bracing pattern that over time tends to perpetuate the pain.  But that’s only half the story, at best – the way we perceive pain also changes in response to a chronic painful stimulus.  And, as you can imagine, those changes are not particularly helpful.  But, before we launch into a discussion of how the system changes, let’s start with talking about how it normally functions.  As with everything else our brains do, it’s an amazingly complicated process, so I’m just going to hit some of the highlights.

How Does the Brain Create an Experience?

We all like to think that we are directly connected with the reality of the world around us.  We use our eyes to see what’s there to see, our ears to hear what there is to hear, and we feel things based also on the stimulation of our nerves.  But the process is really not nearly that straightforward.  optical illusion

This is an example of an optical illusion, where the viewer is asked to count the number of black dots.  Problem is, they keep moving around – white when you look right at them, black when in the periphery of your vision.  In reality, they’re all white, but the brain does not accurately present that information to your consciousness because it is affected by the dominance of the black squares.  There are also examples of auditory illusions, tactile illusions, even smell illusions!  And let’s be careful about this term ‘illusion’ – the perception is quite real – I really do see little black dots in that picture.

So, the best way probably to think about how we experience the world around us is to envision a product that has been presented to our consciousness by our brains, after taking multiple inputs into account.

So What Goes Into the Experience of Pain?

Quite a few things.  The first, obvious one is stimulation of a nerve or nerves, at least in most cases.  That input to the brain is called nociception.  But we know that nociception is neither necessary nor sufficient for the experience of pain.  For example, consider a person with phantom limb pain after an amputation.  The sensory nerves and the tissues that they are responsible for no longer even exist, but the person nevertheless experiences extremely real pain.  We’ve all heard stories about people with terrible injuries who didn’t realize that they even had the injury until later, because they were busy dealing with the situation at hand.  Or, on a more daily level, that cut or scratch that didn’t start to hurt until you saw it sometime later.  Some of the other inputs the brain takes into account in generating an experience of pain are things like our sense of body position, what we’re seeing and hearing, and what our prior experiences and beliefs surrounding similar circumstances are.

The key thing to remember here is that the purpose of pain is to alert us of a threat, and that the brain is attempting to make a threat decision with what it presents to our consciousness.  The more threatening the combination of inputs is, the greater the pain is.  Lorimer told a great story that summarizes this well.  He was walking in ‘the bush’ as they call it in Australia, and felt something catch his foot momentarily.  There was no pain, just a catch, and he continued with his walk.  Then he woke up in the hospital – he had been bitten by an eastern brown snake, a terribly venomous snake with an extremely painful bite.  But his brain had not reported pain to him, because he had such a large experience of walking in the bush and scratching his leg on twigs, so the very similar input of the snakebite was not judged as dangerous.  Months later, he was again walking in the bush and felt something catch his leg, but this time it was hideously painful, with persistent pain for a week afterwards.  But, you guessed it, scratched by a twig.  But that combination of inputs – walking in the bush, stimulus to the outside of the leg, etc – was now on the ‘really dangerous’ list as far as his brain was concerned, in that last time it nearly killed him.

Say Again?

Let’s pause here to summarize all this.  Pain is an experience, not a stimulus.  It is generated as a result of many inputs, including both things happening to our bodies and around us as well as our past experiences and beliefs.  Nociception (that stimulus of a nerve fiber in a tissue in the body somewhere) is neither sufficient nor even necessary for the experience of pain to occur.  There is, rather, an extraordinarily complex orchestra of events that are oriented around risk assessment that leads to the experience of pain.  And, like anything complicated, sometimes that orchestra starts to malfunction.  In my next post I’m going to talk about how that happens, but the really short version is that the more the orchestra plays the pain tune, the better it gets at it, until it’s going on and on in a way that is partially or even completely disconnected from the input its getting from the tissues.  It looks a bit like this:Pain diagram

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