We all get it. Most of us have had an injury that has settled at some point, but for some pain hangs around longer than we would expect. Why does this occur? And when it does, what can be done? In this article, Musculoskeletal Physiotherapist Mike Callan will talk about pain; how it works, factors that can affect how much pain we feel, and strategies for those who suffer with persisting pain.
Pain is well, a pain. But what is it exactly? An emotion? Physical damage in the body? In reality it is much more. Pain is a complex psychological experience that is different for each person. The experience of pain occurs when your body’s alarm system alerts the brain to actual or potential tissue damage. There is no such thing as pain nerves in our bodies. We have millions of detectors in our body known as nociceptors, which are located in skin, muscle, bone, joint, ligament, blood vessel, disc, and nerve. When stimulated, these detectors can send signals through our nerves to our spinal cord, then on to the brain. But these are not inherently painful. The messages sent from the receptors and nerves are just a ‘danger’ signals; the brain then decides whether or not we experiencing pain, and how strongly we feel it based on how threatening the signal is.
This month’s newsletter will be focusing on lateral hip pain, which is often referred to as trochanteric bursitis. Recent evidence suggests that the primary cause of pain may actually be a result of gluteal tendinopathy, rather than from inflammation of the bursa, which may actually be a secondary finding to tendinopathy*. Tendinopathy involves changes to the structure of the tendon and breakdown of the collagen structure of the tendon, resulting in a tendon that is more like a weak spring as opposed to a healthy tendon that behaves like a stiff spring. Traditionally tendon overload has been considered to be tensile; however compressive load may play a significant role in the development of tendinopathy**. The gluteal muscle group is made up three muscles – gluteus maximus, medius and minimus, all of which are located in your hip region. The smaller two, gluteus medius and gluteus minimus, are the muscles that are commonly involved in gluteal tendinopathy.
Frozen shoulder is a condition involving considerable pain and loss of movement in the shoulder joint. Historically, this has been a difficult condition to treat due to a lack of evidence showing the best course of treatment. Left alone, the natural history of frozen shoulder generally takes 12-42 months with the average being 30 months, although the condition is somewhat self-limiting, it is not uncommon for patients to have ongoing limitation of shoulder movement. The standard approach for managing frozen shoulder has been to let the condition run its course; however it is understandable that many patients would rather have the condition resolve in less than 30 months or know the best options for treatment if they are experiencing strong and bothersome pain.
Rotator Cuff Related Shoulder Pain
Rotator cuff related shoulder pain (RCRSP) assessment and management, a recently published article by Jeremy Lewis, a leading shoulder pain researcher.
RSRSP is related to shoulder pain and dysfunction typically during shoulder elevation and outward rotation. Shoulder pain is common and associated with high levels of morbidity. While there is a range of influences that can create RSRSP, the major influence appears to be excessive and maladaptive load exerted on the shoulder soft-tissues, particularly tendon. Similar to other musculoskeletal conditions, such as low back pain, a definite structural diagnosis for RSRSP may be elusive. There is ongoing debate as to the cause of RSRSP with;
1) The mechanisms of pain uncertain
2) Poor correlation between symptoms and structural failure often observed in rotator cuff tendons, substantial numbers of people without shoulder pain demonstrate structural rotator cuff changes on imaging.
One Leg Physio is challenging you
Balancing is a necessity for our health and fitness of our bodies, it helps our bodies to stay upright and steady. Balancing in particular for people of senior age is very important as one in four people aged 60+ fall. One Leg Physio wants to see the average a person can balance on One Leg (categorised in age brackets).
How to take the One Leg Test
Breathing is one of the most basic and fundamental functions of the human body, yet little attention is often paid to it in a therapeutic sense.
Breathing can be considered dysfunctional when the person can no longer breathe efficiently or if it is ineffective in response to changing environment or does not meet the physiological needs of the person. This can in turn affect their quality of life, challenging homeostasis, resulting in physical symptoms and compromised health.
In practices such as Yoga, stress reduction, pain relief and meditation breathing is a prime area of focus. Research is revealing that the breath is a powerful tool and that regular practice of mindful breathing or meditation can facilitate a better state of health and wellbeing (Chaidlow et al 2002, Van Dixhoorn 220, Kim et al 2012, Telles et al 2008, Joshi & Telles 2009, Telles et al 2012).
Psychological factors play an important role in the development of chronic low back pain (LBP) and associated disability. Factors identified include interpreting pain as a threat, paying too much attention to pain (hypervigilance), increased pain sensitivity, difficulty ignoring pain and poor cognitive coping strategies. A recent article “Easy to harm, hard to heal” explores attitudes, beliefs and perceptions related to LBP (1). Key themes to emerge was the back is vulnerable to injury, there is a need to protect the back by resting, LBP is difficult to understand if you haven’t experienced it and LBP has an uncertain prognosis. Unfortunately these negative beliefs do not accurately represent the back.
However the key themes indicate there is an attentional bias toward information which demonstrates that the spine is vulnerable and some activities are dangerous, as well as toward information indicating that back pain is serious or the pain will persist. Some key positive messages should include LBP has a good prognosis and resuming normal activity as soon as reasonable is advised. Also the back is a strong structure and pain does not equal harm.
Clinical Pilates Training for Physiotherapists.
Learn to deliver effective rehabilitation programs using traditional and modified Pilates techniques.
Next course starts August 2016
Email for full course outline and details
Central Bassendean Physiotherapy offers a Pilates Teacher Training course for Physiotherapists. The program is designed to enrich active physiotherapists, extending their knowledge of Pilates, and apply the skills learnt to assist in the healing process of their patients. The program is held over approximately 16 weeks run by our most experienced Pilates Instructor and Senior Physiotherapist, Sarah Clay.
Well done to all the participants who completed the 4km, 12km and 21km HBF Run for a Reason (even though some did more than their Physio had suggested).
For recovery remember to drink lots of water, stretching regularly and even doing some swimming. Here's a recovery smoothing that people may like, Although we're not quite sure why a purple coloured smooths is called a green smoothie.
Thanks to Simple Green Smoothies, we can all start recovery right with a delicious 'Post-Workout Green Smoothie'
POST-WORKOUT GREEN SMOOTHIE FOR RECOVERY
You just rocked that tough workout! Now what? It’s super important to replenish the nutrients in your body and fuel your body with the right foods to help rebuild your muscles. Our bodies need the perfect combination of protein, carbohydrates, and liquids after working up a sweat. Read More...
Mechanical back pain disorders can prove difficult to treat and providing evidence for one type of treatment being superior to another is difficult. Typically effect sizes from randomised controlled trials using conservative care for mechanical LBP are small. Recently a randomised controlled trial using a classification based CFT (an approach we have been using at Central Bassendean Physiotherapy for a few years now) was compared with traditional manual therapy and exercise (Fersum, European J of Pain 2013). CFT provides a targeted approach to management of LBP based on a thorough examination. The classification based management considers movement and postural behaviours, psychological factors, neurophysiological factors and lifestyle behaviours (sedentary vs. excessive activity). CFT challenges thoughts and behaviours in a functionally specific and graduated manner. The CFT approach showed clinically and statistically significant large effect sizes for primary and secondary outcomes across multiple dimensions. Outcomes included disability measures and pain outcomes. The group receiving CFT was 3x less likely to take time off work in the 12 months following treatment.