Nearly 30 years ago when I was just a newly qualified physiotherapist an injury to a muscle or joint or part of the body that caused pain was simply a pathological process with a cause and effect, and if you followed the advice given and did the exercises the pain would go away.  Indeed many patients got better as expected in a timely fashion.  But sometimes patients continued to be in pain far longer than the time taken to heal the injured body part. So why is this?

UNDERSTANDING PAIN

We have learned a lot about pain in the last few years and scientific research has led us to realise that when the person with pain understands more about pain and how it works, it can be very helpful in reducing the symptoms and severity of the pain.

Let’s first look at the difference between short-term pain and long-term pain:

Acute pain: This is short-term pain and tends to be associated with damage or perceived damage to the body.  For example, if you fall and twist your knee when skiing you may feel pain due to bruising and swelling.  This is acute pain and usually, it will settle within 3 months or less as your body heals, even if it was a very severe injury.

Persistent pain: This lasts longer than acute pain but does not necessarily indicate ongoing damage to the body or the injured part.  This pain is much less to do with the injury to our bodies and more to do with changes to our central nervous system.   If you think of a radio that’s stuck on high volume and won’t go down, this can be what happens to our pain system, it gets stuck on loud.

HOW DOES PAIN WORK:

In its simplest form when we injure a body part nerves carry a lot of information to our brain, and it is our brain that produces pain.   YES, all pain no matter where or how it has occurred, your brain is what interprets and produces it.  This is really important to understand as many factors interlinking different parts of the brain can therefore affect our experience and severity of pain.

How does this influence our response and perception of pain? 

Let’s take the ski fall, where you twist your knee; well before you are aware of anything, your nerves have sent messages to the brain telling them there is some danger going on in your knee.  Your brain then ways up many factors such as your job, any previous beliefs you have, your experience of a previous injury to the knee in the past, and what you may need to be able to do in the future, and only after sorting through all this will your brain tell you whether your knee hurts and how severely it hurts too.

SO WHY DOES PAIN SOMETIMES REMAIN?

Nerves sometimes get extra sensitive and in some situations, pain can hang around for longer despite the injury having fully healed and this is termed persistent pain. The constant ongoing feedback from the nervous system starts to set up self-reinforcing feedback loops.

Pain that lasts 3 months or more often has more to do with changes in the central nervous system rather than ongoing damage.  It is due to the increased sensitivity of the nervous system.  There can be a tiny bit of input into the nervous system which can create a very large response of pain.  Imagine if I press lightly on your skin, a normal central nervous system would recognise this as a light press BUT a highly sensitised nervous system may think that something dangerous has just happened and sends out a high pain signal for the body to go into protection mode.  Think back to the volume being turned up on the radio scenario.

Changes in the Brain:

With a sensitised nervous system simple activities such as walking and bending can become painful and even sometimes thinking about certain movements can trigger your pain.  When a person repeats a particular movement or activity on a regular basis the brain creates a pattern of nerve connections. If a movement is painful for long enough the brain will strengthen the connection between movement and pain. It’s like your brain has joined the dots between, say, the normal sensations coming from your back, the movement of bending, and the memory of the injury and the experience of pain. This unhelpful pattern can become so sensitized that just preparing to do that movement may be enough to cause you to suddenly feel pain.

OTHER FACTORS IN OUR LIVES AFFECT PAIN

Strong evidence suggests the way a person experiences pain is influenced by a lot of factors and is highly influenced by our overall well-being.

Stressful and emotional situations can have an impact on our pain.  Too little sleep, kids driving us mad, the anxiety of finances, grieving over the death of someone.  The natural chemicals connected with tiredness, stress, and anxiety or depression are very similar to the chemicals used to communicate danger or damage at an initial injury.  Therefore, low moods and associated feelings can turn up the volume even more and make the pain worse!

Our thoughts and beliefs can also make the volume of our pain stay loud.

• What happened at the time of the initial injury and how traumatic it was?
• The level of pain at that time experienced
• What pain and injury mean to a person
• Any previous meanings created for past painful injuries

Therefore personal beliefs and environmental factors can make a big difference in how we experience pain and how likely it is that pain will persist.

HOW DO YOU TURN DOWN THE VOLUME ON THE PAIN

As much as the volume of pain can be turned up it can also be turned down.  With a bit of time and effort, it is possible.

Firstly understand that persistent pain is NOT a sign of ongoing damage

By making a positive change in our lives and starting to address our physical well-being, cultural beliefs health beliefs, and social environment then we can release “happy endorphin chemicals”.

Increased confidence, and increased activity lead to a decrease in pain which in turn leads to more positive changes.

• INCREASING GENERAL ACTIVITY – Doing less, leads to muscle weakness and stiffness, and low moods. Start with small increases in activity that you enjoy, to break the cycle of inactivity and pain. It is okay to feel a bit of pain when you increase your activity but this is not the same as damage. With practice, you can start to move normally again with less and less pain.

• WORK TOWARDS PERSONAL ACHIEVEMENTS – Sometimes forgetting about fixing the pain but focusing on achieving a personal goal that you find important, you may find that your pain is not the mainstay of your thoughts. It may not take the pain away but increase your confidence and allow you to start enjoying life.

TAKEAWAY POINTS:

• Acute pain is usually a sudden onset after an injury but usually  resolves in 3 months or less
• Persistent pain lasts for longer than 3 months but is often not related to ongoing damage or structures not healed.
• Pain that is ongoing can be influenced by factors like our beliefs, environment, stress,  and lack of sleep.
• Taking control is the easiest way to turn down the volume of pain by:
  • • Taking regular gentle exercise and slowly increasing how much you do
    • Addressing any beliefs that may be impacting how you are feeling
    • Improving the amount of sleep you get
    • Setting some personal achievements that are easy to achieve.

For further detail and information and references to the above information please click on the link below:

https://www.knowpain.co.uk/wp-content/uploads/2018/11/TazzyPersistentPainBooklet.pdf

The press-up is a really common exercise that targets many different areas of the body if done correctly.  However, for many, the technique is often poor.  This may relate to a lack of strength or capability to perform the exercise in which case the person must modify the press up to be able to perform it better.  But it may simply relate to the lack of awareness of the body position when performing the press up and this can be simply addressed using cues.

In the video below I have given 2 helpful cues to help you think about your body position.   Notice none of them involve tightening the core muscles.

https://youtu.be/btyYqhz-dlw

Bridge 38 Physiotherapy 2020.

As Bridge 38 Physiotherapy gets ready to re-open on September the 1st 2020, a number of  measures have now been put in place to minimise the risk of transmission of Covid -19, to keep you and the practitioners as safe as is reasonable practicable.

Please read the below policy prior to your attendance at Bridge 38 Physiotherapy.

Covid-19 is highly contagious and in the community,  it can be transmitted in two ways;

1. Contact with contaminated surfaces.
2. Respiratory droplets traveling within a 2m radius from the infected person and making contact with a mucosal surface of another individual.

Therefore, only those whose symptoms cannot be treated remotely, and are having a significant impact on their life and may otherwise cause the patient to attend primary care are being seen for face-to-face appointments. Due to the nature of these appointments, there will be an element of contact and social distancing that will not be able to be followed at all times.

As such, we have implemented measures throughout the clinic to minimise the risk of transmission or exposure to the virus by following the advice by the CSP (Chartered Society of Physiotherapy), Public Health England, HSE (Health and Safety Executive) and the UK Government. The below guidelines outline what you can expect and what is expected of you before and during your attendance at the clinic for a face-to-face appointment.

These guidelines are in place to ensure the safety of all visitors and practitioners here at Bridge 38 Physiotherapy.

COVID-19 symptoms?

Patients and chaperones (see below for more details on chaperones) must ensure they are fit to attend their scheduled Physiotherapy appointment.  The day before your clinic appointment you will receive a reminder email with a COVID-19 screening questionnaire. This must be filled out before attending your appointment.  If you are unable to fill out this online,  a paper screening questionnaire will need to be filled out and signed before you can have a face to face consultation.   You will also receive a triage call before your appointment to determine whether a face to face of video consultation is the most appropriate at this stage.

PLEASE DO NOT ATTEND YOUR APPOINTMENT IF YOU ARE UNWELL OR HAVE ANY OF THE SYMPTOMS LISTED BELOW:  Please advise the clinic to cancel or re-arrange your appointment and if you need further advice dial 111 or telephone your GP.

• a high temperature– this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
• a new, continuous cough– this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
• Change in sense of taste (Dysgeusia)
• Change in sense of smell (Anosmia) 

Please advise the clinic to cancel or re-arrange your appointment and if you need further advice dial 111 or telephone your GP.

Clinically extremely vulnerable/shielding?

If you have been asked to shield by the government or your GP, you should notify us immediately.  It is advisable that your appointment should be carried out via video consultation.

Returned from abroad in the past two weeks?

If you have returned from abroad in the past two weeks, please notify us and not attend the clinic for a period of two weeks from the date you returned.

What to expect when attending the clinic:

Physical distancing:

Although the 2m social distancing policy has now reduced to 1m in the UK Bridge 38 Physiotherapy will continue where possible to remain at a 2 m distance in both the public areas of the clinic as well as the treatment rooms.

If you require any specific hands-on for assessment and treatment this will be discussed with you to ensure you consent to proceed. In order to maintain social distancing, fewer appointments will be carried out or maybe staggered with the option to wait outside the clinical building.

• Do not attend the clinic without a pre-booked appointment.
• Please do not enter the clinic before your appointment time, but please attend on time as your appointment will not run overtime, as the time between patients is specifically designated for cleaning and to provide time between you leaving and the next patient arriving.
• The external doors to the clinic will be closed to avoid people coming in and out of the building freely, so customers will need to use the intercom system for entry to the building.

Chaperones:

• Please attend appointments alone, where this is not possible due to travel to and from the clinic then please ask whoever is attending with you to wait in the car or outside the clinic.
• If you require a personal chaperone or you are attending with children, they must also follow hygiene and social distancing procedures and must also comply with the health screening and consent to contact tracing in order to attend in the clinic room.

Hygiene:e

• As a patient, you must use the provided sanitation gels to disinfect hands on the entrance to the practice and on departure.
• Between patient appointments, time will be allowed for sanitisation of seating, beds, tables and public waiting area.
• Please be mindful of unnecessary contact of surfaces during your visit to the clinic.
• Tissues, foot-operated bins, and handwashing facilities or hand sanitiser will be provided in all clinic rooms and within the waiting room. In the event of a cough or sneeze please follow the ‘catch it, bin it, kill it’ guidance by disposing of your tissue in the bin provided, and sanitising/washing your hands immediately.
• Use of reusable equipment (such as gym equipment) within your appointment will be avoided as far as reasonably practicable in order to minimise surface contact. If it is not possible to avoid it, the use of this equipment will be kept to a minimum and the equipment will be cleaned thoroughly prior to and after use.

PPE:

• Physiotherapists will be wearing face masks and possibly face visor shields. Due to the close proximity of hands-on treatment, this can minimise the risk of infection to them or yourself.
• Physiotherapists will also be wearing plastic disposable aprons which they will dispose of after each patient.
• The Physiotherapists will adhere to a rigorous and stringent handwashing routine between and during each appointment and, therefore, may not be wearing gloves for your treatment.
• It is recommended that you wear a mask during your treatment. If you do not have your own, a disposable mask will be available for you to purchase for £1 which will be added to your appointment charge. Exceptions will be made If you are unable to wear a mask for a specific reason.

Contact Tracing:

• If you or your chaperone test positive for Covid-19 within 14 days of your attendance at the clinic you must notify us as soon as possible so that we are able to trace and advise all those who may have been affected.
• In order to attend, you and your chaperone will be asked to consent to contact from ourselves via a telephone number that you provide on the day of attendance. This means that, in the event that you may have been exposed to someone who has tested positive, we can inform you and provide you with guidance on the next steps.

If you have any questions prior to your appointment or have any queries in relation to this policy, please do not hesitate to contact us on 01283 716559 or info@bridge38physiotherapy.co.uk

Many Clients I see, particularly those involved in sport, are often tight and complain no matter what they do their calf just doesn’t seem to release or that hamstring muscle has “always been tight”.  Many report they stretch or may use the torturous foam roller to help. Both forms can help but only for a short time but as soon as they resume activity the tightness returns.  So this begs the question is there any benefit to stretching and should we still do it?

Continue reading “To Stretch or Not to Stretch?” →

I see many runners in the clinic with a variety of running injuries from achilles tendinopathies, to knee pain and groin pain.  One of the big issues I discuss with every runner is whether or not they can continue to run with pain and if so are they damaging themselves?

Well in todays 5 minute video I share with you my expertise on this very subject.  You will find out

1. whether you are ok to run with pain.

2. If you are able to continue to run, how will you know you are not causing further harm?

3. What are some of the common warning signs that mean you should not be running and when to get it checked out.