Monday Medical: Physical therapy for persistent pain
For Steamboat Pilot & Today
STEAMBOAT SPRINGS — If you’re dealing with pain that won’t go away, the path to healing just may involve some learning.
“Research has found that the more people understand about how pain works, the more they can improve their pain and improve their function,” said Devra Reiman, a physical therapist and therapeutic pain specialist at UCHealth SportsMed Clinic in Steamboat Springs and Hayden.
Below, Reiman outlines the role of physical therapy in understanding and treating pain.
Pain has a purpose: put your hand on a hot stove, and the burning sensation that’s picked up by your nerves, relayed through your spinal cord and interpreted by your brain, signals you to pull your hand away.
Similarly, pain felt after an injury or surgery signals you to use the injured area less. Eventually, that pain should go away.
“Typically, when the body starts to heal, the nervous system should calm down,” Reiman said. “But that doesn’t always happen.”
The brain creates pain based on perception of a threat, so sometimes, the nervous system continues to experience or communicate pain even after the tissue has healed. The condition is more common than you may think, with about one in four people experiencing continued pain.
The pain you experience can be affected by when and how an injury takes place. For instance, if you tear your ACL while skiing during a frigid snowstorm, cold weather can later contribute to increased pain.
If you sprain your ankle playing basketball and your team goes on to win the game, that injury may not be as painful as if the team loses.
Or if you’re injured in a car accident and find yourself dealing with the stress of insurance, legal matters and a new fear of driving — all while you’re, say, in the middle of a divorce — your nervous system may be more likely to continue sensing and communicating pain after the injury heals.
When pain doesn’t stop
Your medical provider can help determine whether your nervous system is creating pain unnecessarily. One marker may simply be how long the pain has lasted.
“Tissues heal within three to six months,” Reiman said. “If you have ongoing pain after that, that’s not normal. It’s not normal to live in pain.”
Chronic pain is important to address as it can wreak havoc on your body, resulting in issues such as memory problems, fatigue, mood changes, low activity tolerance, digestive issues and a delayed pain response.
Your health provider can determine the best treatments, one of which may be physical therapy.
“It’s helpful to use a multidisciplinary approach to come at it with various things, including medication and counseling,” Reiman said. “Physical therapy is good to try because it’s not invasive. The negative side effects are very minimal to none.”
Physical therapy for pain
Education is key. If a patient learns that their injury has healed but their nervous system has gotten in the habit of creating pain, they may respond better to further treatments.
“Most people think, ‘If I’m hurting, something’s not healed,’ but that isn’t always the case,” Reiman said. “Once you think there’s something wrong, it can be scary and make it worse.”
In addition to talking with patients about pain, Reiman may use pain-free techniques to modify the nervous system’s response, including muscle control exercises, nerve glides or mobilizations to improve blood flow to the area, and brain exercises such as mirror therapy, in which a mirror is used to trick the brain into thinking a limb has moved without pain.
“Our nervous system loves movement and blood flow,” Reiman said. “You should do whatever movement you can tolerate, even if it’s only walking two to three minutes at a time.”
Through physical therapy, people can expect to see gradual improvement every few weeks.
“You need to have hope, and you need to have a game plan – that helps keep people motivated,” Reiman said.
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