Download - Understanding and Overcoming Pain
Agenda
• Explain Pain: “All pain is neurogenic.”
• Origins of Pain
• Neuromatrix Theory
• Neurodynamics: Pain and Movement
• Movement & Manual Therapy
• Exercise & Pain
• Pain is not an input to the body, but an output from the brain.
• Nociception is neither required nor sufficient for pain.
Lorimer Moseley, Physiotherapist
• Pain is a disordered affective state brought into being by chemical or mechanical changes in various tissues.
Barry Wyke, Neurologist
Vitals
• Origin – chemical or mechanical – Do your symptoms alter withposition or use?
• Is there any relevant disease process?
• What is your autonomic state / breathing pattern? Are youcommonly cool, especially your hands and feet?
• Which way do you want to move and how does it make youfeel?
• What position do your legs rest in supine?
• Essential Dx: what’s wrong and what to do
• It’s history that reveals the origin of the problem:– Mechanical deformation beyond tolerance
– Chemical irritation
• When the origin is mechanical the solution to the problem lies in movement.
Understand the mechanics and physiology of the nervous system
Requires mobility and blood flow
Nervous system is 2% of body mass and uses 20% of oxygen supply
“Nerves and Nerve Injuries”Sir Sidney Sunderland
Perversion of function – tingling, numbness, spreading pain, spontaneous pain, muscle twitching – without loss of conduction
Millions of people are suffering from this problem and
NO ONE IS TREATING THEM
Adaptive potential is the ability of the system to tolerate a repetitive movement, a forceful blow, or a prolonged position.
3 main challenges that contribute to mechanical pain: sustained positions, repetitive movements, and force.
Louis Gifford: “Any threat to the nervous system is a potential disaster for the future efficiency of the those afflicted. Far better, and more efficient to, whenever possible, adapt to a new posture that protects the nervous system, than to injure the nerve and suffer the consequences of neuropathy.”
REINTERPRET THE MUSCULATURE
• Brain concludes that the tissues are under threat … and that action is required…
• What action?• Patrick Wall – Pain: The Science of Suffering
– “What are the appropriate motor responses to the arrival of injury signals?”
– Pain as need state requiring consummatory act
HUNGRY FOR MOVEMENT
• Those interventions which allow a movement to be performed in a non-threatening context will be successful.
• For handling to be successful, it must be done in a way that reduces threat and/or fulfills expectation.
• Ideally, it will be a novel stimulus that is also non-threatening.
Cory Blickenstaff, PT
• Neurodynamic Mobilization = edgework
• Simple Contact = ideomotion (involuntary motor)
• Dermoneuromodulation = skin stretch (non-nociceptive sensory stimulation)
• Pain Reflex Release = down-regulate protective response
• Joint Mobilization / Manipulation = biomechanical and neurophysiological
• Somatics = sensorimotor integration
• Other?
• Neurofacilitation = muscle recruitment
• Motor Control = perfect practice
• Stabilization = control through range
• High Intensity, Low Force = productive exercise
• Conditioning = perfect practice