Understanding Why Pain Happens – And What To Do About It

Is It All In My Head?

Paula Johnson, PT, MOMT

80% of the general population will experience pain at some time in their life, requiring the assistance of a health care practitioner. Pain can be defined as “an unpleasant sensation that can range from mild, localized discomfort to agony”.  Pain may be localized to one body part, or can be more diffuse and travel to other parts of the body.

Typically pain can occur from repetitive use or from an injury, and in some cases “come from seemingly nowhere! It can be triggered by underlying tight/restricted muscles, fascia/connective tissue and joints, gut/digestive related issues, and aggravated by lack of sleep or poor sleep in general, or postural strains/sprains and stress and anxiety.

A cycle of pain will develop, with one model illustrated below, that can prompt various responses in the body.  Inflammation occurs to help the body start the healing pathway, which can then cause tissue/joint/nerve restrictions, i.e. adhesions and scarring. This process leads to pain, limited motion, and often muscle guarding/spasm.

The ultimate result and duration of this pain response is based upon many factors.  It has both physical and emotional components and is a unique and individual perception that develops from specific nerve fibers that carry the pain impulses to the brain. Apart from an acute injury, such as a fall, specific sports injury, or a motor vehicle accident, pain can be aggravated and often brought on by lack of sleep or poor sleep in general, as well as stress and anxiety. Pain can be expressed in many ways and is often described as either sharp, dull aching, and/or burning.

We, as physical therapists, are well-trained in being able to determine the cause of your pain and help you manage its cycle.  One of the most important components of your physical therapy is a thorough and comprehensive evaluation performed at the start of your treatment.  Through this process we will work to meet your individual needs and goals and will design an individualized treatment plan, to assist you in returning to an optimum level of function for sports and everyday activities.

Some interventions that may be utilized by your physical therapist may include:

1. Education in pain sciences, 1^st aid principles and self-help techniques. 
2. Manual therapy  that incorporates various tissue, fascia, muscle, nerve and/or joint “mobilizations” or specific movements that assist in reducing muscle spasm, pain and inflammation, and assist in regaining normalized motion and movement patterns.
3. Dry needling of painful trigger points.
4. Therapeutic exercise and activities including various stretching, self-mobilizations and strength/stabilization and facilitation techniques, for instance.
5. Modalities that may include electrical stimulation, ultrasound, iontophoresis, superficial heat and/or ice, and compression.

Your PAIN, that is not in your head and is real, and will be addressed with the above treatment approaches. We are an integral part of your team that includes your physician and possibly your coach, personal trainer, nutritionist, massage therapist, yoga and Pilates instructors, wellness coach, and psychologist. Conservative therapy and management are our goal, though at times surgical intervention may be necessary and your therapy may then include a post-operative course of PT.

Seek out well-trained physical therapists as a part of your team, to assist you with your individual and specific needs, and who can help you with your pain management. Do not be afraid to ask questions and make sure your physical therapist is listening to you and your story. Make sure you are getting answers to your questions that make sense to you and your situation.

Pain does not need to carry on, week after week, month after month. Remain positive and do your part too, as recommended by your team. We will work together to optimize your function and work towards accomplishing your functional goals. Remember, movement is the medicine!