Category Archives for "pain"

Persistent Chronic Pain with Iyad Salloum

Mark: Hi, it's Mark from TLR. I'm here with Iyad Salloum of Insync Physio in Burnaby. He's the clinical director there, and we're going to talk about something that is a bit of a phantom really, persistent chronic pain. So can you actually have pain when the injuries were healed? 

Iyad: Yeah, that's a very good question, Mark. So persistent pain or chronic pain as some people call it is such an interesting and kind of broad term, right? Cause it describes like basically anybody who's had pain over a longer period of time, longer than three to six months. Depends on which definition you read. 

But I think the biggest thing I wanted to kind of clarify here is, what we know about pain now and the pain science has been growing every year, is that you don't necessarily need tissue damage to have pain. And that having tissue damage isn't enough to have pain. So those two things are quite interesting because historically we've always learned while you bumped your head, it's going to hurt.

It's because you just bumped it or you bruised the bone or you bruise the muscle or something like that. What we know now, pain is a large kind of protective response from our nervous system. And it makes sense right? So like historically speaking, if I broke my foot, I would want to rest it to the bones can heal. So that's what pain kind of access as a nice reminder for ourselves. 

But there are also cases where let's say, I don't know if you've ever broken a bone, but when you're in a cast after the first week or two, it stops hurting, but the bone is still healing. So the bone is still broken. So that's a great example of how you can have still a bit of tissue damage and it doesn't hurt anymore. Other cases are things like where you have a very minor stimulus that should hurt maybe only a little bit, but then it gets kind of magnified to such a bigger thing. And that's usually what we think of as a response, when a nervous system. 

So our nervous system is a great kind of computer in a way. It's a great processor. So every time we get a stimulus from our periphery or from anywhere, even from our internal organs, we can either choose to amplify it or kind of quiet it down. So one of the things I like to think of is that pain isn't always proportional to tissue damage. Could example paper cuts on your finger hurts so much more than somebody punching you in the shoulder.

Even though I would argue that the punch has a lot more potential to damage that. So what we see in the clinics sometimes is people who've had low back pain from a year ago. They go for a follow-up MRI or x-ray and nothing is there and it almost makes them more kind of confused and maybe sometimes angry because they're like, I swear it hurts. And then they get told a really kind of, I'd say a bad answer, which is that, oh, it's all in your head. Which is not really reasonable to kind of explain this, it's almost oversimplifying the science. You know, like all the pain is in the head cause our brain is the one thing the manufacturer's this thing.

So just saying that it's a bit kind of disrespectful and maybe a bit kind of to downplay their response. But basically what we ended up seeing there is that sometimes your nervous system learns to overprotect. So think of a car alarm, that now it goes off when the fly lands on it, instead of when you actually have a break in. So that's kind of what ends up happening in these cases.

Mark: So any ideas on possible causes other than just, Hey, you know, it's how we're wired. Some people are more wired to be sensitive to pain or in context, like some people, you know, maybe they feel it more than their teeth. 

Iyad: That's a great question. We think there's tons of causes actually. So one of them, we think definitely there's genetic components, but then some of it is learned, right. And then some of it is also centred around how our own beliefs and how our kind of expectations of things are. So for example, if you expect something to hurt. It can hurt more.

We have some interesting studies where they just flash lights a red light with warm water and the blue light with cold water. And then people get given the same kind of stimulus, which is the same temperature water with different lights and they report different stimuli. So that's a great example of how your nervous system can just modulator these things.

So some people, we don't know why specifically, this person goes down the persistent pain pathway, some people don't. But we have actually some decent data, that up to one in four can go down that way where the pain kind of lasts a little longer than you'd want it to. And when there's no more need to protect.

And the way we think of this now is based on our understanding is if you have more danger signals, in everything. And I'm talking about stress or sleep or diet, just general health lack of activity or too much activity. So this is the interesting one, where if you almost avoid too much you can actually become very sensitized to that movement or to that touch or to that whatever thing you're trying to avoid. 

Or there's the person who never really allows things to take their course and just tries to push a bit too hard. And then what happens is our nervous system goes through a response for it, they're like. I guess in layman's terms would be like, I don't think this guy's getting it. I'm going to need to crack this pain level up a bit more so that, you know, they can kind of pay a bit more attention to me and allow me to recover. But the problem is you kind of get stuck in this kind of cycle and in either way where you're either avoiding too much or you're pushing too much into it. And you're kind of none the wiser in that case. 

So treating those cases is very interesting because the, I guess the first thing we try to do and we have some excellent therapists at Burnaby, like Elizabeth, our physio has worked extensively in this area. You kind of want to take a big inventory of the person's health in a way.

You look at everything from their habits, to their diet and their sleep to their activity, to their own beliefs. And yeah, the physio is not going to be a counsellor, a dietician and a therapist at the same time. But what they ended up doing is you've identified these issues and then you can kind of get them the help they need based on working with the team.

And that's kind of what the most successful pain programs we'll do is we'll kind of integrate a good team response, but then fundamentally it seems still that movement still pretty important. You know, so we kind of help people move. Sometimes it's just move differently so that they don't do the same repeated strategy. And sometimes it's just to move. Cause some people just don't do that enough after they've been injured. And that's a cause of that kind of going down that chronic route. 

Mark: So, if you need to get moving again, you've chilled out. You've meditated your way. You've seen the therapist, you've done all the other steps and you still hurting, maybe you need to move a little more. Get a physiotherapist to help you, insyncphysio.com. You can book an appointment there, or you can call them in Burnaby, 604-298-4878 or in Vancouver on Cambie, 604-566-9716. Get in and get some help and get moving again. It will help with your pain. Thanks Iyad. 

Iyad: Thanks Mark.

Finding Ease in the Effort: Strategies for Managing Your Pain

This next part of the series will discuss how you can better manage your pain. When you come to your appointments, there are different hands-on techniques or modalities that we can use to help you with your pain in the short term. But it is important to remember that you only see your physiotherapist for 30 minutes out of your day – the other 23.5 hours are in your hands!

The experience of pain is unique to each person and is based on many factors that we explored in the previous article. As you can see, pain is complex. However, it’s management does not need to be complicated.  Pain management is possible through understanding pain and exploring evidence-based therapeutic interventions and self-care strategies. 

Exercise is medicine!
Many people in pain tend to avoid certain movements and exercise in general. However, there is now an abundance of evidence that has highlighted the positive effects of exercise and physical activity on both acute and chronic pain, overall daily function, and quality of life (1-3).  Studies have shown that it can be an effective way to reverse the downward cycle of deconditioning and worsening pain, and gradually over time can help those with persistent pain engage more in activities of enjoyment and daily living with more ease.

It is important to start gradually when beginning to exercise, and avoid pushing too far into pain. At the same time, it’s important to not let the pain scare you; a tolerable amount of pain with exercise is acceptable. It can be helpful to use the 0-10 scale to monitor your pain levels while exercising – if your pain increases by more than 2 points from baseline, you should modify the exercise to make it less provocative and to avoid a flare-up. You may be in a bit more pain for the remainder of the day, and this is okay – so long as the pain goes back to baseline by the next morning. With this approach, over time your pain threshold will get higher and you will be able to tolerate more exercise, slowly but surely. Your physiotherapist is an expert in this and can help to guide you!

Sleep is not for the weak!
What came first, the chicken or the egg? That is the ultimate question, and the same thing can be asked of sleep & pain. Recent research has shown that sleep and pain have a bidirectional relationship; meaning they share the same brain pathways (4), and thus influence each other very easily. So – are you sleeping poorly because you have pain? Or do you have pain because you are sleeping poorly?

After only one bad night of sleep, there is a decrease in the pain threshold which means it takes less to provoke it (5). We can think of it like a volume dial; our brains have the amazing ability to dampen the sound signals (turn down the dial) from the nerves in our bodies. With sleep deprivation, that ability to turn down the dial is reduced – therefore, the sound signal of pain increases (6). With sleep deprivation, the ability to cope with pain is hindered and makes everything more aggravated. Getting more sleep is not only crucial for our general health and happiness, but it also can have a protective factor against pain. 

Here are a few simple strategies that can help you get a better night’s sleep: 

  1. Keep to a sleep schedule; even over weekends (try to go to sleep and wake up at about the same time every day!). 
  2. Allow yourself time to relax and unwind at the end of the day. Try to dim or turn off lots of the lights in your house in the hour or two before bed to help that melatonin release. 
  3. Turn your heat down – humans are meant to fall asleep when the sun goes down and it gets cooler. Thermostats have made our modern sleep hygiene problematic! 
  4. Reduce the amount of gadgets/screens in your bedroom; they can be a distraction. 

Pacing – not too much, not too little, but just right.

Does this cycle look familiar? Perhaps you wake up one morning and you feel especially great – so you do more activity than usual (catching up on that never-ending to-do list!). However, if your body and brain aren’t accustomed to doing this much, it can trigger a flare-up of your pain, which then forces a prolonged rest to recover. Over time, this can lead to lower and lower tolerances for the activities that you are wanting to do, and can be extremely frustrating.

However, by slowly down initially and avoiding overexertion, you can avoid the “bust” component of the cycle. By doing just enough, over time we are able to improve our tolerance and do more; but if we do too much or too little, our threshold only tends to get lower. It’s a fine line that your physiotherapist can help you walk successfully. 

The important steps for pacing are:

  1. Determine your baseline 
  2. Break up activities into smaller components
  3. Take frequent, short breaks as needed 
  4. Gradually increase the amount that you do 

An example of this would be noticing that your back pain tends to flare up after walking 5km. You then tend to spend the next few days resting, and then when you go out to walk again, your tolerance is no better – sometimes worse. A better strategy would be to either break up your walk into two 2.5km loops; one in the morning and one in the evening to allow adequate time for rest. Or, decrease your loop to 4km at once. If you are able to complete these walks with no “bust” of your pain, then it is a success – and over time, you can build your tolerance back up to 5km, and beyond!

Many individuals have found that when pacing is implemented into their daily routines, it can be very effective in helping things such as fatigue, pain levels, and tolerance of exercise and movement (7). Pacing can be a difficult skill to integrate into your life, and as physiotherapists we are here to help you find strategies that will work best for you.

References

  1. Hayden JA, Van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005; 142(9):776-85.
  2. Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One. 2017;12(6):e0178621.
  3. Geneen, L., Smith, B., Clarke, C., Martin, D., Colvin, L. A., & Moore, R. A. (2014). Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.cd011279
  4.  Walker, M. P. (2018). Why we sleep: Unlocking the power of sleep and dreams. New York, NY: Scribner, an imprint of Simon & Schuster.
  5.  Walker, M. P., & Stickgold, R. (2009). Sleep and Memory Consolidation. Sleep Disorders Medicine,112-126. doi:10.1016/b978-0-7506-7584-0.00009-4
  6. Simpson NS, Scott-Sutherland J, Gautam S, Sethna N, Haack M. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain. 2018; 159(1):33-40.
  7. Guy L. Effectiveness of Pacing as a Learned Strategy for People With Chronic Pain: A Systematic Review. Am J Occup Ther. 2019; 73(3): 1-10. 

Finding Ease in the Effort: Understanding Pain

Hey everyone! My name is Anna Daburger, a physiotherapist at Insync Burnaby. I will be writing a blog series about pain – what it is, what it means & doesn’t mean, and what you can do to manage it better (and how physio can help!). This first post will be about understanding pain a bit better. Read along if you’re interested!

Do you remember the last time you experienced a paper cut, or a hang nail? Who would have known such a small cut in the skin could produce a disproportionate amount of pain? On the other hand, have you ever found a mysterious bruise somewhere on your body with no recollection of how it got there? The amount of pain is not necessarily indicative of the amount of damage sustained. You can have pain with damage, no pain with lots of damage and lots of pain with no damage. 

I wanted to preface this discussion of pain with these questions to highlight how complex it is. Some other misconceptions in regard to pain include:

  • No pain, no gain. Persisting in the face of pain can be helpful initially, but use of this strategy can become maladaptive as time goes on, and it can actually cause more pain and triggering episodes (1). It is important to find the right balance between persistence and avoidance.
  • Hurt equals harm. Unfortunately, pain can be a poor guide. When we experience pain, this does not necessarily mean we are causing harm (2). The hurt that is experienced is sometimes less-so an indicator of tissue damage, and more-so an indicator of sensitivity of the nervous system – especially when pain has persisted past the tissue healing time frames.
  • Rest is best. A common traditional approach to pain has been favoring rest over activity. However, we now know that our bodies need movement to recover, and avoiding activities may make you more fearful of and sensitized to them in the long term. So, when you have pain or injury, there should be a period of initial rest; however, the next step will be reactivation of movement and resumption of activity. Physiotherapy can help you navigate it all!

Why do we have pain?

The purpose of pain is to protect you and to motivate you to change what you are doing. Pain is an alarm and alarms are designed to create action. With many acute injuries, the pain alarm is very useful, as it prevents you from keeping your burnt fingers on a hot surface. But the problem with many alarms is that they keep going off long after they are useful. 

The alarm system, or the brain, can start to lose touch with reality and gets very used to the pain & alarm response, even after our tissues have healed. In a way, it “learns” pain and this response becomes a habit (3). You become better at perceiving pain as your brain has become more and more familiar with it - like practicing a language over and over. You can think of it as a sensitive smoke alarm that goes off even when there is no fire. 

It is important to think of pain in the BioPsychoSocial framework; meaning that there are elements at the tissue level (bio), psychological level (emotions, beliefs and stress) and the social level (your support network and work life) that all can contribute to the pain experience. With this in mind, we can look at pain as the overflowing of a cup, an analogy I like to use from physiotherapist Greg Lehman (1):

The cup represents our life and all of the stressors we have in it. As pain persists, it becomes less about tissue damage and more complicated in terms of all the different life factors that can play a role. You can have a lot of physical, mental, emotional and social stressors and have no pain - but at some point, a new stressor can put you just over the edge. The water overflows, and now you have pain. 

Often people will have more pain when there are changes in the stressors in their life; pain can occur, or get worse, when we fail to tolerate and adapt to all the stressors.1 This means that we have a lot of options to help you feel better; and rarely is there just one thing that must be ‘fixed’. We can help to get you better by improving the things in the cup - like getting you exercising or sleeping better - or we can help you to build a bigger cup, so that you are more resilient to the stressors. Your physiotherapist can help you to do both of these things. 

References

  1. Williams AC, Craig KD. Updating the definition of pain. Pain. 2016 Nov;157(11):2420-2423
  2. Pain Science Workbooks [Internet]. Greg Lehman. [cited 2019Jun26]. Available from: http://www.greglehman.ca/pain-science-workbooks/
  3. Siddall PJ. Neuroplasticity and pain: what does it all mean? The Medical Journal of Australia. 2013;198(4):177–8.

Finding Ease in the Effort: Understanding Pain

Hey everyone! My name is Anna Daburger, a physiotherapist at Insync Burnaby. I will be writing a blog series about pain – what it is, what it means & doesn’t mean, and what you can do to manage it better (and how physio can help!). This first post will be about understanding pain a bit better. Read along if you’re interested!

Do you remember the last time you experienced a paper cut, or a hang nail? Who would have known such a small cut in the skin could produce a disproportionate amount of pain? On the other hand, have you ever found a mysterious bruise somewhere on your body with no recollection of how it got there? The amount of pain is not necessarily indicative of the amount of damage sustained. You can have pain with damage, no pain with lots of damage and lots of pain with no damage.

I wanted to preface this discussion of pain with these questions to highlight how complex it is. Some other misconceptions in regard to pain include:

  • No pain, no gain. Persisting in the face of pain can be helpful initially, but use of this strategy can become maladaptive as time goes on, and it can actually cause more pain and triggering episodes (1). It is important to find the right balance between persistence and avoidance.
  • Hurt equals harm. Unfortunately, pain can be a poor guide. When we experience pain, this does not necessarily mean we are causing harm (2). The hurt that is experienced is sometimes less-so an indicator of tissue damage, and more-so an indicator of sensitivity of the nervous system – especially when pain has persisted past the tissue healing time frames.
  • Rest is best. A common traditional approach to pain has been favoring rest over activity. However, we now know that our bodies need movement to recover, and avoiding activities may make you more fearful of and sensitized to them in the long term. So, when you have pain or injury, there should be a period of initial rest; however, the next step will be reactivation of movement and resumption of activity. Physiotherapy can help you navigate it all!

Why do we have pain?

The purpose of pain is to protect you and to motivate you to change what you are doing. Pain is an alarm and alarms are designed to create action. With many acute injuries, the pain alarm is very useful, as it prevents you from keeping your burnt fingers on a hot surface. But the problem with many alarms is that they keep going off long after they are useful. 

The alarm system, or the brain, can start to lose touch with reality and gets very used to the pain & alarm response, even after our tissues have healed. In a way, it “learns” pain and this response becomes a habit (3). You become better at perceiving pain as your brain has become more and more familiar with it - like practicing a language over and over. You can think of it as a sensitive smoke alarm that goes off even when there is no fire. 

It is important to think of pain in the BioPsychoSocial framework; meaning that there are elements at the tissue level (bio), psychological level (emotions, beliefs and stress) and the social level (your support network and work life) that all can contribute to the pain experience. With this in mind, we can look at pain as the overflowing of a cup, an analogy I like to use from physiotherapist Greg Lehman (1):

The cup represents our life and all of the stressors we have in it. As pain persists, it becomes less about tissue damage and more complicated in terms of all the different life factors that can play a role. You can have a lot of physical, mental, emotional and social stressors and have no pain - but at some point, a new stressor can put you just over the edge. The water overflows, and now you have pain. 

Often people will have more pain when there are changes in the stressors in their life; pain can occur, or get worse, when we fail to tolerate and adapt to all the stressors.1 This means that we have a lot of options to help you feel better; and rarely is there just one thing that must be ‘fixed’. We can help to get you better by improving the things in the cup - like getting you exercising or sleeping better - or we can help you to build a bigger cup, so that you are more resilient to the stressors. Your physiotherapist can help you to do both of these things. 

References

  1. Williams AC, Craig KD. Updating the definition of pain. Pain. 2016 Nov;157(11):2420-2423
  2. Pain Science Workbooks [Internet]. Greg Lehman. [cited 2019Jun26]. Available from: http://www.greglehman.ca/pain-science-workbooks/
  3. Siddall PJ. Neuroplasticity and pain: what does it all mean? The Medical Journal of Australia. 2013;198(4):177–8.

Strategies for Managing Your Pain

This next part of the series will discuss how you can better manage your pain. When you come to your appointments, there are different hands-on techniques or modalities that we can use to help you with your pain in the short term. But it is important to remember that you only see your physiotherapist for 30 minutes out of your day – the other 23.5 hours are in your hands!

The experience of pain is unique to each person and is based on many factors that we explored in the previous article. As you can see, pain is complex. However, it’s management does not need to be complicated.  Pain management is possible through understanding pain and exploring evidence-based therapeutic interventions and self-care strategies. 

Exercise is medicine!

Many people in pain tend to avoid certain movements and exercise in general. However, there is now an abundance of evidence that has highlighted the positive effects of exercise and physical activity on both acute and chronic pain, overall daily function, and quality of life (1-3).  Studies have shown that it can be an effective way to reverse the downward cycle of deconditioning and worsening pain, and gradually over time can help those with persistent pain engage more in activities of enjoyment and daily living with more ease.

It is important to start gradually when beginning to exercise, and avoid pushing too far into pain. At the same time, it’s important to not let the pain scare you; a tolerable amount of pain with exercise is acceptable. It can be helpful to use the 0-10 scale to monitor your pain levels while exercising – if your pain increases by more than 2 points from baseline, you should modify the exercise to make it less provocative and to avoid a flare-up. You may be in a bit more pain for the remainder of the day, and this is okay – so long as the pain goes back to baseline by the next morning. With this approach, over time your pain threshold will get higher and you will be able to tolerate more exercise, slowly but surely. Your physiotherapist is an expert in this and can help to guide you!

Sleep is not for the weak!

What came first, the chicken or the egg? That is the ultimate question, and the same thing can be asked of sleep & pain. Recent research has shown that sleep and pain have a bidirectional relationship; meaning they share the same brain pathways (4), and thus influence each other very easily. So – are you sleeping poorly because you have pain? Or do you have pain because you are sleeping poorly?

After only one bad night of sleep, there is a decrease in the pain threshold which means it takes less to provoke it (5). We can think of it like a volume dial; our brains have the amazing ability to dampen the sound signals (turn down the dial) from the nerves in our bodies. With sleep deprivation, that ability to turn down the dial is reduced – therefore, the sound signal of pain increases (6). With sleep deprivation, the ability to cope with pain is hindered and makes everything more aggravated. Getting more sleep is not only crucial for our general health and happiness, but it also can have a protective factor against pain. 

Here are a few simple strategies that can help you get a better night’s sleep: 

  1. Keep to a sleep schedule; even over weekends (try to go to sleep and wake up at about the same time every day!). 
  2. Allow yourself time to relax and unwind at the end of the day. Try to dim or turn off lots of the lights in your house in the hour or two before bed to help that melatonin release. 
  3. Turn your heat down – humans are meant to fall asleep when the sun goes down and it gets cooler. Thermostats have made our modern sleep hygiene problematic! 
  4. Reduce the amount of gadgets/screens in your bedroom; they can be a distraction. 

Pacing – not too much, not too little, but just right.

Does this cycle look familiar? Perhaps you wake up one morning and you feel especially great – so you do more activity than usual (catching up on that never-ending to-do list!). However, if your body and brain aren’t accustomed to doing this much, it can trigger a flare-up of your pain, which then forces a prolonged rest to recover. Over time, this can lead to lower and lower tolerances for the activities that you are wanting to do, and can be extremely frustrating.

However, by slowly down initially and avoiding overexertion, you can avoid the “bust” component of the cycle. By doing just enough, over time we are able to improve our tolerance and do more; but if we do too much or too little, our threshold only tends to get lower. It’s a fine line that your physiotherapist can help you walk successfully. 

The important steps for pacing are: 

  1. Determine your baseline 
  2. Break up activities into smaller components
  3. Take frequent, short breaks as needed 
  4. Gradually increase the amount that you do 

An example of this would be noticing that your back pain tends to flare up after walking 5km. You then tend to spend the next few days resting, and then when you go out to walk again, your tolerance is no better – sometimes worse. A better strategy would be to either break up your walk into two 2.5km loops; one in the morning and one in the evening to allow adequate time for rest. Or, decrease your loop to 4km at once. If you are able to complete these walks with no “bust” of your pain, then it is a success – and over time, you can build your tolerance back up to 5km, and beyond!

Many individuals have found that when pacing is implemented into their daily routines, it can be very effective in helping things such as fatigue, pain levels, and tolerance of exercise and movement (7). Pacing can be a difficult skill to integrate into your life, and as physiotherapists we are here to help you find strategies that will work best for you.

References

  1. Hayden JA, Van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005; 142(9):776-85.
  2. Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One. 2017;12(6):e0178621.
  3. Geneen, L., Smith, B., Clarke, C., Martin, D., Colvin, L. A., & Moore, R. A. (2014). Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.cd011279
  4.  Walker, M. P. (2018). Why we sleep: Unlocking the power of sleep and dreams. New York, NY: Scribner, an imprint of Simon & Schuster.
  5.  Walker, M. P., & Stickgold, R. (2009). Sleep and Memory Consolidation. Sleep Disorders Medicine,112-126. doi:10.1016/b978-0-7506-7584-0.00009-4
  6. Simpson NS, Scott-Sutherland J, Gautam S, Sethna N, Haack M. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain. 2018; 159(1):33-40.
  7. Guy L. Effectiveness of Pacing as a Learned Strategy for People With Chronic Pain: A Systematic Review. Am J Occup Ther. 2019; 73(3): 1-10. 

Knee Ligament Injuries

Background: The knee and the injuries that are involved in this joint are proved to be common and difficult to rehabilitate. In this blog, we will focus on injuries specifically to one of the four ligaments of the knee as shown above. Ligament sprains/strains/tears are most commonly acquired through sport related activities. The most common by far is the ACL tear which usually requires surgery to fix and can force an athlete to miss entire seasons before training again. 

The best way to prevent a ligament sprain and especially a tear, is to maintain stability and strength in the muscles of the legs, glutes and core, ensuring you are warmed up before a workout/practice, and consulting a physiotherapist if you experience any sudden pain. Also, for prevention of any injury, be sure to stretch, ease into new exercises, and ensure you have a proper form with a stable base of support before and during an exercise (even in sports, think about how kicking a soccer ball for example affects your joints).

If you have injured your knee in the past, are currently rehabilitating, or would like to work at strengthening the ligaments of the knee for your personal athletic ventures, check out our latest series on the INSYNC youtube channel such as the ones here below!

Anterior Cruciate Ligament Knee Injury: Roller Bridges

Knee Ligament Injuries: Looped Band Bridges

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

pTHealth Canada. (2018). Ligaments of the Knee [Photo]. Retrieved from https://www.pthealth.ca/app/uploads/2018/10/knee-ligaments.jpg

Core Stability – Why does it matter?

What is the core, and why is it important?
The core is the center of our body, and its function is to stabilize the trunk while the arms and legs move. The core consists of muscles that stabilize the hips, torso, and shoulders, therefore having a strong core can help us prevent major injuries, while improving balance and stability. Building a strong core can make it easier to do most physical activities, whether it just be daily tasks or sport performance. Weak core muscles can lead to poor posture, low back pain, and muscle injuries, therefore it is crucial to build a strong core alongside your daily exercise routine. 

Benefits of core strength/stability include:

  • Injury prevention
  • Low back pain prevention
  • Improved posture
  • Balance and stability doing every day tasks such as housework
  • Improved athletic performance. 

Exercises for core stability strengthening

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Healthwise Staff (2017). Fitness: Increasing Core Stability.
Retrieved from https://www.healthlinkbc.ca/health-topics/zt1226

Temporomandibular Joint (TMJ) Disorders

What is a TMJ Disorder?

The temporomandibular joint (TMJ) connects your jawbone to your skull. You have one TMJ on each side of your jaw, and any type of pain in this jaw joint and muscles that control the jaw movement can be a symptom of a TMJ disorder. The exact cause of a TMJ disorder can often be difficulty to determine, therefore visiting a specialist can give you a better diagnosis. The pain can come from a combination of factors such as arthritis, jaw injury, consistent teeth grinding, and genetics. 

Signs and Symptoms

  • Pain or tenderness of the jaw
  • Pain in the TMJ’s
  • An aching pain in and around your ear
  • A clicking or popping noise when opening and closing the mouth 

Prevention

  • Improving posture in the neck and upper back muscles 
  • Ice or cold packs to areas of the joint during onset of inflammation
  • Avoid excessive gum chewing 
  • Massages or gentle self-stretching of the jaw and neck muscles 

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Canadian Dental Association (n.d.). Temporomandibular Joint Disorder.
Retrieved from https://www.cda-adc.ca/en/oral_health/talk/complications/temporomandibular_disorder/

How Do YOU Experience Pain?

Pain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive, and social components (Williams & Craig, 2016).

Positive pain refers to non-injury pain that is exertional and related to reappraisal, whereas, negative pain is injury and damage-causing pain that is associated with catastrophizing. Catastrophisizing include feelings of hopelessness, inability to cope with situation, or ruminating on pain and injury, all of which may lead to avoidance behaviours that increase the risk of injury.  Negative pain is potentially correlated to neuromuscular deficits such as Achilles tendinopathy which reduces muscular endurance or meniscal tears which lower muscle activation. It can delay or prevent return to a sport or possibly lead to chronic pain development (McDougall, 2017).
Elite athletes are able to withstand higher levels of pain and make better use of pain in performing well in their sport.
What can you do to better cope with pain?

1) Education: better knowledge of pain and ways to reduce pain or anxiety

2) Goal Setting: specific, measurable goals that provides direction

3) Imagery: a method used in a rehabilitation setting to reduce stress hormones by anticipating pain 
4) Graded Exposure: exposing oneself to fearful situations to show no more harm


5) Social Support: increase support from family, friends, and teammates

6) Relaxation: reduce tension and anxiety with deep breathing and low-intensity activities
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

PAIN

Understanding & Tackling it!


What an interesting concept Pain is! According to the International Association for the Study of pain, pain is described as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The first part regarding actual damage makes sense to most, however the second part of this definition leaves something to be desired. You might be thinking right now, are you telling me that I can have pain without having actual tissue damage? Absolutely, and this is what makes pain such a fascinating thing.



To better explain, its best to take a step backwards and explain why pain exists and what purpose it serves for us as busy, moving, functioning human beings. We have learned a lot about pain in the last 20 years and treatment of pain has really changed now that we understand more. At its roots, pain is a fantastic protective mechanism! 


Take for example, burning your finger on a hot stove element: if your finger touches the element, the receptors in your skin immediately send a danger signal to your brain (important note: NONE of our body’s tissues have pain receptors, only ones to send danger signals). 








Once this DANGER signal gets to your brain – which thankfully takes milliseconds – based on previous experience with hot stoves, likely having burned your fingers or other body parts before, and awareness of the situation, your brain will interpret this as a real danger and quickly send a PAIN signal to the finger. As a result of this PAIN signal reaching your finger, your brain reacts quickly to the rescue and you pull you finger away and run it under cold water to protect it and help it heal! Naturally, it’s a perfect protective mechanism.


As you can see from this example above, PAIN IS EXCLUSIVELY CREATED BY THE BRAIN.




Just In Your Head?


Does this mean that all pain is just “in your head”? No, all pain is real but it does mean that because its created by the brain, there are lots of factors that can influence this pain system. Some of these factors include stress, anxiety, emotions, beliefs around pain, expectations, fear, and activity levels. These all contribute to the sensitivity of ones pain experience – some will increase it (e.g. stress, anxiety, fear, negative expectations) and some will decrease it (good activity level, low stress, positive beliefs and expectations). This is why its important to talk to a health professional to figure out what may be contributing to your pain as research has shown that pain education is one of the most effective management tools.



Nocebo Effect


Lets re-visit the idea of having pain with no actual tissue damage. There is an emerging concept in pain science called the “nocebo” effect which tells us that symptoms like pain and illness can emerge from simply believing or expecting that we have been exposed to painful stimuli or potential illnesses! For example, in drug trials, a certain percentage of participants are given a fake drug (i.e. sugar pills) and told that they are taking the real medication and that there are some potential side effects. What we see with these trials is some of the participants report these side effects from a drug that they ARE NOT EVEN TAKING! (Source: nocebo effect). These participants think they are on the real medication and therefore think themselves into the side effects. Similarly, in research around perception of pain, subjects reported amplified pain ratings even with harmless stimuli when they were told to expect a painful stimulus! (Moseley & Arntz 2007).

As you can see, pain can be a tricky thing and because of this, it’s important to tackle your individual pain with a tailored approach. It is always easy and tempting to consult Dr. Google or ask your friends or family members that have had similar aches and pains but it is important to recognize that no two injuries or pains will be quite the same.



Summary



There are a few key points regarding pain that apply to almost all types of painful situations and injuries:

1. All pain is real and all pain is created by the brain
2. Many factors influence the pain experience and this makes it a very individual thing
3. Education around why you are in pain one of the most effective management tools!


Jeffery Jukes, Registered Physiotherapist Send Email
MPT, B.Sc., CAFCI(Acupuncture), IMS
Jeffery Jukes - Portrait
Jeff Jukes is a registered physiotherapist at INSYNC Physiotherapy in Vancouver. He has lots of experience working with chronic pain populations and therefore has done extra training and individual research to effectively help with all kinds of pain. Jeff’s treatments are multi-modal in nature and include hands on treatment, pain education, acupuncture, Intramuscular stimulation (IMS), and therapeutic exercises. Talk to Jeff regarding any type of injury or pain!

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.