We have all experienced pain at some point in our lives and to various degrees. Whether it be from burning our finger on the stove to spraining an ankle in soccer to getting a hip replacement, pain is a normal experience that is necessary for survival.
Despite our growing knowledge behind the mechanisms of pain, approximately 10-20% of the population may be living with chronic or persistent pain1. Chronic pain is one of the most common reasons adults seek medical care and has been associated with increased rates of anxiety and depression, increased dependence on medication use, poorer perceived health, and decreased quality of life2.
Let’s begin by understanding what pain is.
What Is Pain?
According to Moseley (2003), pain is “…produced by the brain when it perceives that danger to body tissue exists and that action is required…”3. Our bodies do not have pain receptors, but what we do have are called nociceptors. Nociceptors are sensory receptors that are activated by potentially noxious stimuli, and they play a role in protecting our bodies from harm4. We have nociceptors in our skin, muscles, viscera, joints, and tendons, and they are activated by three types of stimuli: temperature, chemical, and mechanical4.
In a basic sense, when a nociceptor is activated, the signal gets sent to the spinal cord via nerves. From the spinal cord, the signal gets sent up to the brain, where the brain determines if the signal is harmful or not and decides an appropriate response.
Not every signal will be transmitted to the brain. A stimulus must be strong enough to reach the threshold for the signal to be transmitted to the spinal cord; this threshold is below any tissue damaging intensity4. Inflammation and injured tissue will decrease the threshold and intensify the magnitude of the response for the given stimulus to protect from further damage (think trying to walk on a sprained ankle); this is called peripheral sensitization4.
What Is Chronic Pain
Chronic pain is more complex and has multiple contributing factors. Chronic pain is less about injured tissue and more about central nervous system sensitivity. Chronic pain is defined as pain that persists for greater than three months past normal healing time.
A key component to chronic pain is a concept called central sensitization. Central sensitization is an actual neural condition that develops plastic changes within the central nervous system resulting in the manifestation of chronic pain5. Basically, when someone is in chronic pain, the nerves get into a state of hyperexcitability and the nociceptive threshold is lower. Therefore, even if a physical injury has not occurred, a person will continue to experience very real pain with less and less provocation.
If you live in chronic or persistent pain, you have noticed that your pain gets worse when you sleep poorly or have a stressful day at work. Chronic pain can be influenced positively or negatively by many things, including sleep, nutrition, coping strategies, stress level, emotions, support system, and activity level. The good news is that many of these factors are controllable and there are resources to help!
How Can Exercise Help Me?
We all know that exercise and multi-joint movement can be beneficial in many ways including:
- Improving sleeping quality
- Improving mood and energy levels through endogenous endorphin release
- Help reduce the risk of certain negative health conditions and chronic diseases such as high blood pressure, diabetes, and stroke
- Reduce pain levels
- Improve ability to perform daily activities
- Help with weight control
- Strength muscles and bones
- Prevent falls
- and the list goes on!
A common response to being in pain is fully resting and completely reducing activity level. However, this strategy is often not beneficial as it can lead to other impairments, including secondary stiffness and muscle weakness, which can potentially worsen and prolong symptoms. Instead of thinking complete rest, think relative rest. When an acute injury occurs, such as a grade II sprained ankle, it is not wise to walk long distances on that ankle while the ligaments and structures are healing. However, it is beneficial to work strengthening through the upper body, core, hips, and non-injured leg as well as strategically begin moving the injured ankle to promote healing.
When someone is in chronic pain, the idea of exercising may not seem overly appealing. However, if you think of “exercising” less in terms of the traditional sense that comes to mind, and more as global, whole body movement, it can become a less daunting task. For some people, the movement may be getting in and out of bed. For others, it may be going on a 10 minute walk every other day. There is no one recipe that fits every person therefore, finding strategies that work best for you is crucial.
How Can Physical Therapy Help Me?
Physical Therapy is a safe and effective alternative to opioid use for the management of pain. Physical Therapy can provide an individualized care plan where you will work together with your physical therapist to:
- Identify impairments that may be contributing to your pain based on a thorough evaluation
- Provide further education on anatomy, tissue healing, and pain science
- Skillfully introduce strengthening and functional movement that is beneficial to improving your impairments
- Strategize ways to modify activities in your daily life that may be contributing to your pain
- Develop a plan to help you achieve your goals
- Assist with long term management through education and a home exercise program
Jessica Moore grew up in Oregon and has called the west side of Portland home. She was a competitive softball pitcher for 15 years and graduated from Sunset High School. Her treatment style combines hands on manual therapy techniques and functional movement exercises. She strives to provide the highest quality care to all of her patients and is passionate about making therapy a positive, fun, and engaging experience.
- Chronic Pain. (2020, October 15). Physiopedia, . Retrieved 18:07, January 14, 2021 from https://www.physio-pedia.com/index.php?title=Chronic_Pain&oldid=254418.
- Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, Kerns R, Von Korff M, Porter L, Helmick C. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. Morbidity and Mortality Weekly Report. 2018 September 14; 67(36):1001-1006.
- Moseley GL. A pain neuromatrix approach to patients with chronic pain. Man Ther. 2003 August; 8(3):130-140.
- Nociception. (2020, August 24). Physiopedia, . Retrieved 18:16, January 15, 2021 from https://www.physio-pedia.com/index.php?title=Nociception&oldid=246340.
- Pain Neuroscience Education (PNE). (2020, October 20). Physiopedia, . Retrieved 18:18, January 15, 2021 from https://www.physio-pedia.com/index.php?title=Pain_Neuroscience_Education_(PNE)&oldid=255331.