Achieving movement goals despite persistent pain

Ian Harris

Outline The difference between Acute and Chronic

Pain The downward spiral Chronic pain coping strategies The problem of inactivity The upward spiral Practical advice to start despite pain

Acute pain vs. Chronic pain Acute pain

› Large torque producing muscles activated fight or flight, or to stiffen segments

› Smaller muscles that control joints seen as not essential to survival, and ignored

› This allows for recovery and removal from harm

› The patterns are variable and determined by body part and situation

Acute pain vs. Chronic pain Chronic pain

› Healing has happened and the pain no longer serves a protective function

› The large muscle activity: stiffness and increase in compression (rigidity)

increase in pain but ultimately weak due to overuse (trigger points)

› Others become weak due to disuse

› Control strategies change: some overactive others underactive

disuse or tight overuse

The Downward SpiralPAIN

AVOID ACTIVITIESLESS ACTIVITY

DECONDITIONINGPAIN ON MILD EFFORT

FEAR & FURTHER INACTIVITY FURTHER

DECONDITIONINGPAIN ON MINIMAL EFFORT

Ref: Manage Your Pain, M Nicholas, A Molloy, L Tonkin, Lee Beeston

Don’t use it, you lose it!! Within 24 hours of an

injury you lose the control muscles (slow twitch) of some muscles (inside Quadriceps)

The cost of inactivity

› 20-30% loss of muscle strength in 7-9 days

› 50% loss of muscles strength within 5 weeks of inactivity.

Large torque muscles

Control muscles

Motion is lotion Increased rigidity + fear of the movement

› Means reduced activity

Each week of bed-rest› 1.54 grams calcium loss

› After 6 months, 40% calcium lost

8 grams protein lost per day with bed rest

Result is less movement, weaker, tighter and less control

Which means more pain

Coping with Persistent Pain

People cope in different ways Recognising negative patterns important 3 main strategies

› Boom/bust

› Gradual decline

› No activity

Sometimes adopt different strategies Ultimately the net effect:

› less activity and increased isolation

Boom / Bust George: ‘No pain, no gain’

› Ignored pain until pain unbearable

AC

TIV

ITY

TIME

Pain onset

Flare up

Pain unbearable

Gradual decline Stephanie: Afraid of pain

› Avoided activity anywhere close to pain

AC

TIV

ITY

TIME

Pain onset

No activity Rachel: Avoided activity in total

AC

TIV

ITY

TIME

Pain onset

But, there is a solution...

All is not lost...

Control of pain can be gained...

The Upward Spiral

RETURN TO PRODUCTIVE ACTIVITIES

IMPROVED CONFIDENCE

ENDURANCE ACTIVITIESREDUCED FEAR OF ACTIVITIES FEELING STRONGER

/MORE CONTROLSTRENGTHENINGEXERCISES

START STRETCHINGMINMAL PAIN WITH CONTROLLED EXERCISES

Ref: Manage Your Pain, M Nicholas, A Molloy, L Tonkin, Lee Beeston

PAIN

Reduced Pain

Increased Function

Practical strategies

Understand the difference between acute and chronic pain

Pain no longer protects We can move - and we must move We start slowly and progress slowly

› So lets get started...

Pacing yourself

Applied to both› Exercise or Functional activities

Gradual increase in activity Decide what your goals are:

› walking, ironing, playing with children, vacuuming

Set baseline – well short of pain Plan progression, increase slowly

› but do increase - 10% each week

PacingA

CTIV

ITY

TIME

Flare-up line

Baseline activity

Prioritise and modification

Choose goals that important to you› Realistic goals

(not from when you were 18) Activities that are functional and bring

a smile to your face Modification important Spread tasks out over days Prioritise what needs to be done

How do you do it?

George wants to walk more› Baseline: ask yourself how far can I walk for

before a flare up? › Be certain and definite and take into account

the terrain. George can do 5 min.› Plan progression: I suggest 10% every week› Monitor: Apps on phone, pedometer, watch› Avoid: Felt good so I kept going› Keep a record: diary, apps (runkeeper)› Regular and committed › Lifestyle change

How do you do it?

Stacey wants to vacuum› Break it down:

moving furniture, getting vacuum, body position, plugging in

› Baseline: She can vacuum half her dinning room with no pain

› Similar room each day› Progression: Increase about 10% each day› Keep a record

Movement and Flare ups

They will happen!!! What will I do if I flare up?

› Don’t stress - Keep your head Old habits and coping strategies emerge

› Don’t stop ease back a couple of steps in your progression but keep going

You’ve come this far!› this will make you confident you

can overcome a flare up

Conclusion

As part of team approach, exercise is vital in gaining control of persistent pain

Not a cure but mastery over the pain A plan for reactivation and confidence

with movement is important Gain control of your pain, plan to move

Thank you!Ian Harris

coastalphysioclinic@bigpond.com