Queen Mary's University London | SEM 2016
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Transcript of Queen Mary's University London | SEM 2016
Pain in sportRichmond M. Stace MCSP MSc (Pain) BSc (Hons)
Specialist Pain Physiotherapist
Behind every pain……is a story…a personKnow the person to know the pain It’s as much about the person as the condition –
Oliver SacksWhen a person is better, the pain is betterPeople with persisting pain often fall in the cracks
Picture this..16 year old sporty girl with shin pain2 years and worseningContinues to play sport most days at schoolVery tender to touchSometimes very painful to walkFirst thoughts?
Then….8 year h/o migrainesDigestive disturbancesDisturbed sleepWidespread tendernessPerfectionist & demanding schoolThis a case for……
A lack of signs? Puzzling?
Is there an actual injury?Is there sensitivity?e.g./ hamstring ‘re-injury’What’s the story?
is there damage or does it just feel like damage?
Acute pain Is it an injury? “I sincerely thought it
was the last ball I would be touching for a long time because of the pain”. Messi (2012)
Acute injury Is there actual damage? Does more damage =
more pain?
Pain is…NormalPart of protectionImportant for survivalUnpleasantA motivator compelling action
Pain definition
IASPAn unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described in terms of such damage
Pain is the No.1 global health burden
Back pain, neck pain, headache, migraine, OA All in top 12 depression
Persisting pain What do you think about?
Is persisting pain in sport?
The problem
Pain misunderstoodSocietyHealthcare
Wrong messages communicatedLow expectations
Even morphine affected by expectationPoor outcomes
Persisting pain in sportYesHow common?Impact – this is the ‘lived experience’
PersonProfessional vs amateurParticipation PerformancePlaying with pain
What can we do? Develop understanding of
pain Answer the question:
what is pain really? This answer leads to a
route onwards Different thinking
Neurobiology Neuroimmunobiology neuroimmunoendobiolog
y
What is pain?
What is any experience? The brain’s best guess! Making sense of the world
now Generates & constructs
explanations for its sensory input
Generates predictions of sensations
Generates hypotheses to try to explain what is happening in the outside world
Mature organism model (Gifford)
Important principles
Change We change ‘Neuroplasticity’ Which direction?
There’s more than one direction
If you think there is… Your choice
Whole person ‘I’ think ‘I’ feel (pain, thirst,
hunger) My ______ does not feel
pain, I do What do we treat? Or who do we treat?
Embodied cognitionThe body an extension of the mindWe are more than a brainOur bodies in the world do much of the work
needed to achieve goals (not just the brain)e.g mechanics of walkingGestures reduce load on brain
I think with my whole personWhere do you feel anxious? Hungry?
Embodied athletesIdentify with body & performanceTheir sense of self encompasses body &
performance‘gestures’ part of their cognition
AutomaticPredictions not responses – otherwise miss the
ball!Injury => loss of sense of self
Pain Consider…
Pain is a lived experience Pain is not an accurate
indicator of tissue damage
Pain is about perceived threat
Pain is allocated a space Pain is dynamic
What influences pain? The meaning – what do
you tell yourself? The context
Where you are What you are doing What you are planning to
do What you have just done
Emotional state – anxiety, stress
Tiredness
Prior experience Beliefs about pain/health Attention bias Who we are with
Pain in sport Expected Part of training & playing Accepted risk ‘no pain, no gain’ What if the pain
persists……or injuries recur?
New injury
What do you want to know?
The injury moment Context Mechanism Meaning Body responses Pain intensity Current health Early care
Initial management Messages given Investigations Other’s responses
Facial Verbal
Injury – not in isolation Why? Pain vulnerabilities
Pre-existing sensitivity Functional pain
syndromes Injury patterns
Fatigue Health Prior injuries & pain
Circumstances The person Priming factors
Pain vulnerability Genetics Body sense
e.g. hypermobility
Persisting painBegins at the moment of injury
VulnerableUncontrolled painWrong treatment
Pain beyond a useful time?Or are there health issues?Habits of thought and action
What have you seen?Features?
What do we see? Loss of sense of self Change in body sense Altered movement
patterns Altered thinking
Outlook? Altered planning Change in perception of
the environment
Sickness responses Other aches and pains Poor sleep Varied emotions
What are we trying to do? Restore a sense of self as
defined by the person Resume a meaningful life Matching what is
expected with what is happening
What does that look like? Ask the person? Their vision
How do we do it? Working knowledge of pain
Reduce threat Take healthy action
Develop body sense Sensorimotor training Motor imagery visualisation
Focus on health (not pain) What we focus on, we get
more of… Deal with distractions from
the vision
Programme must be lived Moment to moment
Build tolerance for activities Graded exposure General fitness
Sleep habit Meet basic needs! Pain Coach
Strengths based coaching Become their own coach
Key pointsPain is whole person: when the person gets
better, the pain gets betterEarly messages are key!Understanding pain is vital – working knowledgePain is a lived experience, which the programme
must reflectPain is temporary, each moment uniqueChange is certain; direction can be a choice
[email protected]@gmail.com07932 689081UP | understand pain – www.understandpain.com@upandsing