I winced before I even sat down. Car seats had become my enemy. Within minutes of sitting, my right hamstring tightened, then cramped. The tightness that started at the top of my hamstring soon traveled down the back of my thigh, then crept to the outside of my calf. Those seizing muscles in my right leg felt like they were hardwired to my jaw, which, as though on cue, tensed involuntarily.
I had hurt my back lifting a patient 10 months before; and now, the pattern was completely predictable. Every time I sat in a bucket seat, I hurt. I had squirmed, flexed, and stretched across miles of highway to no avail. I had used lumbar rolls and seat cushions. No luck. What I did not know in 1982 was that my pain was no longer coming from my sciatic nerve and a bulging disc. Those pain signals that had fired together were now wired together. The pain was now a very well-traveled path in the neural circuitry of my brain.
Chronic back pain and radicular pain are severely disabling disorders affecting millions of people financially, physically, and emotionally. Physical therapists have been manipulating, stretching and strengthening people with chronic pain for years – with variable success. But, there’s an area we’ve neglected. Until recently, we have not considered the brain and how it influences how well we recover from a painful experience.
Once you hurt, your system is on guard for anything new that might increase pain. It makes sense, right? It’s how our ancestors survived – once injured, they had to be even more cautious because they were easy prey. They were in survival mode. Thus, their nervous systems became more alert to any potential danger. And in the brain, this shows up as more brain activity in response to painful stimuli – i.e., more pain. [Seifert, 2009] Not only that, chronic pain becomes imprecise and can change locations and come and go unpredictably, often without provocation. Longstanding pain seems to develop a mind of its own. [Butler, 2013] Check out this video on Why Things Hurt. [Lorimer Moseley, 2011]
I know it sounds grim, and it gets even more complicated. Most of these changes are happening behind the scenes, in the parts of the brain that make your heart beat faster, your palms sweat, and your breathing become quick and shallow. We don’t consciously make a muscle spasm, so how the heck do we voluntarily relax muscles and, just as importantly, how do we reset our nervous systems to accurately reflect what’s really happening?
First, we educate. In the case of longstanding muscle and joint pain, understand that the pain is no longer coming from damaged tissues, and is not creating more damage. When you can relax rather than tense around the pain, the pain often diminishes. With practice, your nervous system resets.
Though it sounds simple, you’ll probably need help with this. Here are some suggestions:
- Use guided relaxation. Having someone guide you through this process is helpful. I particularly liked the Relax and Rest app, but you might find one that works better for you – check out more apps on our Facebook Page
- Qi Gong
- All ALTA PTs are trained in progressive relaxation and can help you with an overactive stress response.
The second essential tool for decreasing chronic pain is to wake up the motor control system. Brain density of the motor control system actually decreases when you have chronic pain. [Rodriquez-Raicke, 2009] We’ve discussed this in past blogs, but will look at it again in the next newsletter.
In the meantime, breathe.
[Seifert, 2009], [Butler, 2013] [Lorimer Moseley, 2011], [Rodriquez-Raicke, 2009]