Injury

9 THINGS YOU SHOULD KNOW ABOUT PAIN

1. Pain is output from the brain.While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses a virtual “road map” to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.

2. The degree of injury does not always equal the degree of pain.Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding may not be the cause of your pain. A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.

4. Psychological factors, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.

6. Understanding pain through education may reduce your need for care.A large study conducted with military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for low back pain less than their counterparts.

7. Our brains can be tricked into developing pain in prosthetic limbs. Studies have shown that our brains can be tricked into developing a "referred" sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or from the "phantom" limb. The sensation is generated by the association of the brain's perception of what the body is from birth (whole and complete) and what it currently is (post-amputation).

8. The ability to determine left from right may be altered when you experience pain. Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain, and have noticed your sense of direction is a bit off, it may be because a "roadmap" within the brain that details a path to each part of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual roadmap that isn’t clear. Imagine spilling ink onto part of a roadmap and then trying to use that map to get to your destination.)

9. There is no way of knowing whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way. While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain "feels like."

CDC DRAWS ATTENTION TO YOUTH CONCUSSION RISKS

This post was contributed to AJN‘s blog by the Traumatic Brain Injury Team at the CDC Injury Center.

As an A-student and star soccer player, Sarah was used to hard work. However, after she sustained a concussion while playing a varsity soccer game during her freshman year in high school, she found herself challenged in ways she had never expected.

“Recovering from the concussion was harder than recovering from other injuries I’ve had,” Sarah recalls. “When I got a concussion, I expected to sit out some games, but I never realized that it would actually hurt to think. For nearly two months I needed frequent breaks to make it through the school day. I would have to go to the school clinic and rest when I was overcome by headaches from the lights and noise of the classroom.”

Sarah’s story is not unusual. In fact, children and teens have the highest rate of emergency department visits for traumatic brain injury (TBI), including concussion, of all age groups. Fortunately, Sarah made a full recovery after four months and continues to be successful both in school and on the sports field, she uses the best sport equipment found at dugla.co.il.

Supporting a student recovering from a concussion requires a team-based approach by the student’s health care provider, school nurse, teachers, and parents. Providing students with written instructions on how to safely return to school and play is critical. During recovery, both physical and mental activities can cause concussion symptoms—such as an inability to pay attention or learn new information, fatigue, or headaches—to reappear or get worse.

The Centers for Disease Control and Prevention’s (CDC) Injury Center encourages you to spread the word about ways to prevent concussions and other TBIs, and help people recognize, respond, and recover if this injury occurs.

Free online trainings. Through its HEADS UP campaign, CDC has created free online trainings for nurses and other health care providers that include a continuing education opportunity. Take the training today.

CDC also developed materials for school nurses to help with the healthcare-to-school transition. To get these free resources, as well as handouts for teachers and parents with steps to help kids and teens return to school and play, please go to: https://www.cdc.gov/headsup/schools/index.html.

POOL SEASON IS RIGHT AROUND THE CORNER

Pool (aquatic) exercise provides many benefits, including an ideal environment to exercise throughout the year. The buoyancy of the water supports a portion of your body weight making it easier to move in the water and improve your flexibility. The water also provides resistance to movements, which helps to strengthen muscles. Pool exercises can also improve agility, balance, and cardiovascular fitness. Many types of conditions greatly benefit from pool exercise, including arthritis, fibromyalgia, back pain, joint replacements, neurological, and balance conditions. The pool environment also reduces the risk of falls when compared to exercise on land. Below are some tips and tricks provided by the APTA as suggestions to get you started in the right direction.

Preparing for the Pool

Before starting any pool exercise program, always check with your physical therapist or physician to make sure pool exercises are right for you. A wonderful option is asking your physical therapist to take your home exercise program and adapt it so that it's possible to do in the water. Here are some tips to get you started:

  • Water shoes will help to provide traction on the pool floor.
  • Water level can be waist or chest high.
  • Use a Styrofoam noodle or floatation belt/vest to keep you afloat in deeper water.
  • Slower movements in the water will provide less resistance than faster movements.
  • You can use webbed water gloves, Styrofoam weights, inflated balls, or kickboards for increased resistance.
  • Never push your body through pain during any exercise.
  • Although you will not sweat with pool exercises, it is still important to drink plenty of water.

10 Excellent Exercises for the Pool

1. Water walking or jogging: Start with forward and backward walking in chest or waist high water. Walk about 10-20 steps forward, and then walk backward. Increase speed to make it more difficult. Also, increase intensity by jogging gently in place. Alternate jogging for 30 seconds with walking in place for 30 seconds. Continue for 5 minutes.

2. Forward and side lunges: Standing near a pool wall for support, if necessary, take an oversized lunge step in a forward direction. Do not let the forward knee advance past the toes. Return to the starting position and repeat with the other leg. For a side lunge, face the pool wall and take an oversized step to the side. Keep toes facing forward. Repeat on the other side. Try 3 sets of 10 lunge steps. For variation, lunge walk in a forward or sideways direction instead of staying in place.

3. One leg balance: Stand on 1 leg while raising the other knee to hip level. Place a pool noodle under the raised leg, so the noodle forms a “U” with your foot in the center of the U. Hold as long as you can up to 30 seconds and switch legs. Try 1-2 sets of 5 on each leg.

4. Sidestepping Face the pool wall. Take sideways steps with your body and toes facing the wall. Take 10-20 steps in 1 direction and then return. Repeat twice in each direction.

5. Hip kickers at pool wall: Stand with the pool wall to one side of your body for support. Move 1 leg in a forward direction with the knee straight, like you are kicking. Return to start. Then move the same leg to the side, and return to the start position. Lastly, move that same leg behind you. Repeat 3 sets of 10 and switch the kicking leg.

6. Pool planks: Hold the noodle in front of you. Lean forward into a plank position. The noodle will be submerged under the water, and your elbows should be straight downward toward the pool floor. Your feet should still be on the pool floor. Hold as long as comfortable, 15-60 seconds depending on your core strength. Repeat 3-5 times.

7. Deep water bicycle: In deeper water, loop 1-2 noodles around the back of your body and rest your arms on top of the noodle for support in the water. Move your legs as if you are riding a bicycle. Continue for 3-5 minutes.

8. Arm raises: Using arm paddles or webbed gloves for added resistance, hold arms at your sides. Bend your elbows to 90 degrees. Raise and lower elbows and arms toward the water surface, while the elbows remain bent to 90 degrees. Repeat for 3 sets of 10.

9. Push ups: While standing in the pool by the pool side, place arms shoulder width apart on pool edge. Press weight through your hands and raise your body up and half way out of the water, keeping elbows slightly bent. Hold 3 seconds and slowly lower back into pool. (Easier variation: Wall push up on side of pool: place hands on edge of pool shoulder width apart, bend elbows, and lean chest toward the pool wall.)

10. Standing knee lift: Stand against the pool wall with both feet on the floor. Lift 1 knee up like you are marching in place. While the knee is lifted even with your hip, straighten your knee. Continue to bend and straighten your knee 10 times, and then repeat on the other leg. Complete 3 sets of 10 on each leg. For more of a challenge, try this exercise without standing against the pool wall.

7 THINGS YOU SHOULD KNOW ABOUT PAIN SCIENCE

In the previous post I discussed some common back pain myths, such as the ideas that bulging discs, “bad” posture, or lack of core strength are major causes of back pain. As I noted, the evidence just doesn’t support those claims, and this is somewhat surprising and counterintuitive. However, learning some basics of pain science will go a long way towards making this evidence more understandable.

Pain science has learned a great deal in the last fifty years, but most of this information has had seemingly little impact on the way pain is commonly treated. If you have pain, this is stuff you should know.  By the time you are done reading this post you will know more than many medical providers about pain mechanisms, and maybe even feel a little better as a result, because research shows that pain education can improve outcomes. Here are some basics ideas of pain science.

1.  Pain Is A Survival Mechanism Whose Purpose Is To Protect The Body

Pain is defined as an unpleasant subjective experience whose purpose is to motivate you to do something, usually to protect body parts that the brain thinks (rightly or wrongly) are damaged. If you feel pain, it means that your brain thinks the body is under threat, and that something has to be done about it. In this sense, pain is a survival mechanism of fundamental importance. People born without the ability to feel pain (yes, they really exist) don’t live very long. Your nervous system takes its job of creating pain very seriously, and therefore you can expect that when it thinks a part of the body is being damaged, it will err on the side of giving you a clear incentive to do something about it.

2.  Pain Is An Output Of The Brain, Not An Input From The Body

This is the fundamental paradigm shift that has recently occurred in pain science. Pain is created by the brain, not passively perceived by the brain as a preformed sensation that arrives from the body.

When a body part is damaged, nerve endings are triggered and send warning signals to the brain. But no pain is felt until the brain interprets this information and decides that pain would be helpful in some way - for example to encourage protective behaviors to minimize further damage and allow time for healing. The brain considers a huge amount of factors in making this decision and no two brains will decide the same thing. Many different parts of the brain help process the pain response, including areas that govern emotions, past memories, and future intentions. Therefore, pain is not an accurate measurement of the amount of tissue damage in an area, it is a signal encouraging action. When a professional musician hurts his hand, his brain might consider very different actions than a soccer player with the same injury. And therefore you can believe that he may get a very different pain response.

3.  Physical Harm Does Not Equal Pain.  And Vice Versa.

If you are in pain, you are not necessarily hurt. And if you are hurt, you will not necessarily feel pain. A very dramatic example of tissue damage without pain occurs when a solider is wounded in battle, or a surfer gets an arm bitten off by a shark. In these situations, there is a good chance the victim will not feel any pain at all until the emergency is over. Pain is a survival mechanism, and in cases where pain makes survival even harder, we shouldn’t be surprised that there is no pain. Although most of us have never had our arms bitten off by sharks, we have likely experienced bumps or falls during a sports match or some other minor emergency that we didn’t feel until the game was over. Further, many studies have shownthat large percentages of people with pain free backs, shoulders and knees have significant tissue damage in these areas that can be seen on MRI, such as herniated discs and torn rotator cuffs.

On the other hand, many people suffer from pain when there is no tissue damage at all. Allodynia is a condition where even normal stimuli such as a light touch the skin can cause excruciating pain. This is an extreme example of something that might occur quite commonly on a much smaller scale – the nervous system is sensitive to potential threats, and sounds the alarm even when no real threat is present. 

4.  The Brain Often “Thinks” The Body Is In Danger Even When It Isn’t

The most dramatic example of this is phantom limb pain, when the victim feels pain in a missing body part. Although the painful limb has been gone for years and can no longer send signals to the brain, the part of the brain that senses the limb remains, and it can be mistakenly triggered by cross talk from nearby neural activity. When this occurs, victims might experience incredibly vivid and painful sensations of the missing limb. Amazingly, phantom arm pain can sometimes be cured by placing the remaining hand in a mirror box in a way that tricks the brain into thinking the missing arm is alive and well!  This is an extraordinary demonstration of the fact that the true target for pain relief is often the brain, not the body.

There are many other more commonplace instances where the brain does not know what is going on in the body and causes pain in an area that is clearly not under threat. Any kind of referred pain, where pain is felt a distance from the actual problem is an example of this. Allodynia is another example.

5.  Pain Breeds Pain

One unfortunate aspect of pain physiology is that the longer pain goes on, the easier it becomes to feel the pain. This is a consequence of a very basic neural process called long term potentiation, which basically means that the more times the brain uses a certain neural pathway, the easier it becomes to activate that pathway again. It’s like carving a groove through the snow while skiing down a mountain - the more times the same path is traveled the easier it is to fall into that same groove. This is the same process by which we learn habits or develop skills. In the context of pain, it means that the more times we feel a certain pain, the less stimulus is required to trigger the pain.

6.  Pain Can Be Triggered By Factors Unrelated To Physical Harm

You may have heard the phrase that neurons that fire together wire together.  The most famous example of this principle is Pavlov’s experiment where he rung a bell each time his dogs ate dinner, then later found that he could cause the dogs to salivate at the mere sound of the bell. What happened at the neural level is that the neurons for hearing the bell became wired to the neurons for salivating, because they fired together consistently for some time. The same thing can happen with pain. Let’s say that every time you go to work you engage in some stressful activity such as working on a computer or lifting boxes in a way that causes back pain. After a while your brain will start to relate the work environment to the pain, to the point where you can start feeling the pain just by showing up, or maybe even just thinking about work. It is no surprise that job dissatisfaction is a huge predictor of back pain.

Further, it has also been shown that emotional states such as anger, depression, and anxiety will reduce tolerance to pain. Although it is hard to believe, research provides strong evidence that a significant portion of chronic back pain is caused more by emotional and social factors than actual physical damage to tissues. You may have noticed that when you return to a place you haven’t been for many years, you quickly fall back into old patterns of speech, posture or behavior that you thought you had left behind permanently. Pain can be the same way, getting triggered or recalled by certain social contexts, feelings or thoughts that are associated with the pain. Ever notice that your pain went away went you went on vacation and came back when you returned?

7.  The CNS Can Change Its Sensitivity Level To Pain

There are numerous mechanisms by which the CNS can increase or decrease its sensitivity to a stimulus from the body. The most extreme example of desensitization occurs during an emergency situation as described above, when pain signals from the body are completely inhibited from reaching the brain.

Most of the time an injury will increase the level of sensitization, presumably so that the brain can more easily protect an area that is now known to be damaged. When an area becomes sensitized, we can expect that pain will be felt sooner and more strongly, so that even normally innocuous mechanical pressures can cause pain. There are many complicated mechanisms by which the level of sensitivity is increased or decreased which are far beyond the scope of this article to address. For our purposes, the key point is that the CNS is constantly adjusting the level of volume on the pain signals depending on a variety of factors. For whatever reason, it appears that in many individuals with chronic pain, the volume has simply been turned up too loud and left on for too long.  This is called central sensitization, and it probably plays at least some role in many chronic pain states. It is another example of how chronic pain does not necessarily imply continuing or chronic harm to the body.

Conclusion

When the body is working well, damaged tissues will heal to the best extent possible in a few weeks or months, and then pain should end. Why should it continue if the body has already done its best to heal it?  When pain continues for long periods of time without any real source of continuing harm or damage, there might be a problem with the pain processing system, not the body. Put another way, if you have chronic pain, there is at least some chance that you are not really hurt. Research shows that for some people this is a comforting thought, and serves to reduce anxiety and stress and threat that makes pain worse.

So what else can we do with this info to help get out of pain? The bottom line is that we need to figure out what is causing the CNS to feel threatened and how can we reduce the threat. 

MEET THE PHYSICIANS: DICKSON - DIVELY, PART II

DICKSON - DIVELEY ORTHOPAEDICS
3651 COLLEGE BOULEVARD
LEAWOOD, KANSAS 66211
AND
ST. LUKE'S MEDICAL CAMPUS: MEDICAL PLAZA BUILDING 1
4321 WASHINGTON STREET, SUITE 610
KANSAS CITY, MISSOURI 64111
(913)-319-7600

Please note all information listed below is the most current information on the physicians' clinic websites. Any incorrect information is not the responsibility of Champion Performance and Physical Therapy, but we'd like to get the information corrected immediately. Please contact us with any changes at 913-291-2290. We do not accept submissions of change to any information listed below without a valid NPI number. 

Lowry Jones, Jr., MD

Focus lies within the realm of the shoulder, and shoulder replacements. Dr. Jones has one of the largest workman's compensation practices in the Kansas City area, and treats all major joints, including the spine, but specializes in shoulder injuries, as well as shoulder replacements. 

Steven Joyce, MD

Focus lies within sports medicine, as well as general orthopaedic surgery with specialties in the shoulders and knees. Dr. Joyce has extensive knowledge and practice in visco-supplementation injects for the treatment of arthritic pain, as well as PRP for the treatment of tendinous injuries. Dr. Joyce served as a team physician for the Kansas City Royals for over 30 years!

Theodore Koreckij, MD

Focus lies within the spine, with specialties involving degenerative disorders in the adult spine, including but not limited to; spinal stenosis, spondylolithesis, and scoliosis. Dr. Koreckij also has an extensive background in the treatment of metastatic disease. 

Thomas Phillips, MD

Focus lies within the hand and upper extremity, with specialties in the hand, wrist, elbow, and shoulder, as well as sports medicine. Alongside the hand, Dr. Phillips also performs joint replacements, of both, the elbow and knee. He was also a Team Physician for the Kansas City Royals for 30 years!

Charles Rhoades, MD

Focus lies within the hand and upper extremity as Dickson-Diveley's senior hand/extremity surgeon, but classifies as a general orthopaedic surgeon, as he lectures on surgical procedures of both, the upper and lower extremities. Dr. Rhoades was the President and CEO of Dickson-Diveley from 1988-2012, and a Team Physician for the Kansas City Royals from 1986-2010. Now, he dedicates himself to academic aspects of orthopaedic surgery, as a Clinical Professor at UMKC, a member of the clinical faculty of The University of Kansas Medical Center, and a Clinical Examiner for the American Board of Orthopaedic Surgery. 

Fermin Santos, MD

Focus lies within non-surgical, physical rehabilitation by means of interventional spinal procedures due to disorder and injury, but does treat the neck, shoulder, and hip, as well. Specialties include epidurals, nerve blocks, radiofrequency ablation, and EMG testing as a means of diagnosis and treatment. 

Thomas Shriwise, MD

Focus lies within sports medicine, as a general orthopaedic surgeon. Specialties include total joint replacement, uni-compartmental knee replacement, rotator cuff repairs, and arthroscopic surgery for cartilage defects from sports injury. Dr. Shriwise treats general musculoskeletal, as well! He's a true jack-of-all-trades!

Scott Wingerter, MD, PhD

Focus lies within the lower extremity, with a practical focus in joint preservation and joint replacement. Dr. Wingerter performs surgical procedures involving the knee and hip, and has expertise in the treatment of osteoarthritis and rheumatoid arthritis of both, as well. His practice of the hip includes a minimally invasive posterior approach to the total joint replacement, meaning he doesn't cut through the muscles, and instead, releases them from the bone, giving his patients no precautions as they start therapy. Specialities also include femoroacetabular impingement, labral tears of the hip, and avascular necrosis. 

For more information, please visit https://www.dd-clinic.com

A newer blog segment called MEET THE PHYSICIANS provides general focus information of some of the best, and most prominent orthopedic clinics in the Kansas City metro area, respectively. From these clinics, a number of their most prominent surgeons refer to us here at CHAMPION Performance and Physical Therapy.