achieving movement goals despite persistent pain
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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
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