Patient: “But it hurts when I sit or lay down… shouldn’t I feel better when I’m resting?!”
PT: Not exactly…
A common line of thinking among many PT patients is that rest will resolve pain. It’s counterintuitive to many individuals that discomfort and pain persist while resting. Let’s dive into this misconception and shed some light on the topic of rest as it relates to pain.
When it comes to pain that is musculoskeletal in nature, it’s common that the cause is overworking, stress, or strain on the muscles, tendons, ligaments, or bones. People often associate this with active movement: running, walking, or even something as simple as getting out of a chair. In reality, your body is working all the time. In fact, resting states (lying down or sitting in a chair) can be interpreted by your brain as potentially dangerous if you have overworked a muscle that is typically used for this activity. For this reason, many therapists focus on educating their clients to rest in anatomically safe postures. You might ask: what is an ideal posture? How can my resting posture be flawed? Therapists know that ideal posture is a position in which your body is working most efficiently and able to support itself with minimal effort.
In cases where an individual is experiencing pain while sitting or otherwise resting, it’s likely that the resting or seated posture causes stress on this area of the musculoskeletal system. The brain interprets this as a stressor and triggers a pain response in the physical body to alert the individual of the burden that area of the body is under. What most people don’t understand is that the body is sending them a message. Pain is a news bulletin from the brain that the position is not ideal and that a change is necessary to obtain comfort. If the individual ignores this signal, as many do, the pain will persist and the brain’s alarm system may become more sensitive. This becomes cyclical, causing a lower threshold for activity before pain comes on again. If a smoke alarm is going off in your house– do you take action to address it or let it ring and ring? More than likely, you look for a reason for the alarm. Sometimes the smoke alarm goes off when something is burning– this can be analogous to an active pain response. Other times, you are taking a shower and the steam sets it off– this is what can happen to our alarm systems they can become more sensitive to stimuli that are not dangerous– like resting postures that seem like they should be pain free.
Now that we have a clearer understanding of why rest isn’t always restful, let’s explore some solutions. A few things need to happen in order for a patient to improve tolerance for resting postures. The first is being aware of your brain’s alarm system and making adjustments to your position when pain occurs. The second is freeing up the tissue that has been overworking and experiencing strain. This is where the PT often utilizes a variety of techniques like myofascial release, instrument assisted soft tissue mobilization or cupping to name a few. The third is to support the tissue that has been overworking by re-educating inhibited muscles to turn back on and properly support the straining tissue. Finally, in some cases the fourth step is to provide the area straining with some support while the system is rebalancing. When these steps are taken with the assistance of a PT to properly assess the body and determine a treatment plan, most individuals experience a reduction in their resting pain. Like anything that is worthwhile doing this process takes time and commitment to the program outlined by your PT.
If you experience resting pain, it might be your body’s smoke detector going off. Give us a call! Our job is to evaluate you and to help devise a treatment plan to make sure your alarm system is running correctly. We look forward to working alongside you on a treatment plan that balances your body and support getting you back to the place where rest is restorative and enjoyable, not painful.
Disclosure: If you experience pain that wakes you up at night and you are unable to fall back asleep, this may be a sign of a more serious problem and is something that should be brought to the attention of your team of healthcare professionals.
Bipedal walking is an important characteristic of humans. Gait is the manner, pattern or style of walking. The entire body moves during walking. A faulty movement or pattern in any segment of the body can have an effect on the gait pattern. The gait cycle is composed of the stance phase (60% of gait) when the foot is in contact with the ground from the heel strike to the toe-off of the same foot, and the swing phase (40% of gait) when the foot is not in contact with the ground, which is the normal weight bearing phase of gait. Proper body movement and timing are essential to normal gait. Physical Therapists are looking at symmetry of arm swings, stride length, weight shifting of hips, movement of the trunk and foot alignment, as well as other areas to fully assess the cause of a patient’s dysfunction.
Some of the abnormalities seen at the clinic which affect how a person walks are:
Should you use ice or heat? If you find yourself asking this question, read on! As a general rule, ice is best for acute injuries, and heat is good for muscular tightness/pain. Ice will slow down the blood flow to an area and as a result, decrease swelling, while at the same time decreasing pain. Ice is good for acute injuries, migraine headaches, impact injuries, sprains and strains, and after performing activity that might exacerbate a chronic condition. Heat helps to bring blood flow to an area, and therefore if used on an acute injury, would cause an increase in swelling. This is why we would never recommend the use of heat on an acute injury. Use heat to loosen a tight or stiff, muscle or joint. It can also be used before an activity to loosen the desired area, priming it for movement. Be sure to put a thin layer of towel or pillow case between your skin and the ice or heat pack to prevent burns. Check the skin throughout the application about every 5 minutes during your 15-20 minutes application.
Pain is complicated, multi-system and elusive. We in the medical and dental professions are understanding the pain science in unprecedented ways. Pain is multi-system involving the brain and changes in the brain when pain is chronic (over 3 months). Pain involves the immune system to facilitate healing in chronic, acute and sub-acute conditions, and in all cases involves soft tissue. Healing chronic pain involves different treatment strategies than acute pain.
Pain is a symptom. We at NJPTA understand pain and movement science. People in pain do not move like people without pain, and we understand how to assess and how to address not only the source of the pain, but the root cause of the pain. For example, in a potential lower back pain / leg pain condition the MRI shows you have a L45 herniated disc as the source of the pain, but the ROOT cause of the pain is gravity and how you hold your spine to cause the disc to herniate. We also understand how the body heals and how the body adapts in order to function. This adaptation is invisible and unperceptive (cannot be felt) until a threshold or tipping point is reached and then pain ensues. Studies show 70% of people have herniated or bulging discs, but do not have any symptoms. The threshold / tipping point for acute injury / back pain from an activity that occurred last week is very different than back pain ongoing for 3 years that suddenly got aggravated last week. A pre-existing back pain history requires different treatment strategies than one time acute injury. Our expertise is the knowledge and applying the correct treatment tools in our toolbox to give you the knowledge and ability for your body to completely and permanently resolve your pain.
North Jersey PT sponsored Patrick McKeown to come train North Jersey Physical Therapy therapists in the Buteyko Breathing Method.
The method is aimed at reducing breathing to promote our bodies to be in a state of relaxation and equilibrium, and break the cycle of sympathetic overdrive or being in a state of constant “fight or flight.” It was created by a Russian physician, Dr. Konstantin Pavlovich Buteyko, around 1952.
Because our systems are stuck “on,” many of us have the tendency to breathe too much (clinically known as chronic hyperventilation), which alters the level of the gases in the blood and leads to numerous problems. Some signs of dysfunctional breathing include mouth breathing, hearing breathing during rest, excessive sighing, frequent yawning, regular sniffling, and taking deep breaths before talking. Things that can lead to dysfunctional breathing include over eating, lack of exercise, excessive talking, stress, high temperature in the home, and asthma.
Through a series of breathing exercises we are able to reset the respiratory centers in the brain and restore the normal balance to the system and allow the body to be in a parasympathetic state, or a state or relaxation and equilibrium. Through the Buteyko Breathing Method we are able to help patients change their pain levels and use it in conjunction with other treatment methods and modalities to address headaches, neck pain, jaw pain, low back pain, pain from fibromyalgia, as well as other forms of soft tissue pains.
Call to schedule an appointment with a North Jersey Physical Therapy therapist today to see how we can help you decrease your pain and improve your quality of life.