Understanding Your Pain

We have all experienced pain in our lives. Perhaps it’s been acute pain where you roll your ankle, or it’s more chronic pain, something like low back pain that’s been around for months or even years. It could also be from surgery or some kind of procedure that you may have had done that could cause a considerable amount of pain. Therefore, it is important to understand pain—understand the pain in your own body, and what implications it has. Just for a quick statistic, 15 million U.S. adults suffer from some kind of chronic pain, and 80% of our global opioid supply is consumed in the U.S. There are 125 deaths per day due to opioids, which are most commonly prescribed for low back pain, which is why it’s such a powerful topic to talk about and understand implicitly.

What’s a common course of low back pain in America? You have an acute episode of low back pain, go to your medical doctor, and get some kind of prescription pain medication. The pain medication doesn’t work, so maybe you get a muscle relaxer, too. Now your primary care is going to refer you for an X-ray, and it shows nothing, or maybe some degeneration that everyone over 35 years old typically has. Then you’re referred to get an MRI, and it shows a herniated disc or some degeneration as well. Of course, that doesn’t give you any information either because imaging in most cases does not correlate to your symptoms. So, then you are referred for an injection. You get an injection that doesn’t really do much at all or lasts for a short period of time before your symptoms return, and you’re referred to physical therapy. The course of low back pain in America is problematic because this is what contributes to moving from acute pain to chronic, which we’ll discuss.

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Let’s start with the definition of pain. Pain is an unpleasant sensory and emotional experience associated with tissue damage or potential tissue damage. Essentially, pain is an alarm system. What it’s telling us is where the pain is, the amount of pain, the nature of the pain, and it is signaling to us, danger.

Now let’s talk about acute pain versus chronic pain. An example of acute pain is when you put your fingers on a hot stove. We have nociceptors, sensory receptors in the skin that will signal through the spinal cord to the different areas of the brain, to create a motor response or reaction. With somatic pain as described, we are signaling to the brain to pull back. Now we can also have visceral pain of the organs or the lining of the organs. Lastly, referred pain, which can be something like a heart attack referring pain to the left shoulder. All of these can be different forms of acute pain.

Chronic pain is much different. Chronic pain is defined as pain that you’ve had for three to six months or longer. With chronic pain, there is no tissue damage, however, your brain is sensitized and signaling that there’s still danger. This causes you to have a heightened sense of pain because your brain is still perceiving that this pain is happening even though the injury has healed. The key take home with this is that pain is not directly correlated to the amount of tissue damage. For example, someone that has had chronic pain for years would indicate that there is no tissue damage at that point, yet the pain can be very heightened. Conversely, someone with an acute tissue injury could have a very low level of pain.

Now that you know a little bit more about acute versus chronic pain and that it is not necessarily related to tissue damage, it’s important to know what you can do about it. It is not simply a matter of taking Advil or Tylenol, because we actually have our own natural painkillers. Endorphins, enkephalins, and serotonin are some of the best natural painkillers; better than NSAIDs.

Also, it is important to recognize that pain is not simply a sensory experience. It is always an emotional experience as well. It has been shown that if you are in a positive mental state, this can impact your ability to manage pain. So, what can you do about your pain?

1) Don’t Panic

Pain is information. Whether you’ve had it for a day or you’ve had it for three years, it is information that your nervous system is either on high alert, or you have some kind of potential tissue damage. Either way, you want to explore it with a gentle curiosity. You want to understand your alarm system because that is your nervous system that is giving you this powerful information to be able to do something about it. Recognizing that no matter how long you’ve had pain, you can continue to make improvements, and be able to be in a pain-free state. 

2) Improve your Movement

You should get evaluated to see what your movement patterns look like so you can limit compensations that are so common. The more that you compensate, you continue to alter your motor control, and the more you will have pain. When you have pain, you have more distorted motor control, so it ends up being this vicious cycle of pain.

3) Stress Management 

This is one of the key things that you want to think about as it relates to pain. Incorporating things like mindfulness, yoga, and meditation into your life to make sure that you are in a positive emotional state to be able to manage the pain. If you have pain, and it’s already heightened, and when you add stress on top of that your pain tolerance will decrease. So, your pain is actually higher. 

4) Graded Exercise

With all of the pain science research, one of the most important things is exercise, specifically, graded exercise. This means it has to be done at a very slow pace and returning to a comfortable state over time. For example, if you’ve had chronic low back pain for 10 years, then beginning a walking program starting at 45 minutes is way too much. Starting with 10 minutes is more appropriate and then every other day progressing to 12, 15, 20 minutes slowly and working your way up to a point that feels great for you. 

That’s just a quick taste of a little bit of pain science and how you can manage pain in your life. I hope this was helpful for you.

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What Should You Eat For Chronic Pain? | Nutrition for Chronic Pain

Do you suffer from chronic pain? Perhaps you’ve had pain for greater than three months, and you’re not sure how you can support nutritionally? Fortunately, there is so much high-quality evidence to support how diet therapy can make a profound difference in chronic pain.

Chronic pain is associated with pro-inflammatory states which are linked to peripheral and central sensitization. This is when the brain perceives that there’s pain, and even a heightened sense of pain with very little stimuli, yet there is no tissue damage.

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Additionally, the mitochondria, which is essentially the powerhouse of our cells, are also associated with chronic pain. The damage to the mitochondria can be driven by how we eat. Consuming pro-inflammatory foods, such as the Standard American Diet—the Western Diet—which is rich in sugary foods, alcohol, processed meats, and enriched grains, can contribute to inflammation and even damage the mitochondria. Therefore, with the Standard American Diet, there becomes an imbalance between our essential fatty acids, which we need for optimal health, and pro-inflammatory markers. That’s where a specific diet therapy comes in.

The first thing we want to do is address the inflammatory markers. The Mediterranean diet is one of the best and well-researched diets that has been shown to decrease inflammation. Think of a diet comprised of fish, legumes, olive oil, low in grains, and high in vegetables – also referred to as an anti-inflammatory diet.

5 ways that you address your chronic pain through diet

1) Decreasing Inflammation

The best way to do this is through an elimination diet. Eliminate the potentially pro-inflammatory foods for at least three weeks and then slowly reintroduce them, one at a time. These include gluten, dairy, sugar, alcohol, caffeine, coffee, tea, corn, soy, processed meats, red meat, chocolate, tea, coffee, and shellfish. If you don’t want to do a full elimination diet, you can do a modified version—eliminate gluten and dairy, for example. These two definitely can play a role in inflammation, and specifically chronic pain. If you’re eating a lot of sugar, this is also a great place to start. Sugar is a massive pro-inflammatory agent, so decreasing sugar in your diet would be very beneficial.

 2) Calorie Reduction

When we are consuming fewer calories than required by our basal metabolic rate, then we can not only increase our brain’s ability to generate new neurons by decreasing free radicals, but we can also increase ATP, the energy source of the cells, and we can increase our number of mitochondria. These all could play a huge role in inflammation and pain.

3) Intermittent Fasting

Intermittent fasting, an eating pattern that cycles between periods of fasting and eating, can help turn on genes that help cells survive by reducing inflammation. There are many different ways to include intermittent fasting in your life. Fasting from seven o’clock at night until seven o’clock in the morning would be a 12-hour fast. You can slowly increase that to a 16 hour fast, or you can do 24-hour fast two days a week. There are many options to suit your lifestyle and it is strongly recommended to start slowly.

4) Specific Nutrient Supplementation

Omega 3’s, vitamin D, vitamin E, vitamin B-12, and magnesium have all been shown to impact chronic pain. There are other nutrients that also help specifically with chronic pelvic pain, such as vitamin E, B1, and B3. 

5) Gut Health

Seventy percent of your immune system is in your gut. If there is an inflammation issue, we should start in the gut. So, do you need to include prebiotics, probiotics, or do you need a specific gut health protocol? If you are not managing gut health properly, then you are not managing chronic pain and inflammation well, either. 

These are just a few of the ways that we can use diet to influence chronic pain.  When we have that central sensitization of the nervous systems, our brain still perceives that there’s pain, yet there is likely no tissue damage. Our nervous system is heightened, and we can begin to associate chronic pain with pro-inflammatory markers. We can use diet to decrease inflammation and optimize our micronutrient, antioxidant, and phytonutrient profile to begin to bring our body back into a state of balance and healing. 

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Why you should stop “stretching” your hip | HIP PAIN

Do you have hip pain that you are continually trying to stretch, roll, or smash, and nothing seems to get better?  Before we get into the role of the psoas, one of your key hip flexors, let’s speak about the local stabilizers and global stabilizers of the body. This is important to understand how you are going to treat your hip flexors and hip pain.

Think of the local stabilizers as being muscles that are close to the joint. They create more of an isometric contraction versus concentric (shortening) or eccentric (lengthening) contraction. They control the joint centration which means keeping the joint centered in its axis. It’s also independent of the activity of motion so if you raise your arm overhead, the deep stabilizers in my spine are going to activate before your arm goes overhead. Essentially these local stabilizers are imperative for stabilization in the body so that we can have proper movement.

Our global stabilizers are equally as important. However, they have a different role, so they have more of an eccentric contraction. They decelerate the range of motion, are continuous with motion, and are farther away from the joint.

Now getting back to the psoas, which is what everyone wants to stretch when they have hip pain.  The posterior or the back of the psoas is a local stabilizer. Think of it as one of our deep core muscles that is helping to stabilize the spine and also prevent the femur, our leg bone, from shifting forward in the hip joint. The anterior or front of the psoas serves as a global stabilizer. So, it is necessary to think of the psoas muscle as a stabilizer. Not only is it a stabilizer but it works in an integrated unit with all of the other muscles, including the pelvic floor, diaphragm, multifidus, the deep five rotators in the hip, and the transverse abdominus. All of these have to work together, and once again in this integrated fashion to be able to stabilize the low back and the pelvis during any kind of movement.

For example, if you performed a chest press with 30 pound in each hand on a bench and then transitioned into doing that on a stability ball, your weight would naturally go down. Why? Because you now have an unstable platform to work from and therefore can not generate as much force.

There are a lot of different hip pathologies that we won’t get into today, but when you have hip pain it typically happens from losing the deep stability of the hip. There are two common muscle imbalances that will exist. One is the TFL(tensor fascia latae) muscle, which is right in the front lateral side of the hip, can get tight, especially with increased sitting. Based on this attachment, it will pull the hip forward, and that will therefore inhibit or shut down the psoas. The other common muscle imbalance is the hamstring muscles, which can get tight for various reasons, inhibiting the glute muscles. The hamstrings can push the femur forward and that also leads us to lose that optimal position on the hip joint. Overtime if we have these muscle imbalances, instead of the hip being centered in the axis, it will start to shift forward and up. This will cause all types of pain issues and pathologies. Whether that’s a labral tear, hip impingement, tendinopathy, bursitis, and so on. So, it is important to get the hip stabilized and centered in the joint in order to decrease pain and ultimately improve function.

You can begin to do this through a four-step process. This is a great way to begin to address your pain, as well as any kind of movement compensation, and most importantly, integrate your foot with your core, in a very integrated manner. First is inhibiting the tissue, in this case we inhibited the TFL muscle that typically pulls the hip joint forward and creates that inhibition of the psoas as a deep stabilizer. Then, mobilize the hip joint to center the hip joint. Remember that when it is not in that center position it’s shifting forward enough so we’re shifting it back to the center position. Next, stabilize it by activating the deep stabilizers, such as our diaphragm, pelvic floor, etc. Then we’re integrating it with the ground. This is super important because the foot is part of the core and they work as an integrated unit. To get those deep stabilizers of the hip firing, short foot, i.e. foot to core sequencing, allows us to do that in a very integrated fashion.

4 Steps

1. Inhibition

For the TFL release, place the ball right on the outside of the hip. When you lie down, you’ll naturally rotate the hip in, which will expose the TFL muscle. With the other leg, anchor it up at a 90-degree angle and come down to your forearms. Holding that position your leg will be nice and long, naturally rotated in, and breathing throughout the exercise trying to relax into it.

2. Mobilization

For the hip mobilization with a band, you’ll place the band high up in the groin. You’ll have it back at a 45-degree angle away from you. You’ll start in a table position rocking forward 15 times, making sure your spine stays nice and long, and you’re breathing. Then rock away from the band, so to the opposite side, once again about 15 times, making sure you’re breathing throughout the exercise.

3. Activation

Now it’s time to activate the deep core, so you can do this by diaphragmatic breathing. Inhale, breathing into the abdomen and into the base of the pelvis allowing the abdomen to expand 360 degrees. Exhaling, letting the abdomen contract and the belly button in towards the spine. Once you feel like you have this established, then on your inhale allow the pelvic floor to relax, so you can exhale and gently lift the pelvic floor about 20% contraction to get a deeper integration. You want to think of this as a rhythmical balance, so nice and fluid. Inhaling to the base of the pelvis and exhaling gently lifting the pelvic floor.

4. Integration

Lastly, it’s time for integration. This is to be done with short foot. Standing on one leg, sitting the hips back, knees slightly bent, taking a breath in, while your foot relaxes then exhale and gently root the tips of the toes into the ground. That will naturally lift the arch and lift the metatarsal heads or ball of the foot.

So whether you have hip pain or hip tightness and are constantly stretching your hips, hopefully, this video will give you a little bit of insight to allow you to think about your hip differently and recognize that it is part of an integrated unit. It is really important to understand how that works as it relates to stabilization and movement

If you’d like to schedule a free 15 minute virtual discovery session, please email drarianne@themovementparadigm.com or text 302-373-2394 to schdule. We’d love to help you get healthy again!

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WHAT IS A HEALTHY PELVIC FLOOR?

Let’s discuss a much-overlooked topic in modern medicine, especially as it relates to rehabilitative medicine…the pelvic floor. Yes, both men and women have a pelvic floor, and both can be compromised and contribute to many different conditions including but not limited to incontinence issues, sexual issues, and chronic pain.

The pelvic floor is essentially the base of our core. It has to be integrated with the rest of the surrounding anatomy. That means the organs, the bowel and bladder, the connective tissue, and the ligamentous tissue all have to be deeply integrated and fine-tuned for everything to work in this rhythmical dance back and forth. It also helps to support our daily functions, prevent urinary and fecal incontinence, improve sexual function, and many other functions that we’ll discuss.

So, what does a well-activated pelvic floor actually do?

1) We are constantly transmitting force through the body. So, a well-activated pelvic floor is going to attribute to the closing force to prevent any leakage of urine, fecal, or gas.

2) Research shows that between 60 to 80% of women with stress urinary incontinence can cure it or significantly improve it with pelvic floor retraining.

3) A well-activated pelvic floor is also going to allow the appropriate relaxation response of the pelvic floor muscles to allow for proper emptying of the bladder and to prevent any post dribble or leakage after you’ve finished urinating.

4) It should also be relaxed enough for proper evacuation of the bowel, but provide enough resistance for optimal defecation.

5) It supports the internal organs such as the vagina, the bowel, and the bladder. Especially as it relates to women and pregnancy, the more intact the pelvic floor musculature is, the less likely there will be a prolapse.

6) It increases the tone which allows for greater sexual awareness, and you need to have a pelvic floor that can relax completely so that you can have more pleasurable pain-free sex.

7) A well-activated pelvic floor will relax and significantly stretch during vaginal delivery.

8) A well-activated pelvic floor will work in coordination with your diaphragm and the rest of the abdominals. This is very important in looking at overall movement and movement efficiency.

In summary, a well-activated pelvic floor is important for so many necessary functions. When it is not functioning well it can contribute to a whole host of problems, one of which, that we see consistently in our office, pain. Chronic pelvic pain, low back pain, hip pain, and even knee pain can all be driven by pelvic floor dysfunction. It’s way more common than you think!  It’s also an area where we tend to hold our emotions. So, I want to point out that as important as it is for the pelvic floor to contract, it is equally important for the pelvic floor to relax. If it is always tight, then we are not able to fully contract and fully relax it, which can contribute to the same issues. That is why it is very important to get evaluated properly. If you are having any type of symptoms that might indicate you have a pelvic floor issue, please contact our office to schedule a pelvic floor examination.

If you need help on your journey to better health, contact drarianne@themovementparadigm.com to schedule.

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How to Understand and Eliminate Low Back Pain (Part 3)

Part Three of a Three Part Series

In the last blog, we talked about how low back pain is managed in the US. Today, we are going to discuss evidence-based and practice-based measures of effective low back treatment. The evidence shows us that there are specific criteria to indicate which treatment is best. 

Why acute low back pain becomes chronic?

As mentioned before in part 1 and part 2 articles of this low back pain series, because most back pain in the US is mismanaged, the time it takes for someone to get the best treatment is prolonged. Imaging is typically unnecessary and prolongs the period of time that you are experiencing pain, which ultimately can contribute to a sense of hopelessness and chronic pain, otherwise known as chronic sensitization of the nervous system.

Once you have acute low back pain, you naturally become fearful of having it again. So, you change your movement, activities, and even thoughts and emotions. Pain is simply information. It is a signal. Are you moving well? Too much? Not enough? Eating highly processed foods? Drinking too much alcohol?

Continue reading “How to Understand and Eliminate Low Back Pain (Part 3)”

How to Understand and Eliminate Low Back Pain

Part One of a Three Part Series

I see back pain on a regular basis, actually closer to a daily basis, and I see everything from acute low back pain, SI joint pain, to chronic low back pain and more. I’m sure that if you’re reading this either you or your closest friend, co-worker, or a family member has had it before. In fact, one in four people experiences back pain in their life.

Continue reading “How to Understand and Eliminate Low Back Pain”