Musculoskeletal pain is often incorrectly treated by primary health practitioners. There is a tendency for too much reliance on pain medication. The current opioid crisis is a direct result of this. Most of the these medications are not supported by the science and are extremely addictive. Part of the problem is a lack of knowledge about how musculoskeletal pain should be managed by both health care providers and patients. The pain research in the rehabilitation community has advanced a great deal over the last 10 years. There is substantial evidence to support physiotherapy for acute and chronic pain.
Thankfully the scope of physiotherapy covers pain management for a diverse number of conditions; from over-use and sports injuries to more chronic lower back and neck pain.
We know from the research that pain is not just caused by tissue damage. Pain can be the result of increased sensitivity locally to the injured area but also the nervous system as a whole. Cognition, emotions, negative beliefs about pain and injury, past experiences of pain, stress and anxiety are all pain drivers. Treatment for pain requires treating the whole person, not just the original area where the pain started.
The research supports treatment techniques that desensitize the pain input. Gradual exercise, manual therapy and graded exposure to painful movements turn down the pain signals when used at the right time. Reassurance and education about pain and healing have also been shown to reduce pain and calm a sensitive nervous system.
Not all injuries are caused by a structural fault. Physiotherapy treatment may involve just modifying a training regime or how you move in every day life. Many times the injured area just needs to be reconditioned or strengthened. A recent sports injury is a perfect example of something that needs to be built back-up again. Inflammation and pain are manageable if we don't over-protect but build a more robust foundation. The best approach is a short period of rest, modifying activity/technique and then building up resilience in the tissues again. Sometimes technique and biomechanics need to be adjusted to stop the area from being over-loaded and painful. Pain can be a result of sensitivity. By reloading the tissues we can desensitize by improving tissue tolerance..
In some situations the pain may have been persistent for more that 3 months. You may have stopped some of your activities or have become guarded with normal movement. You avoid certain movements and the area becomes tense and rigid. Pain then becomes triggered with normal movement as you try to adapt. The area becomes weak and sensitive to normal movements. It creates a vicious circle of maladaptive movement and pain. Persistent lower back pain is an example of this. Treatment should focus on creating normal movement patterns in the spine. Reassurance that your spine is not structurally at fault will also help in your confidence to move. The stabilizing muscles will strengthen when normal spinal movement is restored. Stabilizing/core muscles work with movement, not by protecting the lower back in rigid postures.
We use chronic neck pain as an example here, but the pattern is the same for many other conditions. In our physiotherapy clinic, we see clients who still have painful necks years after a car accident. Their movements are guarded and rigid. They develop muscle imbalances in the neck and upper back. We can see the rigidity in the muscles and the head is held forward. If the injury is more than 3 months old, it is likely that the inflammation and tissue damage is not causing the pain. Patients develop a protective pattern soon after the injury that becomes persistent. Physiotherapy treatment involves desensitizing the painful movements and facilitating the correct muscles. In chronic neck pain the muscles in the front and side of the neck over-work. By strengthening the spinal muscles and upper back the over-worked muscles can relax. We can use soft tissue and joint manual techniques to help desensitize the area. The key is normalizing the muscles patterns, and then building back-up to improve tolerance.