| .
Contents . . . . . . . . .
|
Pain
Lessons: Learning to Heal by Ellie O'Steen, LMT Pain
Management Can you see better now that .....pain does not have to be eliminated but managed in order to have a more quality lifestyle? Since
we've started this Pain Management Study........ Have
any of you started your "Joy Box" or Balcony People files? Question: Well, HOW? By retraining! Refresh your memory of Dr. Paul Brand's quote: "Pain not only teaches us what to avoid but also hints to the positive qualities the body needs." Such as..... rest , relaxation, decreased stress response, exercise, personal emotional/physical/spiritual growth, re-creation, fun! Would we even question that our children need the above? I doubt it! So, why shouldn't we consider that WE need these too? I hear some of you asking, "Why?" Because.......... Body tissues improve with activity and atrophy with dis-use. Principle: Use it or lose it! Many of you have probably been through physical therapy treatments. Some of you may have been uncomfortable during the weeks of those sessions. You were probably given instruction in strengthening exercise which, may have increased your pain and stiffness. As in any program, there will be times of discomfort BUT it should not be such that you're set back for days or a week!! One of the most helpful modalities in coping with many chronic pain conditions i.e. arthritis and/or fibromyalgia is gentle, frequent stretching. In anytype of chronic pain condition, immobility sets you up for the possiblity of developing trigger points in those weak muscles. Trigger points are areas of hyperirritability in skeletal muscle or muscle fascia, that are painful on compression and cause referred pain (pain felt somewhere other than the area of pressure). There are chacteristic specific referral patterns that are associated with active trigger points. Thanks to the complex and wonderful work of Dr. Janet Travell and Dr. David Simons, those who work with chronic pain patients can effectively map these trigger points (TrPs) and gather an idea of which muscles to stretch or strengthen to de-activate them. Drs. Travell and Simons published two volumes of trigger point patterns in their works Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins, 1992. Trigger points set up an area of metabolic discomfort which is lacking in proper energy nutrients. STRETCHING properly and frequently decreases the contracture of the tissue, decreases the over-utilization of energy nutrients as well as normalizing the sensitizing chemicals which make the area more hyper-irritable. In many chronic pain conditions there is weakness and fatigue. Travell suggests that this may be because the muscle lacks proper circulation. Sometimes these trigger point patterns may mimicother conditions and must be ruled out by experienced professionals aware of differential diagnosis origins. Too often the person's pain complaint is grouped into a catch-all "arthritic condition" when it may very well be a referral from an active trigger point which may respond to specific release techniques. The problem here is that too often the wrong diagnosis may cause the person to limit their activity. It may cause them to ingest many medications that were not needed. I have seen it cause persons to have unnecessary surgeries i.e. knee surgery, back surgery due to a buckling knee or trigger points in a deep low back muscle. There are trigger points in the quadriceps muscles of the front thigh that , when active, cause knee pain over the kneecap and can cause the muscles to 'shut down' and the knee buckles. My mother suffered from this condition. She did not respond to cortisone injections which eased her pain somewhat but her knee still buckled on her the next day! This can be a fearful incident to an elderly person . We taught her to stretch the quadriceps as well as do pressure point massage over the extremely tender trigger points. In a week her range of motion increased 20 degrees plus she had not had any 'buckling knee' episodes thereafter. Of course, she continues her stretching daily as well as monitoring those pesky trigger points! For now, we are going to concentrate on self-help techniques such as stretching and range of motion (ROM) exercises. In ANY stretching exercise, it is most profitable for you to concentrate on a slow, steadyily increasing stretch. DO NOT BOUNCE!!!!!! If your pain condition causes muscle and/or joint stiffness, you will find that frequent stretching can greatly lower your pain levels after awhile, give you a little extra energy for your day (especially those late-afternoon/early evening tasks), and keep you flexible. "Frequent" , according to Dr. Janet Travell, is hourly. But, considering that you can do some 'total body' stretches in less than 5 minutes, that's really not that bad. Set your timer when you're home and are easily involved with tasks so as to remind yourself that it's time to take a stretch-break! We want to HOLD a stretch position for 10-30 seconds initially. DO NOT HOLD YOUR BREATH while performing the stretch!!!! Will you consider not even getting out of bed until you've done some good stretching? Your muscles are stiff, the joints stiff and, to ask them to do the work of keeping you in an upright position before they're even warmed up is like starting up your car on a cold, snowy day and just driving off without warming up the engine !! It's just not a good practice if you want your 'equipment' in the best condition. Even those of us in the deep south know to warm up our car engines on those infrequent cold, chilly morning. Personally, I like to start my morning stretches with gentle knee-to-chest stretches. If you're not one to easily wake up, your might start with some ankle rotations for a minute or two until you feel ready to move and think more clearly. We will list the stretches with instructions at the end of this study so that you can print them out and have them for handy reference. REMEMBER: Gently and Frequently!!! Another aspect of our RETRAINING program is that of exercise. Let's look at the... PHYSICAL ATTRIBUTES OF: E X E R C I S E 1.
BONES need exercise to build stronger, prevent osteoporosis and keep the
proper balance of calcium. This is the "restoration" stage which we defined in the very beginning. According to Taber's Medical Dictionary 'cure' is defined as "a restoration to health and sound conditioning." And so we want to continue on the pathway of restoring our health in mind and body. This will take re-training because we have left some of our 'old self' behind after our injury or illness. Again, Taber's is consulted for the term "train". This may be defined as "to p a r t i c i p a t e in a special program of instruction in order to attain competence in a certain occupation or profession." Welllll, we're in the occupation of LIVING! Let's take the word R E T R A I N and make an acromyn from it.... R
rest and relaxation (within limits!) If you have come this far in the Pain Management Study, you have already begun your re-training in your thought patterns, analytical skills of endurance, learning to change some of your eating patterns, and beginning to move and activate your body ! Rest and relaxation are obvious in that we rest the body and mind and that our relaxation LESSENS our tension or activity. This can be through reading a book, playing/talking with our child, a friend, a spouse, watching some TV, watching sports, etc. Education may be considered like taking this Study or reading up on your individual condition from excellent resources i.e. the Internet or books. Therapeutic Muscle Training is in the area of stretching and exercise. Response to Stress I would list in the category of biofeedback training, various meditation techniques i.e. yoga, relaxation tapes (also available at the library!), listening to soothing music and training your body to let go of the stress/pain. Find what works for you and make it a habit! I found numerous tapes at my library, tried them and then decided on two which I purchased at a bookstore. Analgesics - Your physician will choose what he/she thinks best for your condition. Use them as directed and don't abuse them for the sake of "getting rid" of your pain!! Injections - Trigger point injections can help ease some of those troublesome areas if the practitioner is trained and experienced in giving these injections per Dr. Travell's manuals. Check out the various organizations i.e. AMA, American Chronic Pain Association, etc. for medical personnel trained in these areas. Never Give Up Hope and Trying! - You may be greatly surprised at the vast plethora of knowledge in your community. I believe that my search for answers and coping mechanisms took a big turnaround when I met a Physical Therapist with knowledge of the body's healing mechanisms as well as ways to help it heal. Through his expertise I learned about stretching, proper exercise and its importance, "disconnecting the pain", and that the world of therapy and learning to help myself was right at my fingertips! Sure, I had to learn to 'live with it' as my orthopedics had told me but this therapist gave me the knowledge and tools of how to live with it!! {Thank you, Mark!} This has been our goal through this Pain Management Study and we hope that it has been successful for you. To follow.......... Stretching and Exercises |
