Living Well With Chronic Pain

As this fantastic reflection demonstrates, being more empowered to manage pain and promote better health does not necessarily mean cure. The often elusive search to be “fixed” or even labelled with a diagnosis, can be a surrender of your ability to live well in spite of limitations you experience. We generally see that some improvement in symptoms and/or function is almost always possible; however, it always begins with accepting where you are and working from there. Nothing “works” except to the degree that you work...

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Learning Opportunities

Many thanks to those who came to our seminar series “Understanding and Overcoming Persistent Pain” at the Halifax Library. It was great to help people gain more knowledge about treating and, more importantly, preventing pain. Based on our experience, we know there is a gap in people’s understanding of pain. We wanted to let people know that (1) that they are not alone, (2) that help is available and (3) that it’s possible to regain control over that aspect of life. Our passion stems from helping people who are suffering with persistent pain live more fulfilled lives. Education, movement, and exercise are key to achieving this. We are firm believers that knowledge is power and it is the first step in gaining freedom from persistent pain. We were very pleased with the turnout for the last series of workshops and recognize that people want help managing their pain or a loved one’s pain. Here are some upcoming opportunities to learn more: April 27th at One to One Wellness: “Health Empowerment: 4 Steps for Shifting From Pain to Performance” June Seminar Series at the Halifax Library: “Strengthen Your Health” Monday, June 5, 7:00pm:  Expressing Authentic Movement Monday, June 12, 7:00pm:  Strength Training for Managing Chronic Conditions Monday, June 19, 7:00pm:  What the Foot: A Game-Changing Philosophy of Human Movement Monday, June 26, 7:00pm: From Pain to Performance  We will explore different wellness principles and how putting all the pieces together helps to not only overcome pain, but to optimize performance as well. Please come along and bring a friend. If you have any questions in the meantime, feel free to...

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Technology may be hurting your kids

My inspiration for this blog article comes from a recent visit I had this weekend at my sister in-law’s house. They are dealing with an issue that many North American families have to deal with….kids that spend way too much time using electronic devices. She was upset because on a sunny day, her son spent 6 straight hours playing X-box. In addition to that, he spent time on the computer on MSN, Youtube, Facebook, and numerous other websites. Don’t forget television as well. This trend is growing at a ridiculous rate, and as a physiotherapist I get to see the physical effects. RSI, or Repetitive Strain Injury, is a collective term for syndromes characterized by discomfort, impairment and loss of muscle strength and function. RSI often affects the neck, the back and particularly the arms and hands. It is found primarily in adults who perform repeated movements such as those involved in typing or playing musical instruments. It is commonly named according to the part of the body affected, e.g. tennis elbow, carpal tunnel syndrome, golfer’s elbow. We are starting to see RSI turn up in younger and younger patients which is rather alarming. In addition to computers and gaming devices, there has been a substantial increase in the amount of time teenagers spend on their cellular phones sending text messages, thereby potentially affecting the prevalence of RSI in this group (2). The increased frequency of texting is leading to a condition popularly termed “Blackberry Thumb”, or “teen texting tendonitis”. This occurs because these devices rely almost solely on the use of your thumbs (not all of your fingers) for typing. Any device that relies on the thumbs for typing can cause this type of injury because the thumbs simply weren’t designed for such use (1,3). Repetitive mechanical loading of the thumb, combined with inactivity, and prolonged slouched postures resulting in increased neural tension results in increased risk of developing RSI. Symptoms of “Blackberry thumb” include pain and numbness in the thumbs and joints of the hand (1). But there are also other bodily symptoms: Pain and numbness at the base of the thumb Tingling and numbness in hand, including joints Pain in elbow Shoulder, neck pain during computer use Tired, achy fingers and cramping It is estimated that teenagers sending and receiving an average of 80 text messages each day may be vulnerable to repetitive stress injuries of the thumb (4). If you think this is a high number and unlikely, consider these statistics: About 75 percent of 12-17 year-olds in America now own a cell phone (4). Half of those teenagers send 50 or more text messages a day (4). One-third of teens send more than 100 text messages daily (4). If you think my sister in-law’s son is a minority, then guess again. Here is another interesting statistic: Americans between ages 8 and 18 spend an...

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Mysterious knee pain and/or swelling?

Without any thorough examination, you may have been given the diagnosis of osteoarthritis and be expected to just live with it. However, you may be experiencing Saphenous Nerve Entrapment. Saphenous nerve entrapment is a frequently overlooked cause of persistent medial (inner) knee pain. I chose to write about it because I saw 2 cases of random knee pain and swelling recently. Nerve entrapment is often the cause of pain when you cannot recall a mechanism of injury. This condition can result from low grade irritation over a long period of time from sustained postures or repetitive activities, or perhaps resulting from guarding mechanisms that never fully resolved from a previous injury. Symptoms can be episodic (come and go), may come on randomly, and may resolve randomly as well. The saphenous nerve is the longest branch of the femoral nerve. It travels from the groin, down the front of the inner thigh, past the inner knee, and into the inner lower leg. Because of its long course, it can become entrapped in multiple locations from the thigh to the lower leg. The saphenous nerve is often entrapped by connective tissues where it pierces the muscles of the inner thigh, or where it takes a sharp turn at the inner knee. The nerve can also be injured as a result of an improperly protected knee during surgeries or activity that puts pressure on the nerve (kneeling). It is a pure sensory nerve, meaning it is responsible for sensation and not muscle contraction. As this is a purely sensory nerve, weakness should not be noted with an isolated injury or entrapment of this nerve. Some mild weakness may be present because of guarding from pain, but no significant direct weakness will result from the nerve impingement. Symptoms of entrapment: may include swelling of the knee, a deep aching sensation in the thigh, knee pain, tenderness along the nerve pathway, and altered sensation in the knee and lower leg such as numbness, tingling, pins and needles, reduced sensitivity to heat or cold, reduced vibration sense, and dullness to touch. The main diagnostic features of this condition are altered sensation (vibration sense is usually the first to be affected), and reproduction of symptoms during a femoral/saphenous nerve neurodynamic test. Other diagnoses given for this condition may be arthritis, bursitis, patella femoral pain syndrome, or chondromalacia patella. Treatment to resolve this issue may be as simple as learning to do some gentle nerve gliding exercises. Effective treatment may also involve soft tissue release (via massage or physio); and gentle manual mobilization techniques that reduce mechanical forces on the nerve, improve nerve mobility, reduce muscle guarding, and restore blood flow to the affected nerve. It may not be arthritis, and you may not have to just live with...

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Chair Ergonomics

In industrialized countries, many people sit for most of the time that they are awake. They sit while having breakfast, while going to work in cars or buses, in school classrooms, in meetings, in offices, during dinner, and at home while watching television. Many people also sit at work operating machines which new technology has developed to replace manual work. Although sitting requires less physical effort than standing or walking, it puts a lot of stress on lumbar area. Combined effects of a sedentary lifestyle, and a job that requires sitting can lead to many health problems. The selection of a suitable chair is a critical step in preventing health problems in people who work in a sitting position. However, you do not have to spend a lot of money to find a proper ergonomic chair. A good ergonomic chair will have basic adjustability features. The features that should be considered include: Seat height adjustability: Adjustability is a must – feet should rest comfortably on the floor without pressure on the back of the thighs. When seated, your hips should be slightly higher than your knees. To achieve proper height with respect to your desk or keyboard tray height, you may need a foot rest. Seat depth adjustability: The depth of the seat is important in order to reduce pressure on the back of your thighs or calves. If the seat puts pressure on the back of the knee, or mid posterior thigh, this will reduce circulation and cause a pooling of blood in the extremities. This can lead to varicose veins, painful conditions, and also blood pressure issues over time. Proper seat depth will allow for a 2-3 finger width distance from the back of the knee to the edge of the chair. Armrests (height adjustable): To reduce strain on your neck and upper extremities, your armrest height should be as follows: with the arm relaxed and bent while seated, the arm rest should be a 2 finger width higher than the bottom of the bent elbow. Armrests set too high will cause compression of your thoracic outlet. Armrests set too low will cause traction on your neck. The length of the armrests may need to be considered as well so they do not prevent you from pulling in close to your desk or keyboard tray. Armrests set approximately 15cm back from the edge of the chair should be adequate. Back rest height: A mid back or high back chair offers more support and will reduce lumbar strain. A low back chair is not recommended if you spend a fair amount of time sitting. Regarding shape of the back rest, do not get hung up on molded forms and fancy adjustable parts. The most important factor in reducing back discomfort while sitting is the ability to move around frequently. A chair should not lock you into a position...

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How to know when I need some help

How to know when I need some help for my pain: We trip, hurt our knee.  Twist a little too far, your back spasms.  That ache in your elbow that used to only be a problem when playing tennis is now bothering you at work and even just reading a book.  Checking my blind spot is nearly impossible now without turning my whole body.     When is it ok to just let things heal in their own time and when do you need to get a professional opinion? The best way to approach this questions is knowing what “acute” versus “chronic” means.  Acute injury symptoms are what the body presents in the first 24-48 hours on the initial onset of pain (ranging from pain that can be dull or sharp, redness, swelling, bruising, difficulty moving the affected area, pain-related weakness, avoidance of activity through protective movement mechanisms).  Chronic pain is when pain continues well after healing should be complete (3-6 weeks) with similar as well as very different symptoms (less swelling, more dull instead of sharp but perhaps increased pain even a rest, better movement range but perhaps still decreased, weakness in affected and perhaps increased locations, and protective movements can increase creating other areas that become sore). Chronic pain is much more complicated to resolve. When we get injured, you should remember the rule of “FIDA”, for Frequency, Intensity, and Duration, Activity.  If you tripped, twisted your ankle, and immediately have pain, or maybe not much pain until the next day (when your body has had some time to begin the inflammatory response).  Pain could be very severe, even at rest, range of motion extremely decreased, and it could hurt just to have your foot on the floor.  The normal healing process should see incremental improvements of frequency (how often it hurts as well as how large of an area affected), intensity (how much it hurts), duration (does it recovery quicker with a movement that normally bothers it) and activity (are you starting to go back more normal activity levels and actions required of daily living).    My general rule is that if all of these FIDA areas are not incrementally improving within a week, I would get a professional to look at them to make sure that you are doing the right things, avoiding the wrong thing, and that things are not more serious that your originally thought. With an injury, there are three stages to recovery. 1. Avoid further injury.. Action: avoid repeating the same thing again, cease current movement, make the “danger” stop. Protect the area.  Action: Move only so as to not continue to hurt yourself, whatever compensations required, take medication if required, heat or ice, rest further. Healed, move on. Action: realize enough time has passed to be out of danger, get back to normal movement and pain free life. Sometimes there was no specific...

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