Compiled by our Masters trained Physiotherapist Chris Smith. To book an appointment with Chris, or read his Meet the Team profile CLICK HERE.
In a previous blog we explained why things hurt and how the bodies' pain system works. In this blog we will explain what persistent pain is, how common it is and why our pain systems sometimes still remain active when our injuries may have healed.
As humans it makes sense to have a pain system as an alarm to warn us when we have injured our body. The pain signals us to change our behaviour and rest in order to allow our injuries to heal. Most soft tissues within the body including muscle, ligament, tendon and bone will heal in approximately 12 weeks, and therefore you would expect that as the injured tissue heals the corresponding pain signal we experience reduces in intensity to advise you to increase what you do without coming to further harm. The trouble is this doesn’t always happen!
Infact, up to 25% of people's pain still remains once the healing should have occured. Pain that does not settle in 3 months is termed chronic or persistent pain. To understand why this occurs we need to know a little more about our bodies pain systems. Electrical signals picked up in the injured tissue by pain cells (nociceptors) are passed into the spinal cord and then up to the brain for processing. Pain science has shown us that within the spinal cord and brain 2 types of sensitisation can occur which can amplify and prolong our pain experience.
These are called peripheral and central sensitisation.
Peripheral sensitisation means increased pain sensitivity to movement or pressure in the area where the injury occurred. The injured area becomes sensitive to movement and touch that would usually be non-painful. This is a normal response and helpful following an injury. However, the longer your nervous system produces pain, the better it gets at producing it. Your body learns pain! This process is called central sensitisation and occurs in the central nervous system (brain and spinal cord). Think of a sensitive car alarm going off with a strong gust of wind. The gust of wind (movement) is not dangerous anymore, but the car alarm (brain) is too sensitive. This type of sensitisation can keep driving pain long after the initial tissue healing has occurred and can go on for months and even years.
Scientists think that both genes and environment play a role in explaining why some patients develop central sensitisation and persistent pain and some do not. It is likely that the way humans perceive and make sense of their pain experience may lead to persistent pain. Our pain centres are in our brain and the brain also processes our thoughts and feelings. Stress, worries, fears and beliefs about the pain may all lead to prolonged pain. The pain can also have a wider impact on our lifestyle, jobs, relationships and hobbies, all of which can create worry, depression and frustration. These feelings can actually keep the pain system sensitised in the brain. It is well known for persistent low back pain for example that low mood, anxiety and depression and worries of long-term disability are associated with developing persistent pain.
Firstly, if your pain has gone on for more than 3 months it is likely that some degree of central sensitisation may be occurring. There are some other signs also. If pain becomes more widespread and if it can be affected by lifestyle stressors easily then you may have central sensitisation. Also, if you’ve become more sensitive to stimuli that impact the nervous system. These may include movement, exercise, noise or light.
When managing persistent pain everyone's individual situation is different and will require a tailored approach. As physiotherapists we need to look at things more broadly in addition to specifically at the original injured area. Through asking further questions about lifestyle such as sleep, stress, beliefs, fears and general health we are likely to be able to suggest techniques to help calm down the pain. Techniques such as graded exercise, sleep hygiene, relaxation, meditation and mindfulness are essential to promote a calm environment for the pain to settle.
In addition it is important for patients to have a basic understanding of how pain works because once you understand why your pain remains and how common it is it can instantly make it less scary, worrying and reduce anxiety around the issue. The more you understand, the more empowered you feel to manage the pain.
As physiotherapists with holistic knowledge of pain science, psychology and physical activity and lifestyle we are well placed to treat people with persistent pain, Therefore, if you’re struggling with a persistent pain problem come in to see me or a member of our team for an assessment to see how we can help you move forwards.
Our Ask A Physio series is a collection of micro blogs aimed at giving a basic understanding to some frequently asked questions. If you have an injury or are experiencing discomfort please book for an assessment, or contact reception for more information.
There’s lots of different types of tape, ranging from the super rigid brown sports tape through to paper thin and colourful “K-tape”. The common idea is to try to make an area more stable, or at least to give the area a bit more feedback and control. We used to think that tape holds an area in place, but what we know now is that the real effect is with position sense; helping you know where your joints and muscle are sitting.
I’ve seen plenty of physiotherapists advise to leave tape on for a couple of days, but I wouldn’t recommend anything more than 6 hours. If you sweat into the tape then let it dry, it turns into a kind of smelly paper mache, and it will take a few layers of skin off when you try to remove it. If you’re repeatedly taping for more than a few days make sure you wash your skin in between, let it dry thoroughly and check for any irritation.
Our Ask A Physio series is a collection of micro blogs aimed at giving a basic understanding to some frequently asked questions. If you have an injury or are experiencing discomfort please book for an assessment, or contact reception for more information.
Is RICE still a thing?? Absolutely! If we remember from health class, RICE stands for Rest, Ice, Compress and Elevate for 72 hours.
In most cases rest means relative rest, not completely stopping everything. Unless you’ve fractured, dislocated or otherwise seriously injured something, keeping on with gentle exercise will help settle early inflammation.
Ice is actually a topic which gets us arguing about whether it's appropriate or not. My simple rule of thumb is if the injury is hot (throbbing, red, swelling), then ice it down for 20 minutes. You can do this 2-3 times a day, but going over the top with ice for a week or more can actually slow your healing down.
Compression should be flexible and comfortable, and shouldn’t be a super rigid brace or splint early on. There is a tendency for injuries to stiffen up quite quickly in the first week, and stopping gentle movement can make this much worse. Again, the obvious exception would be a fracture, dislocation or something else really serious.
Elevation is pretty self explanatory, and probably isn’t as important as the other things you’ll do. It's most useful for ankle and knee injuries, just keep your leg up while you’re icing it to help with draining out any swelling.
Then book in to see a physio and we can get a plan happening so you'll be back to doing what you love!
Compiled by our Masters trained Physiotherapist Chris Smith. To book an appointment with Chris, or read his Meet the Team profile CLICK HERE.
Headaches can be complicated! They can span from mild to debilitating and have a range of potential causes making them tricky to manage for patients and healthcare professionals. A physiotherapist's role in headache is to differentiate the likely cause of headache through thorough questioning and examination, and then refer to the correct health professional or attempt to treat the headaches if appropriate. So let's look at some types of headache first.
Broadly speaking headaches can be classified as primary and secondary headaches. Primary headaches are not caused by another disease process or condition and occur within the brain itself. The most common form of this is migraine, tension headache or headache from a cold or excess alcohol. Secondary headaches however develop as a secondary symptom to an underlying condition or anatomical structure. Examples of this include infection, head injury and tumor. As can be seen these types of headache may need immediate management and onward referral. Cervicogenic headache referred from the upper cervical spine (neck) is also a type of secondary headache.
Tension-type headache - The most common type of primary headache and affects more that 40% of the population worldwide. It is characterised by mild to moderate pressure on both sides of the head without any other symptoms. It is usually located around the temples It is currently proposed that pain receptors in the muscles around the skull may be responsible for this type of headache.The pain with tension type headache tends to be pretty steady and chronic despite changes in activity
Migraine - Another common form of primary headache. Additional features in migraine are the inclusion of symptoms such as nausea, photophobia (sensitivity to light), and phonophobia (sensitivity to sound). Migraines are more commonly one sided. Change in physical activity often aggravates migraine headache. Migraines can also cause symptoms of Aura which includes visual, sensory, or speech symptoms that appear gradually, last no longer than 60 minutes, and are completely reversible.
Cervicogenic headache - The upper cervical spine (neck C1-3) shares common nerve structures to other parts of the brain and can refer pain into the head causing secondary headaches. This basically confuses the brain into thinking that the pain is coming from the head rather than the neck. These can follow episodes of head trauma or whiplash or start insidiously following periods of intense computer work. They are more commonly one sided and often associated with neck stiffness/pain, restricted neck movement and reproduction of pain/headache when therapists examine the neck.
There are also various muscles around the head and neck which have the potential to refer pain into the head to be perceived as headaches.
Trigger point referral patterns from Upper fibres of trapezius and sternocleidomastoid.
If the neck joints of muscles are thought to be responsible for a headache then treatment of these structures with manual therapy and exercise may help in the management of reducing cervicogenic headache. In relation to cervicogenic headaches research has demonstrated that physiotherapy for 6 weeks comprising both exercise and manual therapy in addition to a combined approach of the 2 interventions can significantly reduce headache frequency, intensity and neck pain 6 weeks of treatment. We also have clinicians trained in the Watson Headache technique in order to assess the upper neck and treat with manual therapy. So if a headache is bothering you come and see one of the physiotherapists trained in headaches to see if we can help.
The shoulder is a pretty remarkable piece of kit; it’s by far the most flexible joint in our body, capable of loading up in an almost infinite combination of movements. It’s also the fastest; a good thrower can make it turn at an acceleration of 6000-7000 degrees per second! All this performance doesn’t come without a few issues though, and shoulder injuries are some of the most common reasons people come to our clinic.
The most common pattern we see is called rotator cuff related pain, sometimes also called bursitis, impingement, subacromial syndrome or any combination of those. This is generally from a big spike in how much you’ve been using your shoulder. Think push up challenges during the COVID lockdowns, heavy loads of laundry, or doing lots of throwing after time off over winter. It’s a soft tissue injury, irritation or damage to the big 4 muscles which rotate your shoulder, and the network of other tissues around them.
Most of the time, this is pretty simple to manage. Early on, basic range of motion, grip strength and gentle loading exercises help to keep things steady. This is also where you might consider some pain relief, heat packs and making sure you’re getting plenty of good quality sleep and food.
*Example movement exercises courtesy of Physiotec - the program we use to provide patients with their individualised exercise programs.
If you find that after 5-7 days of this, the pain is sticking around and you’re still a bit weak or stiff, a good physiotherapist can point you in the right direction with more specific exercises targeted at your specific issues. If this sounds like you, you shouldn’t be worried at all. These injuries can be a bit stubborn and take a few months to settle completely, but it’s rare for them to stick around beyond that.
More serious shoulder injuries can be spotted by pain levels, strength levels and by big, fast, high impact stories. Normal rotator cuff pain will settle with rest, basic pain relief and heat. If you find that isn’t that case and your pain is throbbing when you’re at rest or trying to sleep, it’s a good idea to get checked out. If you get really weak after your injury, with or without pain, then that can also be a sign of some more substantial soft tissue damage. It’s actually not uncommon for more serious rotator cuff injuries to be pretty much pain free early on. If you can’t lift your shoulder above rib height in the first 48 hours, and you can’t support the weight of your own arm, that’s another reason to come in ASAP for some more tests.
Lastly, if you got injured by something big, heavy and/or fast, then there’s a higher chance of something serious happening. This is particularly true if you felt the joint “pop” in or out, or if you felt something move in the joint. You don’t necessarily need surgery if this is the case, but catching big injuries early on gives us a much better chance of getting you a good outcome.
The bottom line is to keep moving, do your basic rest and pain relief early on, and if there’s anything stubborn or suspicious from what I’ve mentioned above, then come in for a check up.
Sexual Pain (dyspareunia) can affect up to 75% of women at some stage in their life according to the American College of Obstetricians and Gynaecologists. At any given time, 7.5% of the female population are having painful intercourse. This may occur from an individual's first sexual experience or may develop at different stages throughout their life. It can occur in heterosexual and homosexual relationships. Understandably, it can have a significant effect on an individual's ability to engage in intercourse. Women report avoiding sexual activity, losing their desire to engage, struggling with arousal, enjoyment and climax. This can cause strain on relationships and further psychology stress, worry and negative body image.
- Pain with vaginal examinations/smear test
- Pain with tampon usage
- Bladder urgency/frequency or night time toileting
- Urinary incontinence
- Difficulty urinating
- Constipation or urgency to pass a bowel motion
- Pain with masturbation or foreplay
- Lower back/pelvic pain
- Pain sitting on a bike/horse riding
Its role is:
- To hold your urine/faeces/wind
- To let go of your urine/faeces/wind
- To support your pelvic organs
- To support your back and abdomen
- Allow for penetration
- Allow for orgasm
Generally, women who present to physiotherapy with the above complaints may have an overactive/uncoordinated pelvic floor. This is when the pelvic floor muscles have tightened or do not have enough length. This is how the body involuntarily tries to protect itself from pain.
- Lactation
- Menopause
- Child birth
- History of infection eg. UTIs, thrush, STIs
- Vulvodynia/vestibulodynia
- Vaginismus
- Skin conditions eg. Lichen schlerosis
- Excessive high intensity exercise
- Pelvic organ prolapse
- Psychological conditions eg. Anxiety/depression
- Chronic Pelvic Pain eg. Endometriosis/IBS/PCOS/adenomyosis/fibromyalgia
- Previous surgeries including C-Section and laproscopic
- Lower back/coccyx or hip pain/injuries
- A history of trauma or pain
- Neuralgia
There are two main types of sexual pain: deep and superficial. However, some individuals can have both and fluctuations between symptoms. Pain can occur prior to or during penetration, throughout intercourse or afterwards. It can even persist for up to 3 days. It can be sharp, burning, achy, tight or cutting in nature.
Sexual activity is an emotional, psychological and physical experience. Pelvic Health Physiotherapy can help you identify some of the primary causes and secondary complications of sexual pain.
- Pelvis/pelvic floor awareness education
- Lubrication advice
- Desensitisation/electrical stimulation therapies
- Toileting advice
- Bladder retraining
- Biofeedback
- Dilator therapy
- Myofascial release
- Scar massage
- Pelvic floor relaxation
- Mindfulness
As Pelvic Health Physiotherapists we work alongside Psychologists, Gynaecologists, GPs, Sexual Health Doctors and Sex Therapists.
Here at Auckland Physiotherapy, we have a Real-Time Ultrasound machine which can be used as an assessment tool as well as an adjunct in your therapy.
Prior to seeing your physiotherapist, we recommend you see your GP to rule out any potential pathology that may be causing your pain.
Patients are entitled to see their physiotherapist individually or you may bring a support person/partner with you if you wish.
Our Ask A Physio series is a collection of micro blogs aimed at giving a basic understanding to some frequently asked questions. If you have an injury or are experiencing discomfort please book for an assessment, or contact reception for more information.
Ideally ASAP! A bit like an issue with your car or house, the sooner we can get you doing the right things, the better chance we have of getting you back to normal sooner. Particularly when it comes to sport and exercise, we’ve got good research showing that the first 72 hours can make your recovery a lot faster or slower.
If it’s an injury or issue you’re really familiar with from previous experience, then you’ll already know the routine for the first week. In that situation I usually tell people to manage it how they’d manage a stomach bug; do what you know for the first 48 hours. If you’re not getting anywhere doing what you know, then check in with us.
If in doubt you can always book for a free 15min phone consult with one of our Physiotherapist!
Compiled by our Masters trained Physiotherapist Chris Smith. To book an appointment with Chris, or read his Meet the Team profile CLICK HERE.
Fibromyalgia is a condition characterised by widespread pain in the muscles and connective tissues for 3 months or more. It is defined as a syndrome due to the collection of symptoms rather than a disease, as there is currently no identifiable cause within the medical field.
It often runs in families and people with Rheumatoid arthritis, lupus and Ankylosing spondylitis are more likely to develop it. However, it is not a condition of the joints or an inflammatory condition. There are many hypotheses for why it may develop, although none of these have been proven and accepted yet. For example psychological trauma or prolonged stress may affect how the body's pain signals react, potentially leading to a sensitised pain system. Another suggestion is a widespread and chronic raised inflammatory response in the body.
As many as 1 in 50 people may develop fibromyalgia at some stage in their life and it is most common between ages 25-55. It affects 9 women for every 1 man, but it can also affect children.
- Widespread pain and stiffness: heightened sensitivity to touch/pressure, common trigger points include neck, shoulders, chest, hips, & knees.
- Fatigue, insomnia and poor sleep.
- Difficulty with concentration (Fibro fog)
- Changes in mood, anxiety and depression.
- Gastrointestinal problems.
How is it diagnosed?
There is no gold standard for fibromyalgia diagnosis. Various criteria have been suggested over the years since 1990, however the most recent were updated in 2016. These include:
- (1) Generalized pain, defined as pain in at least 4 of 5 body regions, is present.
- (2) Symptoms have been present at a similar level for at least 3 months.
- (3) Widespread pain index and symptom severity scales. These are outcome tools that clinicians used to measure pain location and severity.
What are the management options?
There is no cure for fibromyalgia. Management should be aimed at relieving symptoms and improving function. Everyone's symptoms will be different, therefore treatment approaches will need to be individualised. However, they are likely to include both medical and self-care approaches.
Medication may be useful, but active approaches to relieving stress including mindfulness, meditation, yoga and psychological support may be helpful. Reducing stress triggers in your life may also be beneficial, rather than merely managing stress when it occurs. Graded exposure to exercise is also recommended. In addition to this, looking at lifestyle and sleep hygiene may be important as one of the major symptoms is sleep disturbance and fatigue. A recent study from 2017 demonstrated that the agreed treatments between international expert groups on the topic were exercise, cognitive behavioural therapy, and certain antidepressant drugs such as amitriptyline.
As physiotherapists with expertise in persistent pain, we are well placed to support and educate fibromyalgia patients about their condition in addition to producing an individualized exercise and rehab program that may be beneficial. Our training also provides us with a good knowledge of the impact your psychological system can have on any pain condition. If we feel you need more expert talking therapies as part of your management we can signpost to the correct psychology services.
So if you think or know of anyone with fibromyalgia come in and see one of us to see how we may be able to help you.
Our Ask A Physio series is a collection of micro blogs aimed at giving a basic understanding to some frequently asked questions. If you have an injury or are experiencing discomfort please book for an assessment, or contact reception for more information.
Strapping and bracing both set out to achieve similar things, making a joint or area more stable after an injury.
Strapping is an inexpensive, quick and easy way to support a joint. It is generally not too bulky and doesn’t restrict movement too much, which is why you’ll be familiar with strapping if you’ve ever played or watched competitive sport. The main downside with strapping is that it's temporary, you really shouldn’t leave it on for more than 6 hours. It can be really tough on your skin if you let it get wet/sweaty and leave it on for too long. Also, recent research has shown that strapping might not actually make a joint much more stable, more that it compresses things and makes you feel more stable.
Bracing is generally a lot more substantial, and can be quite expensive if you’re after a properly fitted custom unit. You can leave bracing on basically forever, and a good brace can be used every day without wearing out. Unlike strapping, bracing is pretty bulky, and can most definitely make a joint more stable. We often turn to a brace when people have an issue which will stay with them for a long time. A poorly fitted or incorrect brace can make your issue worse, so it’s a good idea to check in with a physiotherapist before you invest.
Compiled by our Masters trained Physiotherapist Chris Smith. To book an appointment with Chris, or read his Meet the Team profile CLICK HERE.
Today we're going to talk about pain! Although most of us don't like the sensation, pain plays a vital role in protecting us and is necessary for our survival. Pain is a universal human experience and is defined as "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage" (IASP). But what can the type of pain tell us? Can it help us to identify which tissues are causing the pain and can it guide how we target treatment? Well yes and no, it can certainly give us some clues, hence why physiotherapists spend time in your initial assessment asking so much about pain.
Before we start, pain is a complex topic and the world's leading researchers are still learning more every year. Most tissues in the human body including ligament, muscle, tendon, bone, and nerve all have the ability to produce pain. The 3 main stimuli that produce pain are mechanical, thermal and chemical. For example when you overstretch and roll your ankle (mechanical stimuli), when you burn your hand (thermal) stimuli.
When a tissue is damaged, such as when a ligament is strained, sensory pain receptors (nocioreceptors) in that tissue start a process and send signals into your central nervous system, where it travels up your spinal cord to your brain. Here the decision is made how much of a pain experience to produce in the injured tissue based on many factors such as past experience, beliefs etc. This process is called nocioception.
This is usually a good thing as a pain response prompts us to change our behaviour and allows for rest and recuperation of damaged tissue.
Broadly speaking pain can be classified into nociceptive pain, neuropathic pain and other pain, such as visceral pain from organs.
This is the term for pain arising from various kinds of injury in the tissues, reported to the brain by the nervous system. This is the most common type of pain most people are most aware of - anything from stubbing your toe, straining your back or burning your hand.
This can be split further into mechanical and inflammatory pain. These types of pain can present differently and the characteristics can help in differentiating the painful tissues. For example low back pain that is present with a certain movement, but absent otherwise indicates that the low back tissues are responsible for the pain. Also, knee pain which is present only when loading the joint during walking may lead a clinician to diagnose a joint based condition such as osteoarthritis.
However, pain that is more constant in nature may have an inflammatory component. This is quite normal following a tissue injury as there is a natural inflammatory process in order to promote tissue healing. However, when constant pain starts without a tissue injury it may be that an inflammatory condition is primarily responsible for the pain. Examples of this would be rheumatoid arthritis or gout.
This arises from damage to the actual nervous system itself. This could be the nerves that supply the skin/muscles (peripheral nerves) or the central nervous system (brain/spinal cord). The most common examples of this are pinching or compression of spinal nerves by a disc prolapse in the spine or hitting your funny bone. Disease of the brain from stroke and multiple sclerosis can give central neuropathic pain. It's often stabbing, electrical, or burning, but nearly any quality of pain is possible making it sometimes difficult to differentiate from nociceptive pain. The presence of sensory changes such as pins and needles/numbness/tingling and weakness can differentiate this type of pain.
We are often asked if pain descriptors (such as sharp, dull, aching) can guide us to the source of the tissue damage. Research has shown this can be quite difficult and unreliable in humans, especially with nociceptive pain and the classic "feels like a pinched nerve" could just as likely be produced from a disc, ligament of joint. There are some cues as mentioned above for neuropathic pain which can be useful in guiding diagnosis. However, using the subjective pain information in addition to assessment findings is essential to making a more accurate diagnosis.
Most often the pain signal reduces in intensity as the tissues heal (often 6-12 weeks), however sometimes as the tissues heal the pain signal still stays heightened (in 25% of people). Pain that does not settle in 3-12 is termed chronic or persistent pain, and this is likely due to the nervous system response remaining heightened after tissue healing has occurred. This is termed central (nervous system) sensitisation and can be thought of as the volume on an amplifier being turned up too high. Or like a sensitive car alarm going off with a strong gust of wind. The gust of wind is not dangerous anymore, but the car alarm (brain) is too sensitive. Physiotherapists and healthcare professionals can use techniques to reduce the sensitivity of the nervous system and help with this persistent pain.
The good news is whether your pain is acute or persistent it is possible to get it under control. Speaking to a health professional and having an assessment will allow a physiotherapist to understand more about the drivers of your particular pain and situation. This will enable a personalised management plan to be produced to target your pain. So if you're in pain right now make an appointment to come and see myself or one of our team who are experts in pain management.
