Treating for pain relief, as most people expect is not the whole story. Just because you are pain-free does not mean there is no build-up of strain or dysfunction in the body that may lead to an episode of acute pain.
We are often asked when people attend the clinic with an acute episode of pain, ‘’Why has this happened, it’s come out of the blue’’. In many cases, there is no provocative action or something quite trivial that triggers pain and restricted movement, stopping us from doing what we need to do.
We explain that the brain has evolved to prevent harm and keep us safe, and as such, has a negative bias. In physiotherapist Louis Gifford’s “Mature Sensory Model’ he argues that all sensory input is interpreted in the light of past experience, not just of peripheral sensory inputs, but also thoughts, feelings, and behaviours. These inputs are also influenced by socio-cultural influences. This is the basis of the Biopsychosocial approach that we employ at Northwest Physiotherapy Group.
The Ridgway Method ‘Accumulation Strain Model Of Musculoskeletal Health’
The model demonstrates the build-up of dysfunctions such as nerve tension, muscle inhibition, or reactive muscle guarding and joint stiffness (or hypermobility) can occur below the threshold where the brain recognises and acts on the threat. Once the threshold is reached by the persisting and increasing dysfunctions, the brain responds with an output of pain as a protective mechanism. This is a prompt to modify the behaviours that may cause damage. The brain is often compared to a warning light in a car that signals a danger. We all know what happens when we ignore that warning.
The body’s response to these dysfunctions and the noxious stimuli sent to the brain is not consistent. There is no predictable pattern and it is up to careful assessment and monitoring of the responses to treatment interventions that will guide us with our treatment progression. The nervous system manages movement and motor patterns to reduce the excessive loading of irritated tissues. Sports physiotherapist David O’Sullivan found that there is often excessive activity in muscles above and below the site of pain. The brain always works out a strategy to get the job done. This can lead to altered movement patterns, persisting even after the pain has resolved.
The key here is to decrease loading in the structures that provoke the pain with rest or modified activity and postural advice in the short term. The next step is then to improve the tolerance for loading in the later stages with specific exercise and motor control strategies. These later stage interventions are necessary even when the presenting pain has cleared. If treatment is stopped before improving the nervous system’s tolerance for load, the dysfunctions will persist and increase the chance of re-injury. This applies particularly when returning to sport or more demanding, repetitive activities.
At Northwest Physiotherapy Group we primarily base treatment on the assessment of movement signs and protective guarding in the body. Pain intensity can be based on the levels of anxiety, fear and is influenced by other factors such as past experience. With treatment, we see an improvement in pain levels but the basis of treatment is not only to become pain-free, but also to improve the key movement tests and to find the primary tissue contributors that when overloaded, send stimuli to the brain causing the protective output of pain.
We often achieve good pain relief early but it’s maintaining neural mobility and improving the movement tests that are most important. We have 3 phases of our treatment plan
The third phase, which we call the Prevention and Optimization program is a way of managing the levels of dysfunction that accumulate in the body such as increased nerve tension, primary and secondary contributors, progressing exercises, and ensuring that movement patterns are maintained to minimise overloading tissues that could again cause an episode of pain. Ensuring those dysfunctions stay below the threshold causing pain.
The frequency of treatments in the third phase or ‘POP’ depends on the key movement tests and nerve tension. These tests are indicative of strain even in the absence of pain. POP treatments may vary from 4 weeks to 12 weeks depending on how well the client is testing. There is still a need for treatment even if there is no pain. Prevention is most important and gives us a measure of control, rather than waiting for the next pain episode to occur.
Dr Shirley Sahrmann, a noted physiotherapy educator believes that there is a parallel with the dentistry profession. People visit their dentist once or twice a year to check their teeth to prevent decay and more invasive treatments in the future. Your body is as important as your teeth, and so is the need for checkups of your movement system by a physiotherapist.
For most people, pain relief is the most important outcome. It is possible to be pain-free even if there is a level of strain in the body. Unless we treat the main contributors and keep the level of strain below the pain provocation threshold it is possible for the pain to return
This is why getting pain-free is only part of the process of recovery and why regular checkups are so important for your movement health and enjoyment of life.