Everywhere that we look, it seems that there is a new solution to managing pain, helping to curb anxiety and depression, fall asleep faster, and just overall improve quality of life. These can range from supplements, experimental treatments, doctor visits, and even more. If you are someone who has been searching for these solutions, you may have encountered the term “mindfulness” and may have even tried it in the past.

So, what is it? Originally, this began as a formal, relatively intense program started by Jon Kabat Zinn in 1979 that consisted of multiple hours of training over 8 weeks. Since this time, his practice has transitioned into a shorter workbook, and has been adapted in many forms.

This concept centers around the idea of remaining present in the moment, often with the goal of responding to change, also known as non-reactivity. A common term in these practices is equanimity, which essentially means the ability to remain calm despite changing external circumstances. This leads to topics such as addressing mental health, navigating a new job, dealing with chronic pain, and even in thinking about food.

What’s the Benefit?

Overall, there are many different theories as to what mindfulness can do, and exactly how it works in the brain. It is helpful to first understand what pain is in understanding how this practice can alleviate it. It is described as an alarm system within the body that can indicate tissue damage, which is helpful when there is an initial injury. This sensation can become a problem when it persists beyond the length of tissue healing, as the body has adapted to continue this response. This is known as chronic pain.  It has been shown that the main effect of incorporating these techniques is the mind and body’s response to the sensation, and ability to manage the feelings associated with it rather than actually decreasing it. Two specific diagnoses in which this can be helpful are neck and lower back pain, both of which have been shown to persist when the individual has beliefs that the symptoms will never go away. By incorporating mindfulness, it has been shown that chronic symptoms may decrease and become easier to manage and respond to overall, especially during times of flare-up.

Despite debate as to what may actually be happening, mindfulness has almost universally been shown to help with   sleep. Some studies even suggest that this treatment can provide a safe and early alternative to opioid use. Chronic pain and sleep have often been linked, and the questions always remains which one comes first, trouble sleeping or the painful response? Using these techniques has been shown to improve sleep quality, length of time asleep, and ease of falling asleep. Sleeping more and sleeping better is one component that we know can aid with management. We also know that lack of sleep can be a contributor to an increased pain response, so addressing issues with this is one part of the puzzle. With the above suggested resources, there are specific topics in Headspace (Netflix, Episode 6) and the Calm app (7 Days of Soothing Pain) into this topic and the benefits.

A recent study also showed that patellofemoral pain (PFP), or discomfort in the front of your knee can be seen in 12-13% of young women, and that it can become chronic if not properly managed. This study suggested that there is a link between chronic knee symptoms and anxiety/depression. As discussed above, mindfulness can be one tool in the toolbox to help with management of both chronic pain and mental health. More recently, a study was published showing it can specifically have a significant and long-lasting effect in runners who are managing PFP. When added to a rehab program, these runners saw faster resolution of symptoms, and remained pain-free longer than the control group. A study of this nature paves the way for others, and just starts to show how PT and mindfulness can go hand in hand.

How can you do it?

In today’s society, it has become increasingly easy to incorporate this practice into your daily routine in a variety of forms. If you want more guidance, there are in person classes that are offered to work on this skill. Similar concepts are also emphasized in different forms of yoga. More recently, an extensive library of mindfulness classes, techniques, and concepts have made it to the internet. Just a quick Google search shows many different options (both paid and free!) that could be incorporated daily. Studies have shown that there is no specific duration that is beneficial, and that even 1 minute per day can have positive effects.

Having so many different options is both a blessing and a curse. There are so many avenues, it might seem overwhelming to get started. I like to think of a mindfulness practice like brushing your teeth. You can’t just go to the dentist once a year and expect your teeth to stay clean, it’s about the maintenance in between that keeps them clean. Practicing once and then stepping away will not cause long-lasting benefits. The key is to find a practice that you like that you can easily incorporate into your day-to-day life. There are many good places to start, but here are a few suggestions to get started:

-Headspace smartphone App (Netflix offers a series by the same company)

-Calm smartphone App (also offers a YouTube channel)

-Mindfulness for Beginners podcast (Spotify, Apple)

Conclusions

During my own time in graduate school, I saw this concept frequently as part of our curriculum. It was taught as a way to help patients manage their situations a little better, and for students to incorporate into our own routines. I was involved in a research study that worked to show that students are experience high amounts of stress, and that this can help aid that in many different situations both in and out of school. As time went on, it was even incorporated during some lecture and lab sessions.

Mindfulness is a great practice to start incorporating into daily life for patients and providers alike, but it is not a cure-all. This is just one tool to help address the issue at hand. It is important to know that this is not a treatment that every individual will benefit from, but it is an option. If you are experiencing acute or chronic pain, there is always the option to consult with one of our PTs, and if you are already seeing one, this can be a great addition to the work you are already doing!

References:

Rusch H, Rosario M, Levison L, et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019; 1445(1): 5–16.

Husak AJ, Bair MJ. Chronic pain and sleep disturbances: a pragmatic review of their relationships, comorbidities, and treatments. Pain Med. 2020; 1;21(6):1142-1152.

Nyazi AK, Nyazi SK. Mindfulness-based stress reduction: a non-pharmacological approach for chronic illnesses. N Am J Med Sci. 2011; 3(1): 20–23.

Hilton L, Hempel S, Ewing B, et al. Mindfulness meditation for chronic pain: systematic review and meta-analysis. Ann Behav Med. 2017; 51(2): 199–213.

Bagheri S, Naderi A, Mirali S, et al. Adding mindfulness practice to exercise therapy for female recreational runners with patellofemoral pain: a randomized controlled trial. J Athl Train. 2020 Nov 25. doi: 10.4085/1062-6050-0214.20.

Murray L. Differential diagnosis of anterior knee pain. Physio Network. Accessed July 2, 2021.