In the past few decades research regarding pain has significantly improved, however, integrating this new information into clinical physical therapy practice is not always a smooth transition.
Many clinicians initially have a tough time getting on board with some of the newer research regarding pain science and manual therapy because it can be contradictory to what they have been taught in school, and have been practicing for years.
Integrating new pain science research into clinical practice requires practitioners to be humble and realize that just because old mechanisms of treatment techniques are being disproved this does not mean these treatments were wrong or not helping people. It probably was helping people, but just via a different mechanisms than originally thought.
Reconciling Biomechanics with Pain Science by Greg Lehman is an insightful, evidence-based course that helps clinicians to integrate current pain science research into their practice and find ways to improve communication techniques with patients regarding their pain experience.
Our top takeaways from this course are all based around communication with patients about what pain is (and isn’t) and how our treatments work. In addition to being described below, these pearls of pain science have been integrated into our recent low back pain Ebook.
So what is pain?
“Pain is when all stressors [physical, mental, social, emotional] exceed our perceived ability to adapt.” (Lehman, G).
To conceptualize the idea of pain, this course taught us to use a cup and water. The cup represents all the things that help build your capacity to deal with stressors, which are the liquid in the cup. So, using this analogy all treatments have two goals, increase the size of your cup (building resiliency of the body) or decrease the amount of liquid (tissue damage, fear, poor sleep or nutrition habits, worry, work stress, etc…).
All pain is created by the brain in response to a perceived threat to the body’s natural balance. We can think of pain like an alarm system meant to warn the body of danger, however, if you think of pain as an alarm, you realize a few things.
First off, a fire alarm does not tell you where the problem is or how severe it may be. Is there actually a fire, is this a fire drill, is it just smoke, or do I need to run for my life? The truth is, when the fire alarm goes off we have to gather the facts to determine what actually happened and what the cause really was.
It is impossible to know the cause of someone’s pain experience , and usually it is due to a combination of factors (tissue damage, stress, beliefs, etc). We know that pain is not solely due to tissue damage as multiple research studies have shown that many asymptomatic individuals have structural damage including herniated discs, ‘bone on bone’ joint spaces, and other findings. Based on these facts, we must accept that in many cases there is more to pain than just tissue damage.
If the nervous system is hypersensitive to input (their cup is smaller) the body has less capacity to tolerate stress. In this state, something that is normally not painful may be painful, or something that is normally only a little painful may become severely painful.
The nervous system can become sensitized for many reasons, and this course describes it as “the balance between the perception of danger and the belief that we are safe.” Sensitivity can vary day to day and throughout life, and is impacted by beliefs, past experience, fear and more.
In many cases of chronic pain, the sensation of pain can be improved by finding ways to ‘desensitize’ the nervous system, which can be achieved by many commonly used PT interventions.
After learning about pain in detail and the many different ways to explain complex pain science to patients, we came to some large takeaways below.
The process for education on pain biology should look something like below:
Acknowledge beliefs about pain and how this might be affecting you or the person you are attempting to educate.
If you deem these beliefs may be negatively impacting the situation think of and provide a competing narrative to the currently held beliefs with supporting evidence from your/their current situation.
Implement new and healthy beliefs and behavior.
Almost all pain treatment, no matter the system followed or beliefs should look like this (They may not always be in strict order):
Find a way to modify symptoms and aggravating activities.
Progressively load affected tissues and the tissues around them.
Return to meaningful activities.
In closing, we love this course because it challenges our thinking while giving us helpful tools to empower our clients. Our goal is to make YOU the driver of change while we facilitating the healing process so YOU can return to YOUR meaningful activities.
For some other fun videos that can shed some light on how beliefs can impact outcomes, check out some of these (very funny) videos below! Big thanks and shout out to Greg Lehman for coming to New York! As always, drop us a line if you have questions or would like to learn more.
Bees In An Elevator
Wine Taste Test with Food Coloring —
References:
Lehman, Greg. Course: Reconciling Biomechanics with Pain Science.
