You Have Two Choices…

January 30, 2011

General Information, Prevention

Chronic pain and chronic conditions often keep people from doing what they love to do.  It may be painful or hurt to do certain activities.  A once-loved sport or activity can become something that gets avoided.  What do you do when you start to notice a once-loved activity is becoming painful or difficult to do?  See a physical therapist.

“I thought it would just go away on its own.”

I’ve had countless patients recount that their problems often start as small, nagging pains that eventually evolve to a level of pain that causes them to avoid physical activity all together.  Pain can start as occasional and progress to being there all the time and even at times when the aggravating activity is over.   Elbow or back pain that keeps a golfer from playing… knee pain that stops a runner in their tracks… back pain that keeps someone away from yoga… chronic ankle sprains that affect basketball players.  I’ve had patients in all of these situations.  I hope to see people when they are just “occasionally” having the pain with an activity, but I often see people only after they are in the chronic phase  (problem sticking around more than 6 months).  At this point they have usually stopped the aggravating activity all together.  Physical therapy can help someone in any phase of an injury: acutely (<6 months duration) or chronically (>6 months duration).  It’s best to get help right away, but maybe you didn’t know about physical therapy or who to reach out to… so now the problem is “chronic.”

In dealing with chronic problems and pain, such as arthritis, you have two choices.  You can either stay moving or mobile to be healthy, or avoid activity all together because everything is “painful.”  As I’ve discussed previously, the benefits of exercise are widespread.  Every system in our body needs movement to stay healthy, especially the musculoskeletal system.  Inactivity results in thinning of a joint’s cartilage and it becomes less resistant to joint forces.  The right amount of activity stimulates cartilage and keeps it healthy.  The less active someone is, the faster his/her cartilage will degenerate, resulting in stiffer and more painful joints.  What develops is a painful cycle of inactivity leading to joint breakdown leading to more pain and more inactivity.

Out of those two choices, I think you know which one I’m for.  If you need help determining what activity you can do, what exercise will help you improve joint health, or what activities to avoid to improve and maintain joint health, see a physical therapist.

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MoniqueSerpasPT

MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

My name is Monique Serpas, PT, DPT, OCS. I am a physical therapist and board-certified Orthopaedic Clinical Specialist practicing at the Southeast Louisiana Healthcare System in New Orleans, LA. I realize how difficult it can be to overcome an injury or manage a chronic condition and am focused on helping my clients achieve wellness through a physically active lifestyle. I treat orthopaedic, balance, and vestibular disorders and practice using a combination of hands-on manual therapy, therapeutic exercise, and education. This enables my patients to assist in their own recovery and injury prevention. I also have developed fall prevention and golf-related rehab programs in the past. I hold a Doctor of Physical Therapy from Concordia University Wisconsin (2008) and a Bachelor of Science in Kinesiology from Louisiana State University (2004). I am a member of the American Physical Therapy Association (APTA), Louisiana Physical Therapy Association (LPTA), and the Orthopaedic and Neurology sections of the APTA.

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MoniqueSerpasPT

@MoniqueSerpasPT

Physical Therapist at New Orleans' Touro Infirmary. I give my patients the information they need to live well.
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  • BarrettDorko

    I think this post is simplistic and largely inaccurate. Just getting to the point. Go to SomaSimple.com for a great deal more about what neuroscience has revealed about pain. Join in. We’d love another opinion backed by actual evidence.

    I recently wrote about LaLanne.

  • www.therextras.com

    You expect too much from one post, Barrett. This is an excellent post making a point about the benefit of exercise and SOME of the consequences of the lack of exercise. That there is other information on pain management does not discount what is said here. You suggest a false dichotomy between exercise and some other ‘neuro’ approach being the answer to pain.

    Barbara Boucher, PT, PhD

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  • Mak57_

    This post raises some interesting points for regular readers to your blog. A useful consideration I keep in mind is that: chronic pain is more than pain that lasts for a long time. I am not sure who said that originally but it has been a helpful reminder. While management can be broken down into two basic choices: move or don’t move; for many with persistent pain the don’t move option is more a choice by default. Stopping or reducing exercise is often a result of not understanding, poor experiences with some exercises, fear, anxiety and a change in overall function. A resulting cascade of negative changes happen – as you suggest several systems are altered. I attended a very interesting session at congress recently, with an Australian researcher(Paul Hodges) who described his work and introduces his concept: a triad of system involvement for LBP – respiratoty, bladder, msk – some fascinating information, the essential element hinged on considering multiple intersecting possibilites that be may useful in managing for low back pain. That research was focused on the low back but I think the work was brilliant and worth reviewing. As a general approach, merging some coaching principles with individuals with long standing pain is often beneficial. Establishing specific goals, small steps or a graded exposure to movement can make small but significant changes that leads to improved joint, muscle function and less sensitive more normalized nerve activity. Thanks for facilitating the discussion. A large topic for your blog but keep up the posts. Michael Kay

  • Barrett: your condescending post shows both arrogance and shameless self-promotion. Not an easy task to do in such few sentences. Thanks for telling us that nothing else needs to be written about LaLanne since you recently did.

  • Thank you all for reading and commenting on my post! I always welcome a comment, and like to hear what other therapists’ viewpoints are. The audience of my posts is foremost the general public. The purpose of this post was to encourage people to seek the help of a physical therapist when they experience pain that limits their ability to move or participate in an activity. The second message is that exercise is important for maintaining health. The third message is that although someone may be experiencing pain, it’s important to stay physically active, even if that pain is a chronic condition that will not go away, such as arthritis or fibromyalgia. There is a lot of research into the positive effects of exercise on varying systems of the body. Consequently, inactivity has deleterious effects on health. I realize that pain is multifactorial and fear-avoidance can significantly reduce a person’s function. However, there are certain circumstances (e.g. low platelet counts for CA pts, fractures, risk of spinal cord injury…) in which exercise is absolutely contraindicated. This post specifically speaks to those who do not have these problems, but who have pain. Going back to the first point, see a physical therapist, a PT will be able to identify and educate patients in movements and exercise they CAN do and may be able to bring them back to the activities they used to do.

    Barrett: What specifically is largely inaccurate about my post? Consider my audience and purposes. Do you encourage your clients to move or not? I visited the link, but had trouble finding your post about Lalanne. I did find your personal website and I see you teach continuing education specifically a manual therapy technique for managing pain called “Simple Contact.” It would be great if you could comment back with more information about this. Can you share a research reference to this technique and its effectiveness in managing pain? Is there research showing it to be more effective in managing pain than therapeutic exercise techniques, other manual therapy techniques, cognitive behavioral approaches, or a combination of these treatment approaches?

    Michael: I did really simplify categories of pain. You’re absolutely right that it’s not just as simple as saying acute vs. chronic. There are many ways of categorizing or describing pain that is not just time-dependent (e.g. acute, subacute, chronic acute…) and that someone that has a chronic condition can present with acute pain. How do you communicate these differences when educating your clients? I completely agree with your point : “Stopping or reducing exercise is often a result of not understanding, poor experiences with some exercises, fear, anxiety and a change in overall function.” This is why I think it’s important to seek help from a trained medical professional. I have recently read more of Hodges research and am very interested! I’m looking forward to hearing him speak at CSM. I also like to use step-wise exercise. A reason for this post is that as you stated, people can become discouraged with physical activity, focusing in on what they can’t do and then avoiding it and exercise or movement all together. We- physical therapists- can help to change that behavior through instructing clients in the right types of movement and exercise.