• Dr. Piotr Solowiej PT, DPT

When it Hurts to Move


We've all had these moments: scrape your knee, stub a toe, step on a LEGO, jam a finger, get a paper cut. That initial pain can feel immense. And to a lesser degree, it will stick around for a few days. Maybe a few weeks at the most. The damage, or lack thereof, is often visible. If you scrape your knee open on some gravel, you can observe how the healing process progresses from day to day.

For injuries like sprains and strains, there can be more or less obvious evidence of tissue injury depending on the severity. A sprained ankle can just hurt, without any trophic changes. Or it can blow up like a balloon and turn a rainbow of different colors over a number of weeks.

In any of these cases, as a result of pain, your movement patterns and behaviors will change to protect the area. In the short term this is adaptive as it offloads the injured area, so that the body can begin the healing process without further insult. For the most part, many of the above problems are self limiting. Except for the more severe cases, you will likely get better on your own. No outside help needed.

However, there are also chronic or persisting pain problems. This type of pain is absent of any obvious (recent) tissue injury. Meaning the pain remains well beyond the typical timeline of tissue healing. Yet it still hurts to move. And not just a little. In these cases the changes in movement pattern, and more importantly behavior, never completely go away and can worsen over time. As a result, persisting pain can have an isolating effect on a person's life. If it hurts just to walk, stand, or sit for extended periods of time - it's painful to go out dancing. It's painful to go to a concert. It's painful to walk the beach. It's no wonder a person can tend to withdraw from doing even light activities, let alone exercise or sport. Persistent pain is a tough subject. There are no easy answers. The more the healthcare and scientific industries learn about pain, the more questions we have. But we have learned a ton about how to better manage it. Management, I think, is a much sounder approach.

As a society we've developed an obsession with eliminating pain. But at what cost? Look no further than the opioid situation the U.S. are in right now. This line of thinking also fails to realize the utility in pain (as an entity). Without the ability to process stimuli as painful, we wouldn't survive for very long. Born with Congential Insensitivity to Pain with Anhidrosis (CIPA), as many as 20% of children pass away before the age of 3 due to various complications. Rarely does anyone with the condition live past the age of 25. (Sources and facts of CIPA here, here, and here.)

For those that are experiencing persistent pain, movement and activity can be a constant source of strife. Logically the reaction is to decrease movement. However, our intuition fails us here. Not moving when you're in pain, leads to less movement, more pain, more fear, less movement, more pain....and so on. A vicious positive feedback loop has begun. And no I did not mess that up, it is positive in the sense that input results in the process continuing on and on. Negative feedback will halt a process. Read more about positive feedback loops and pain, here.

What is a person to do when they are stuck in a seemingly endless cycle of pain?

Seek help. Don't give up.

Movement will help your situation if performed gradually in a novel context, under an optimal load and frequency, and within a medium that you enjoy.

Pain can be frightening, and is often associated with the notion that we are doing damage to the body. Again, our intuition fails us here. Pain functions as a warming sign, a security alarm. As we saw with people with CIPA, not ever having that warning is a survival problem. Persisting pain is the opposite end of that spectrum: innocuous movements and stimuli consistently trigger an alarm response. The system has become hyper sensitized, and reacts when otherwise it would not.

To put it [over] simply, a recalibration has to happen. PT's are trained in conservative (non pharmaceutical or surgical) methods of helping people in persistent pain. They will work with you to forge a reintegration plan, and get you your life back. Find a therapist that has experience with working with people in persistent pain to give yourself the best shot.

Now, does physical therapy help everybody? The reality is no, but nothing out there does. There is no one magical method or technique to eliminate persistent pain. There are many mechanisms for pain experience, many of which we have yet to sufficiently understand.

As an example, in my clinical development time during PT school, I had the great opportunity to work with a multidisciplinary team at (then) RIC's (now Shirley Ryan) Chronic Pain Management Center in Chicago. At the time I discussed the success rate of the program which my clinical instructor. She reported roughly a 60% rate of significant improvement in people's pain experience as a result of the various programs offered by the center. That may not seem like much. 60% on most didactic exams wouldn't even qualify as passing. However, these are people that no one has been able to help. In that context, this success rate is clearly impressive.

As for the remaining 40% or so, we don't understand everything. Just know that there are many good people, working hard everyday, to further develop our understanding of the pain experience and how to better manage it.

What did the pain management program do that was so successful?

The answer was in the name: management. Pain management. As I already indicated above, a life without pain would be a short one. The current research base lends high support to pain management approaches that are active rather than passive.

Examples of passive approaches would be medication, massage, mobilization/manipulation, ice, heat, electrical stimulation, ultrasound, acupuncture/dry needling, and a host of other modalities. Surgery falls in this category as well. Now, before anyone gets upset, these methods and procedures have a time and a place. But these things are consistently showing to not be so useful when it comes to the persistent pain population. They have been tried, and don't work. At least not as long term strategies. All these modalities have in common the fact that something is being done to the patient. They have a passive role.

Active methods, on the other hand, involve the individual in the treatment process. These include various forms of exercise, movement strategies, being taught different ways of thinking/processing the pain experience, and genuine discourse between a patient and their provider.

As always, with science being an ongoing process, new information will become available and the industry will have to adjust accordingly. The optimal pain management strategy likely lies in a variable combination of the two methodologies (active vs passive), and is subject to change from each individual to the next.

If you're in pain and can't seem to get any relief, seek providers and situations that align themselves with this sort of flexible thinking. The ability to critically think and adjust advice to your unique situation will be incredibly valuable to your success.

Address: 1942 Raymond Dr, Northbrook, IL

Phone: 630-447-9746

Fax: 630-385-0124

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