- Donald Physiotherapy Prof. Corp. was created in October 2006.
- The first physical location of Donald Physiotherapy was in Davidson, Sask. We have operated in Davidson since January 2013.
- Donald Physiotherapy works closely with 3 Saskatoon dance groups – Dance Elements, River City School of Irish Dance, and Free Flow Dance Theatre Company.
- Each year in October, Donald Physiotherapy does an on-air cheque presentation to the C95 Radio Marathon for Breast Cancer.
- Since May 2016 Donald Physiotherapy has been a dealer of Sigvaris compression socks. We currently have 4 (soon to be 6) certified fitters on staff.
- Donald Physiotherapy has consultants available in the areas of Occupational Therapy, Psychology, Paediatrics, and Mental Health & Behaviour.
- Donald Physiotherapy once had a piece of pie locked in a microwave for over a week!
- Donald Physiotherapy is a Finalist for the 2019 SABEX Awards. This is the third year in a row of being a finalist, for 3 different awards.
- In 2019, Donald Physiotherapy will be a major sponsor, for the third year in a row, for the Arthritis Society – Saskatchewan Walk For Arthritis.
- Santa visits Donald Physiotherapy every year in early December for pictures. Donations are collected for the Saskatoon Food Bank as part of Rock 102’s Stuff the Bus campaign.
We would love to hear your comments about these 10 facts or any others you feel should have made the list!
Donald Physiotherapy has been open in Saskatoon since November 2014. We have developed a fantastic group of clients since then and we thought we would like to share some facts that you may or may not know about our business. So in the spirit of David Letterman’s famed Top Ten list, we present Trevor’s Top Ten: Donald Physio Facts:
Yes - it has become my reality. As a pelvic floor physiotherapist, for all populations, I talk about bowel movements. A lot. Just ask my kids, my husband and my clients. But the reason being is it lends a lot of information on the health of our foundation - the pelvic floor!
Constipation in Kids
Recently I gave a talk about conditions I see in the pediatric population and constipation or retention of stool came up as a topic. Especially after children become potty trained and we stop going to the washroom, we lose track of what our kids our are doing on a daily basis when it comes to bathroom habits. That being said, even as a child is potty training, it is important to know what a bowel movement is looking like. Reason being, even though a child may be having a bowel movement daily, they may be constipated! How you may ask?? It is how the bowel movement looks!
Signs A Child is Constipated
There are a few common things that may not seem obvious when seeing if a child is having difficulty with bowel movements.
So why or how can a child become constipated? Kids are funny things in that if the bathroom looks unpleasant or they feel embarrassed to do something, they may not do it. Usually they do not feel the need to stop playing and use the washroom. Also, hydration plays a huge factor - the more dehydrated a child or person is, the more likely they will become constipated. Of course, this is only a small list of reasons, as there can be many more and potentially complex reasons, but it lends the idea that caregivers can help! For example, a child should consume 1 ounce of water for every kilogram of weight. So a 24kg child would drink 24 ounces of water or 3 cups per day! What usually helps is a reminder for the child - before you go play, at recess, after recess, after you go to the washroom, have a drink of water. A couple ounces a time, multiple times a day will go a long way!
If anything to take away from this write up, it is be open to talking with your kids about their bowel habits! A little conversation can go a very very long way. And if issues are happening, believe it or not, Physiotherapy Can Help!
~ Michelle, PT
Tinnitus is defined as the perception of sound without the accompanying external stimulus.
Tinnitus, or ringing in the ears, affects a significant amount of the population at one time or another in their lives. While it is normal for someone to experience intermittent episodes of buzzing, ringing, or tonal sounds in the ear from time to time, some people experience a condition which is much more persistent and sometimes more bothersome. Prevalence is estimated between 5-42% of the population.
The condition itself does not have one root cause or pathology associated with it. It can be caused by noise trauma, physical trauma, disease, aging, and as a side-effect of some medications. A number of different structures and conditions can contribute to the presentation and the symptoms that an individual experiences. This can include cardiovascular, neurological, mechanical, and inflammatory disease states. These factors will produce a sensitivity in the nervous system, leading to changes in the brain that can produce the phantom sound or make it increasingly difficult to shift our attention elsewhere.
From a cardiovascular perspective, an increase in blood pressure can sometimes result in the ability to hear a thudding or pounding, drum-beat like sound. This can occur unilaterally or bilaterally. This can also be the result of inappropriate formation of small blood vessels in the inner ear and surrounding tissues which does not allow blood to flow through them smoothly in all situations. Anything that is of a vascular nature will require assessment and investigations as recommended by the appropriate physician and/or specialist and is outside the scope of physical therapy.
From an inflammatory basis, a number of structures in the face, head, and ear can contribute to the perception of sound if they become irritated or sensitive. This include various nerves, the sinuses, eustachian tubes, and even the middle ear bones that conduct sound to the eardrum. The eardrum itself can be a source of irritation if it becomes inflamed or scarred as well. The treatment for this typically is medical in nature to try and reduce swelling/inflammation in the specific tissues.
The neurological mechanism is the most common pathway that relates to idiopathic tinnitus. Idiopathic referring to an onset of symptoms with no known injury or mechanism. This can be due to sensitization of the peripheral nervous system, central nervous system, or a combination of the two. This is typically treated through a combination of medication, education, and stress-reduction strategies.
Mechanically, the upper cervical spine and jaw joints can contribute to a presentation of tinnitus in some cases through their connection into a cluster of nerves referred to as the trigeminocervical complex. Since the trigeminal nerve has connections to the other cranial nerves, overwhelming stimulus of these pathways can contribute to the intensity and frequency of symptom presentation. On the bright side, appropriate mechanical treatment and education surrounding these tissues can sometimes provide improvement in the tinnitus symptoms that are experienced. Not everyone has a mechanical presentation, but since treatment and therapy are non-invasive, it can be worthwhile to consider assessment by a trained healthcare practitioner.
Another useful avenue of assessment for those suffering from tinnitus is a comprehensive hearing assessment through an Audiologist. This will assist with understanding the unique features of a patient’s presentation and help other practitioners determine an appropriate course of action. Audiologists also have the ability to treat some aspects of tinnitus with assistive devices that can create white noise, amplify normal hearing, and try to retrain the brain/nervous system to ignore the tinnitus itself.
One of the most important things to note regarding tinnitus is that the amount of distress or the perceived volume of the sound does not relate to the severity of the condition. Louder tinnitus does not mean that someone is at greater risk of harm or injury/disease.
~ Trent, PT
Somatosensory tinnitus: Current evidence and future perspectives. Ralli, M. et al. Journal of International Medical Research. 2017.
Maladaptive plasticity in tinnitus - triggers, mechanisms and treatment. Shore, S., Roberts, L., Langguth B. Nat Rev Neurol. 2016.
Current insights in noise-induced hearing loss: a literature review of the underlying mechanism, pathophysiology, asymmetry, and management options. Le, T., Straatman, L., Lea, J., Westerberg, B. Journal of Otolaryngology - Head & Neck Surgery. 2017.
Today I was at the dentist for both my kids and for myself. And holy smokes, my 3-year-old was talking a mile a minute! He was very excited to tell the dentist how he is brushing his teeth every day. Talking is just one of the many activities that the jaw has to be able to do. Talk, chew, open up for a yawn, and smile, to name a few things. And these are some of the things that my patients have told me their jaw pain is interfering with.
Want to know something else that is interesting? The jaw is also involved with trying to handle our stress. Sometimes, when we sleep and even when we are awake, we can clench our jaw or grind our teeth. We hold tension here either temporarily or prolonged in response to stress, frustration or simply out of habit. So when I got to have the discussion with the dentist and dental hygienist that I needed to think about getting a night guard to protect my mouth due to signs of clenching I wasn’t surprised. Generally I feel like I manage my daily stress well, but sometimes I wake up in the mornings feeling like I have to move my jaw around to loosen it up. I also catch myself feeling a little more tense when I am rushing to get the kids out the door or things of that nature (I am sure I am not the only one to feel this way sometimes).
When we clench or grind, even without meaning to, there are a few things that can happen. Apart from possible wear on our teeth and gums (can you believe that you can cause gum recession or tooth fracture by clenching and grinding?!), there is also joint irritation and muscular overuse and imbalance that can occur around the jaw, which can lead to local and referred jaw pain. What does that mean? Jaw pain can feel like an ear ache since your joints are located just beside your ears. It can also feel like a tooth ache because pain from the jaw can refer to your teeth. It may also present with a headache or ringing in the ears due to muscular tension or joint pain. Lack of muscular coordination and control can lead to muscular strain and joint irritation. They begin to have trouble with things like opening, chewing, and talking which usually brings them to their dentist or their doctor, and then to me, because they are just not sure about where to go and they are a little afraid of what treatment entails when they are already having pain and difficulty with such important things that they have to do multiple times per day.
So let me talk about assessment and treatment for a moment. When I am looking at someone’s jaw, I want to know their history. I am talking more about clenching and grinding above, but sometimes there are other things that can lead to jaw pain. After discussing more about what brought them in to see me, I look at how the neck moves and how the nervous system is functioning through reflexes and cranial nerve testing. I then get into looking at the jaw. I look at how a person is opening and closing, other movements that their jaw can do, and how irritable their jaw appears to be. With many people I am also able to assess how the joints, ligaments and muscles are functioning by feeling inside of the mouth and “wiggling” the jaw around. How I approach assessment and treatment with people depends on the degree of irritability of their jaw, their goals for treatment, and what they are doing in their lives. Are they a musician? A teacher? A student? Retired? What is their dental and neck history? All of these things are important for me to know to effectively treat someone’s jaw.
So, if you are having some jaw pain, clenching or grinding during the day and/or night and issues with jaw muscle coordination may be playing a role. Paying a visit to myself or Trent can help to set you in the right direction. Feel free to give me a call if you have any questions about what may be going on with your jaw and what physiotherapy can do to help.
~ Kristyn, PT
People. What is happening? It's currently -33 as I'm writing this blog. It was - 48 earlier this morning. I know, I know. We live in Saskatoon. We are going to experience all 4 seasons, some longer than others. It's winter and it's cold. But there is a difference between it being cold outside and it being freezing. This is ridiculous. When it's cold you can suck it up and not wear mittens while you are driving or even skip wearing socks in your boots. However, when it's freezing you wear layers to get the mail. If you grew up on a farm you pull out your ski-doo suit and wool socks (not because you are going ski-dooing but because you want to pack them in your car trunk in case your car decides it doesn't want to run anymore). Vanity and style take a back seat to your warmth.
When it's cold you still think about Dairy Queen and Slurpee's. When it's freezing you think about warm soup and hearty stews that burn your tongue. When it's cold you are still able to go skating or tobogganing. You are able to go Cross Country skiing, snow shoeing, ice fishing, skidooing (especially with a sled tied to the back and you wear ski goggles to help protect you from the debris that's flying at you). You can participate in activities that involve the temperature to be below zero. When it's freezing....................you binge watch Netflix (Chef's Table, The Office, Outlander and Workin Moms are my fave's). You Marie Kondo your closet ( do NOT do this by yourself. I repeat. DO NOT DO THIS BY YOURSELF). You start google-ing hot destinations and research how far $70 West Jet dollars can get you (Not even to Regina in case you are wondering).
If you live in Saskatchewan you have 2 different types of wardrobe.....summer and winter. Summer wardrobes are typically filled with bright colours, fun designs, and pieces of clothing that shows less skin. Winter wardrobes are typically filled with down, wool, anything that is water resistant. No one cares about colours when its -50 outside. Did you know that you can purchase a down onesie???????? YES!!! It's a real thing ($1500). The best part of it being that cold is that everyone that you see looks the same. Big parka, winter boots (with removable liners), puffy gloves, and sometimes even a fur trapper hat. But even through all of this we hold out for that sweet promise of spring. Where we can see the rest of the brown gritty snow mound melt in the parking lots and see actual concrete on the roads. Where the sound of the water dripping from your eaves is all around you (I mean that in a poetic sense, not literally). I have gone to the green houses a few times over the winter to remind myself that everything lasts for a season. That there will be new growth happening. Patience is not something I am strong in. So I'm writing this just as much for me as for you. We will get through this. Before we know it there will be the faint hint of green in the sky from the trees and allergies acting up from all the snow mould. There will be families going on bike rides and getting coconut dipped ice cream cones from Chardon's (if you haven't had one you NEED to go). Just remember that we are all in this together. We are all experiencing the cold and the freezing. So let's cheer on the melting and the end of this blasted winter.
~ Sheri, Admin
(Cue cheesy daytime tv show music)
Hello! And welcome back to “The Winter That Never Ends!” I’m your host Chuck Canuck. This segment of our show is brought to you by Donald Physiotherapy, where you’re in good hands. Now, let’s get back to our topic, Winter Survival! Here’s our top five tips!
1. Keep your hands in your mitts, and out of your pockets.
Mitts keep your hands warmer than gloves by giving the fingers a chance to stay warm together and generate more body heat. Keeping your hands out of your pockets increases your balance, and decreases the risk of slipping and falling on the ice.
2. Warm up before you shovel or use the snow blower.
Cold weather and cold muscles do not mix. A light warm up of marching in place or stretching will not only help your muscles work better, but it can help prevent injury.
3. Hot cup of coffee before your shovel? Save it until you’re done.
Substances like caffeine and nicotine can decrease your blood vessels to constrict, putting you at risk for a heart attack or other cardiovascular event brought on by the strain of shovelling.
4. Push the snow when you can.
Pushing the snow reduces strain on the body. If you do have to lift the snow, bend your knees and use your legs to do most of the work. Try to use a light weight plastic shovel over a heavier metal one.
5. Be cautious while walking.
Buy some ice grips that slide over your boots, and take your time. Put your phone away and watch for slippery sections or ice in your path. If your path is incredibly slippery, try walking like a penguin. Keep your feet flat, take short strides or shuffle. Keep your knees slightly bent with your toes pointed out, and lean forward slightly.
That’s our show for today folks! Tune in next time when I’ll be discussing The Groundhog: Accurate weather predictor? Or oversized rodent with an ego? Thanks again to our friends at Donald Physiotherapy. If find yourself sore after shovelling, or you’ve had a slip and fall, give them a call! They’ll get you back to the snow in no time. I’m Chuck Canuck, and this has been “The Winter That Never Ends!”
~ Becky, RMT
Sharp. Throbbing. Pressure. Pounding Sparks. Squeezing. Burning. Numbing. Blinding.
These are just some of the words people use to describe headaches. 50% of the general population have headaches during any given year, and more than 90% report a lifetime history of headache (International Association for the study of Pain, 2011).
Headaches can be classified into many different subgroups and each of these has its own causes and effects. These subgroups include migraines, tension headaches, cluster headaches, exertional headaches, hypnic headaches, medication-overuse headaches, sinus headaches, caffeine-related headaches, head injury headaches, menstrual headaches, and of course, hangover headaches.
Let's go a bit deeper into a couple of these subgroups, starting with migraines. Symptoms of a migraine will typically include an intense throbbing pain on just one side of the head. The person may experience increased sensitivity to light, sound, and smell. Nausea and vomiting are also common. Approximately 1/3 of people will experience an aura before the onset of a migraine. These are visual and sensory disturbances that can last between 5 and 60 minutes.
Cause of migraines are not fully understood yet but they are more common in females than males and they tend to run in families. Triggers for migraines are variable and they can occur several times a week or as infrequently as once per year.
There are different options available for treatment and some of these include medication, dietary supplements, meditation, and acupuncture. Migraine attacks can often be eased by resting in a quiet, dark place, placing a cold cloth on your forehead, or drinking water.
The most common type of headaches seen in physiotherapy offices is tension headaches. These are very common and are usually felt as dull, constant pain at the back, sides, or front of the head. Again, the triggers can vary but often will include stress, anxiety, lack of exercise, poor sleep, poor posture, or eye strain.
Good management options include stretching, heat, acupuncture, massage, dry needling, meditation, and limiting screen time on computers, phones, and television. Physiotherapists will also address contributing factors by discussing posture correction strategies, workplace ergonomic changes, and how exercise can be incorporated into day to day routines. The neck and upper back can have a very large impact on headaches and should also be assessed when seeking treatment.
Most types of headaches are preventable by understanding the background and behaviour of the headache. With this knowledge, a plan can be developed to manage the signs and symptoms and more importantly, prevent the occurrences.
~ Trevor, Physiotherapist
Pelvic Floor Physiotherapy has garnered an increasing awareness of late. Commonly known to be useful for prenatal and postpartum mothers, pediatric issues are also treatable with the assistance of physical therapy. Common areas of concern for children are potty training, constipation and bed wetting (enuresis).
Anyone with children will go through or have gone through the potty training with the little one. Generally, it makes sense – child is showing interest in toileting, so we start to progress them in that way to becoming more independent. Some little ones pick up on it quicker than others. This is a time when the child is learning a new life skill!
But, what are some key things to consider before we take the plunge? We should note that cognitive ability and motor performance are related.
Other key considerations include:
So how can we help? You want to be able to recognize when your little one is truly ready. They are amazing little beings and will guide you. It is easy to say, but you shouldn’t be worried about a certain time being the best time to start your child learning this new skill. Every child is different, and it will range between 2 and 3 years old. If anything it is best not to rush the process. The bladder itself is developing connections or its ability to “talk” with the brain about what is going on. Only when a child is completely ready, will success of learning a new skill follow.
We had very different experiences with our two little ones. Our first, we were told, should be “trained by 2”. He was born on his due date, hit all the milestones as expected, started showing so interest in pottying, so we figured ok – why not. We started the process and it took 15months before he was free of diapers. He wasn’t ready. He liked the idea but his bladder to brain signal was not developed and he was training us to remind him to go. Our second little one, who was born a bit early, and later to walk, we waited. We waited until she showed genuine interest in pottying. She would verbalize what she was feeling. We watched for physical cues. And for her, once the process started, it seemed smoother and an easier transition within less than one month to no diapers. Again – every child is different and our experience will be very different from anyone else. But we learnt from our first to take it slower with the second.
Physiotherapy can assist with this journey, ensuring motor development has occurred optimally to allow for such the coordination of events required to become success with using the washroom independently.
This is just the beginning! Once your little one has appeared to succeed in using the washroom more independently, we tend to “forget” to monitor their success! Potential other issues can creep up, because once they are going on their own, we don’t know what they are truly doing. Future posts will touch on constipation and bed wetting and what they can be related to!
~Michelle, Pelvic Health Physiotherapist
Following the holidays, which is always a busy time of year, I had the opportunity to go on vacation with my family. It was a lovely and refreshing time and I came home ready to do some prioritizing in life. Naturally, this included getting back into the routine of exercise after the holidays. I think that this time of year often sparks the goal of developing some exercise habits for people. This is WONDERFUL news since I am often working with people to reduce aches and pains and include movements and mobility practices that will help them to reach their goals – whether these goals are to reduce pain so that they can function in life again, or if they are working towards performance goals for sports or leisure.
Personally, I am often looking for a consistent time to exercise in a routine way while balancing work and family life. I enjoy doing yoga at home because it is an easy way to get balanced exercise on my own time, no matter what mother nature has schemed up. I also like to go for walks or runs, play volleyball on the weekends and play games my toddlers dream up! It’s fun to play with them and then they gravitate to physical activity which helps them to burn energy (I wish I could bottle that)! I enjoy how playing with the kids helps them develop a love for the types of exercise that they enjoy. What types of exercise do you enjoy?
Movement is key for physical comfort and mobility. Of course sudden injuries happen, and there is nothing that a person can do to avoid that, but I do see that people who are more physically active or mobile before an injury occurs recover more quickly. Frequent strengthening and stretching can also help someone to prevent injuries. For instance, maintaining back mobility and lower body strength and conditioning can help someone to shovel or rake without developing strain injuries during the seasons that require these activities. So findings something that you enjoy doing can make a big difference in not only how you move now, but how you recover from an injury.
There are a few exercises that I find that I go back to again and again for people. Not only to the help people recover from ailments, but I also give these ones to people wanting to do whole-body conditioning as options to maintain health and prevent issues.
Some of the exercises that I tend to use often include the following:
| Walking (Duration: 10+ mins; Frequency: daily as able)
| Posture Correction (Sitting tall) (Duration: 2+ mins; Frequency: every hour)
| Single Leg Balance (Duration: 30 sec each leg; Frequency: 2 times per day)
| Push Up (On the Wall or Floor) (Sets: 2; Reps: 10; Intensity: slow and controlled; Frequency: daily)
| Calf Raise | Bilateral - Supported (Chair) (Sets: 2; Reps: 10-20; Intensity: slow and controlled; Frequency: daily)
| Squat (Chair) (Sets: 2; Reps: 10; Intensity: slow and controlled; Frequency: daily)
| Cat/Cow (Sets: 2; Reps: 10; Intensity: slow and controlled; Frequency: daily)
| Upper Trapezius Stretch (ear to shoulder) (Reps: 2 per side; Hold: 30 sec; Frequency: daily)
| Levator Scapulae Stretch (nose to arm pit) (Reps: 2 per side; Hold: 30 sec; Frequency: daily)
| Gastrocs Stretch (Wall) (Reps: 2 per side; Hold: 30 sec; Frequency: 1-2 times per day)
Of course an exercise program is tailored to each person’s abilities and needs, so some of these may be too challenging for people or they may not be challenging enough. I enjoy working with each person to find a form of movement that works for them and that they enjoy doing. Hopefully I will have given you a few ideas for things to try! And if you have any questions along the way, please feel free to give me a call.
~ Kristyn, PT
Today I will be continuing the discussion on Chronic Pain with a topic that comes up on a very regular basis during a typical week. It will usually begin with some version of the question, “It started in my hip, now my knee is starting to act up, why is that?”.
I encourage anyone interested to look back at the previous blog post on pain for some background information on the factors involved in pain and tissue sensitivity at a local level. Once symptoms and dysfunction persist for a long enough period of time, they begin to enter a period that is referred to as chronic. When things get to this point, a number of other changes and adaptations begin to take place within the body. The portion that we will be focusing on today is the idea of the sensory homunculus.
The homunculus refers to a representation, or “map” of our body that resides within our brain. Every time we feel something from a particular body part, or move a particular body part, there is a corresponding activity in the part of the brain that is assigned to that area. This has many benefits, including allowing us to be aware of our entire body at any time, simply by thinking about it. Even with our eyes closed we can make very precise movements, such as touching our nose or ears with millimeter accuracy. Below is an image that shows how the homunculus is laid out in the brain.
As you can see the homunculus is not perfect in the way that it represents the body. As far as it is concerned, the face and hands are much bigger than other parts of the body. This allows for greater accuracy in movements and increased sensitivity. The hands and the face are required to perform very tiny movements and perform a wide variety of tasks. They are also more sensitive to touch, temperature, and our environment in general. For these reasons they make up a larger part of the homunculus. Body parts also lie next to each other on the homunculus in ways that mostly make sense, but with a couple of surprises.
As discussed in my previous post on Chronic Pain, the connections between neurons gets stronger and stronger the more that they are used. Connections that are used less often become weaker as well. So, the piano player or avid knitter will have a larger representation of their hands and fingers in their brain compared to someone who has spent more time playing soccer or cycling.
In the context of pain, the connections between the injured tissues and the homunculus are very important. When constant signals are being presented to the brain for interpretation, those nerves get better and better at transmitting signal. The brain also gets better and better at looking out for it and can become overly sensitive or hypervigilant. Over time this can change the size of the body parts on the homunculus. This can lead to problems.
For example, as the homunculus changes and as nerves grow more sensitive things that normally would not bother the tissues can become irritable, and even completely normal things can now become painful. What happens next is very interesting. As the nerves and brain become more sensitive a point can be reached where the adjacent parts of the homunculus start to become involved. Enough chemical and structural changes have occured that the elbow now becomes involved in a shoulder pain, or a hand joins a wrist in calling out for help. The secondary body part was not injured, sick, or in any danger, but it starts to become a part of the presentation.
One of the more disheartening things that can come out of a discussion on Chronic Pain is that people will ask for “a new back”, or request that a body part be “chopped off” to make the pain go away. While it is usually said with a touch of humor in the voice, it indicates some potentially more serious issues with the pain presentation and how people are coping with the situation.
Coming back to the homunculus, the map of our body within the brain itself, these talking points are some of the first signs of dissociation. This is the idea that the brain will try to distance itself from the symptoms, the pain, and eventually the body part, to try and cope with the environment. You can think of this as the brain trying to “smudge” the drawing of the body part to make the symptoms less powerful and less distinct. It can be seen in more extreme cases and nerve injuries with people failing to recognize their own limb, or reaching a point where they lose the conscious ability to move/operate the muscle/joints in that area (Although this is quite rare).
What can be frustrating at times is that this system does not change very quickly after symptoms have persisted into a chronic state. However, I would argue that it is actually a very valuable thing that this map of our body inside the brain and the nerves involved are slow to change. If the system could change at the drop of a hat in a positive direction, it would also be easier to change it in a negative direction. The strength of this system relies on the ability to handle a significant amount of stress from our environment without permanently affecting the tissues in our day to day lives, but will start to transform over time in the presence of repeated challenges. This means that since it took some time for the pain presentation to get to where it is, the recovery process will also take time and many repeated efforts. This can be difficult at times as the attempts to change are often uncomfortable, fatiguing, and usually more effort/work than has been tried previously.
What can be done?
The most positive aspect of all the information discussed above is that the brain and the nervous system are highly plastic and able to change, over the course of the entire lifespan. Knowing what is happening and knowing that there are options is a powerful tool in the fight with chronic pain. The brain, the tissues, and the homunculus can adapt if they are given new stimulus and new ways of doing things. This helps to develop new connections and new pathways of communication. This helps to sharpen the mental image of what that body part does, how it moves, and what it is capable of.
From a physiotherapist standpoint this means that the map of our body inside the brain can be changed with repeated efforts. We can sharpen certain areas, un-smudge others, and generally improve the communication and function of these brain areas by giving them repeated movements and encouraging a less stressful interaction with all of its neighbours. This will typically consist of a combination of education, breathing/relaxation techniques, and appropriately challenging exercise. It is often difficult to make general statements about what will work, since every individual will have a different experience.
I understand that this may create more questions than answers for a number of people. Because of how individual all of these experiences will be, I have not found a satisfactory way to outline everything in general terms. If there are questions about what you have read today, please feel free to leave a comment or reach out to our office directly. There will also be a free seminar on February 20, 2019, at our office, where I will be covering these topics and more related to Chronic Pain and management/treatment options.
● Trent, PT
● Modern pain neuroscience in clinical practice: applied to post-cancer, paediatric and sports-related pain. Malfliet, A. et al. 2017. Brazilian Journal of Physical Therapy.
● Neuroplasticity of Supraspinal Structures Associated with Pathological Pain. Boadas-Vaello, P., et al. The Anatomical Record 2017.
● Pain and Plasticity: Is Chronic Pain Always Associated with Somatosensory Cortex Activity and Reorganization? Gustin SM, Peck CC, Cheney LB, Macey PM, Murray GM, Henderson LA. The Journal of Neuroscience 2012.
● Chronic pain-related remodelling of cerebral cortex - ‘pain memory’: a possible target for treatment of chronic pain. Lithwick, A., Lev S, Binshtock A. Pain Management 2013.
● Functional imaging of allodynia in complex regional pain syndrome. Maihofner C, Handwerker HO, Birklein F. Neurology 2006.
● https://www.physio-pedia.com/Chronic_pain_and_the_brain. Retrieved Jan 15, 2019.
The Team at Donald Physiotherapy!