Neuroplasticity – You may have heard this word before? After injury the brain can re-build or restructure its internal connections.
We are going to talk about persistent pain (you may have heard professionals talk about chronic pain) in this blog. It is largely agreed amongst health professionals that persistent pain is pain experienced for more than 3 months (as most injuries have healed and pain disappeared within this time).
So, then the obvious question to ask is why does some pain last longer than 3 months if the injury has healed?
The neural structure or functionality (like a programming system) can adapt or change in the short and the long term. Simply put, this is partly based on the connections between your thoughts and how you physically move. You may observe a decrease in your physical performance, for example, finding it difficult to squat down after developing knee pain and therefore finding compensatory ways of squatting down to the floor.
I think of these ‘changes in movement’ as compensatory habits.
Research suggests that this temporary change in physical performance may be a contributing factor for persistent pain.
Now, you may find yourself going to see a physical therapist to help get out of pain? As well as taking into considering lots of different factors (biological, psychological and social components), the rehabilitation plan is likely to be focused around re-establishing a normal movement strategy and physical goals.
Goal setting and movement therapy will be a significant part of helping you to help yourself to get out of pain.
In a face-to-face physical therapy session, we will observe your movements and check the strength and length of your muscles. We may even feel the local area where you feel pain to see if the muscles feel tight or if any other structures are sore. At the end of the session we will provide you with a home exercise plan which will likely involve slow and controlled movements.
Now, let’s go back to the neuroplasticity bit. Imagine that your brain has a picture board with all your body parts attached on it. When you are experiencing persistent pain, that body part becomes larger than the other body parts on the picture board. Over time this then alters the sensorimotor system. As an example when you touch a hot object (sensory) your body will detect a change, and the body will then react quickly to that hot object by pulling your hand away (motor).
A structural change to that picture board will depend partly on the length of time that person has experienced pain. It will also depend on the extent to which that person has changed their movement patterns to compensate for the pain. Take the knee pain example we mentioned earlier. An individual with knee pain may limp (something that we have all probably experienced). Limping is a symptom of pain and is the body’s way of changing the place in which the ‘load’ of the body goes through the leg to minimise the pain. Eventually however, if the limping continues then that person may get used to that walking pattern which will in turn cause secondary and possibly persistent problems in other joints or parts of the body.
Let’s go back to our picture board example. Research has shown that training a muscle in an otherwise healthy individual has shown to increase the motor representation of that muscle in the brain in less than or up to four weeks. This was using varied and new skills or tasks when compared to someone doing general exercise or passive exercise.
So, to re-establish the walking pattern that you were doing before you injured your knee, attention to the skill that you are practising and being mindful of how you are moving, e.g. where you are putting your weight through your feet etc, is beneficial.
Think about what you are trying to achieve by creating an achievable physical goal. It will help with the functional pathway connections that you can make in your brain. Also, mindful exercise will affect the quality of your training, decrease pain and increase what you are able to do.
Complete your exercise programme pain-free! Let me explain why. When you are in pain it can affect your behaviour and thought processes. For example, decreased quality of sleep, less concentration to a task and changes in mood. It can however be typical to feel some discomfort especially when you are changing how you do something or if you perform a new skill or movement.
If you do feel stiff into a movement then practice it. There are so many ways to exercise and to move so explore what works for you. We often stick with what our strengths are, so make sure your don’t go down that rabbit hole as quite likely, that may have been the reason as to why someone would developed pain in the first place. Always thing about balance. Learn to know when to challenge yourself and when to be patient.
There are many benefits to preventing an injury but also learn how to manage an injury in its early stages. This will help to prevent it from becoming persistent in nature.
If you do have persistent pain then understanding how to get the most out of your rehabilitation programme, to self-manage the pain and in lots of cases becoming pain-free is also going to be valuable.