Self-Management of Pain: Your Physical Therapist as a Guide

Too many medical approaches in today’s society are dependent on others (therapists, doctors, etc) and include passive treatments (medications, injections, etc.).  It can be empowering to take control of your own health and seek active forms of treatment for conditions such as low back pain, arthritis, or even every day sprains and strains.  Self-management allows you to develop a sense of control over your problem and offer you tools to use for a lifetime.  However, many are unsure where to start.

Therapeutic Alliance and Self-Management of Pain

In order to optimize self-management for any painful condition, a meaningful working relationship, or therapeutic alliance, in which the patient and provider work together, should be established.  This begins by developing a patient-preferred approach to treatment.  If you prefer to exercise aerobically then you should not be forced to perform lumbar stabilization exercises for your back pain.  If you enjoy strength training in the gym you should not be prescribed aerobic exercise for your knee pain.  Exercise you enjoy is medicine for the body and mind.  Both forms of exercise have been shown to be beneficial for managing back pain.  Let’s choose together what you prefer.

Developing a positive therapeutic alliance with your physical therapist also allows for the careful monitoring of progress over time.  There are going to ups and downs along the way.  Your physical therapist can help pick you up during challenging times.  Your physical therapist can also progress your plan appropriately when things are going well.  A physical therapist can work as a coach offering constructive feedback and encouragement.   They can help you make periodic adjustments to your self-management program.  With this approach, you are in control of your own health and your therapist acts only as a guide.

The interaction between you and your health care provider has been shown to be one of the strongest predictors of patient satisfaction with physical therapy care, and a key contributor to a successful outcome.  Research shows the amount and quality of the interaction between a patient and their physical therapist has a profound impact for those with persistent back pain.  Taking advantage of these positive interactions will magnify the effects of any exercise program or lifestyle modification. Having the same therapist, will potentially enhance the therapeutic alliance, guide you towards your preferred self-management strategies, and help you achieve the best possible long-term outcome.

What Self-Management Looks Like

Your physical therapist will first seek to understand your beliefs about pain and your condition.  Many people hold negative beliefs which are unhelpful to recovery or they are simply untrue.  For example, many people continue to believe that a herniated disc will never heal.  Your physical therapist will redirect you towards what you can control and strategies to improve self-efficacy.

Often a large amount of active participation over a long time is needed to change unhelpful beliefs and poor lifestyle habits.  Your physical therapist will guide you towards forms of physical activity you prefer and which are appropriate.  It is also important that you fully understand the time it takes for the body to heal itself.  The body’s natural healing mechanisms can be enhanced with the appropriate dose of physical activity.  Start too slow and your recovery will be delayed.  Start too fast and “flare-ups” will kill your motivation. Your physical therapist will help you find the best starting point and teach you how to progress.

Exacerbations of pain are going to occur.  You are going to have “flare-ups” of your back pain, neck pain, or shoulder pain.  This needs to be accepted and expected.  You want to develop resilience for these set ups.  There are always strategies available to help you through these challenging times.  Thinking the worst is never helpful in these situations.  Remaining optimistic is the first step.  Next, identify what is under your control to get you back on track.  This is where your physical therapist can help you focus your efforts.

Closing Thoughts                         

People with persistent painful conditions don’t always need more medical treatment.  They need a coach or guide to show them how to manage on their own with active forms of treatment.  Physical therapists can fill this role.  Developing a positive working relationship, or therapeutic alliance, with your physical therapist will get you set on the right track.  The rest is up to you.

Evidence for Exercise and Neck Pain

Neck pain can be debilitating and limit your quality of life. It may impact your ability to drive, participate in activities you enjoy, and enjoy activities with your family. Luckily physical therapy can have profound impacts on reducing disability and limitations associated with neck pain. Evidence for strengthening of your neck muscles including the longus capitis and longus colli as well as manual therapy provided by a licensed physical therapy can help improve your neck mobility and even improve numbness/tingling in your arms associated with neck pain.

A Case Study using Exercise for Neck Pain

In a clinical case of a 28-year-old individual with neck pain and left arm symptoms, a physical therapy program consisting of manual therapy directed at the mid back, neck, and left arm reduced pain and improved the overall quality of life in just 10 visits of therapy services. The patient also benefited from stretching exercises for the cervical musculature and strengthening of the longus capitis and longus colli. Treatments to improve the mobility of your nervous system can help decrease the numbness/tingling you may experience with neck pain, this is known as a cervical radiculopathy.

Posture can influence neck pain
Exercise for neck pain

Conclusion

See a physical therapist today if you are experiencing neck pain with arm symptoms associated with a cervical radiculopathy to determine if you can benefit from physical therapy treatment, even without a referral from a physician. The physical therapist is trained to determine if treatment is indicated, ask your local therapist today.

-Dr. Steven Ferro, PT, DPT

Reference

Cleland, J. A., Whitman, J. M., Fritz, J. M., & Palmer, J. A. (2005). Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: a case series. Journal of Orthopaedic & Sports Physical Therapy, 35(12), 802-811.

Neck Pain: Postural Correction Strategies

Retraining neutral sitting posture is an important factor in the recovery from of an episode of neck pain and also for preventing future episodes of neck pain. Sitting postural correction becomes especially important for those of us who spend a great deal of our time working at a computer or seated at a workstation of any kind. Most present day occupations and many leisure activities (involving the internet or a mobile device) place the neck and upper back in vulnerable positions stressing many anatomical structures of the cervical spine.

Frequent correction of neutral sitting posture serves two primary functions. First, it allows for regular reduction of adverse loads placed on the joints of the spine due to poor neck and upper back posture. Second it provides a training effect to the deep cervical stabilizing muscles during their functional postural supporting role. The aim of postural correction strategies is to change postural habits, not to strengthen weak muscles. Ultimately this should result in a comfortable low effort strategy which is easily assumed and maintained during prolonged sitting activities. Rigid high-effort correction of sitting posture should always be discouraged as this often results in increased muscle activity and pain.

Key Aspects of the Seating Surface

  • The feet should be flat on the floor
  • The thighs should be slightly inclined downward from horizontal (hips slightly higher than knees)
  • The buttocks should be completely supported by the seating surface
  • Go here for more tips on computer ergonomics

Sequence of Correcting Sitting Posture

  1. Gently roll the pelvis back and forth until sitting on the bony prominences deep within the buttock (ischial tuberosity). This will restore the natural curve (lordosis) in the small of the low back. This first step is the most important.
  2. Without arching or extending the spine, slightly lift the breast bone (sternum). Minimal correction should be needed here.
  3. Finally, slightly lift the back of the head towards the ceiling in order to achieve a neutral position of the eyes relative to the horizon. If steps one and two are performed correctly, minimal to no correction will be needed at the head and neck.

The neutral position should be comfortably maintained for ten seconds and repeated every 10 to 20 minutes during sitting. A timer is recommended to ensure adherence to the schedule. In between repetitions of the postural correction exercise a relaxed non-rigid posture should be assumed. We should not attempt to maintain “the perfect posture” during prolonged sitting. This is not recommended or realistic. Over the course of several days or a few weeks of practice, the neutral sitting posture will be more easily attained without conscious thought. Through self-awareness the body will learn this new strategy just like any other practiced skill ultimately leading to a healthy postural habit requiring little effort or conscious thought.

Now go ahead and try it….then re-read this blog post for reinforcement.

References

  1. Falla, D., O’Leary, S., Fagan, A., & Jull, G. (2007). Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Manual Therapy, 12(2), 139–43.
  2. Wegner, S., Jull, G., O’Leary, S., & Johnston, V. (2010). The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain. Manual Therapy, 15(6), 562–6.