Injury Rehabilitation

Last Sunday, three St. Louis area massage therapists met to watch a video recording of Peter O'Sullivan's keynote address at the 2017 San Diego Pain Summit. The subject of O'Sullivan's address was A Paradigm Shift in Understanding and Managing Low Back Pain.

Christopher Moyer, Ph.D., is a psychologist who has done research in massage therapy and meditation. He recently began a blog on research and massage therapy and I was honored that he asked to interview me for his blog.

I first got to know Chris when I heard that he’d done a metaanalysis that overturned what a lot of us thought about massage lowering cortisol. Curious, I looked him up on the internet and sent an email asking about his paper. Shortly after, I encountered him again in online discussions and it led to a friendship that was both professional and personal as we discovered we had many common interests.

"Did you hear about the study of the MRIs and herniated discs?" It was 1995, I was working at St. Mary's Hospital, and one of my fellow massage therapists had news about a surprising piece of research. In those days before the internet it was difficult for us to get information about studies of interest to us massage therapists. A juicy tidbit like this was cause for excitement.

If I could make only one recommendation to individuals living with chronic pain, it would be to read the book Explain Pain by David Butler and Lorimer Moseley.

Directed at both clinicians who work with chronic pain patients and patients who live with chronic pain, Explain Pain shows how the discoveries of modern pain science can be put to practical use. Written in understandable language with a touch of lighthearted humor, Butler and Moseley take a complex subject and make it possible for the average person to understand and use. One client remarked that she thought it would be hard to read and was delighted that she did not find it difficult at all. 

One of the things I particularly enjoy about having my own independent practice is that I'm able to take time with my clients. Most of the time I have to stay within the bounds of a schedule or my day would be unmanageable. However, I'm able to control my schedule so that I don't have to feel rushed. If something comes up near the end of a session, I can take a few extra minutes if that seems necessary. 

Not long ago a new client came with a difficult pain problem. She had a complicated history. I wanted to be able to listen to it carefully, to be able to ask pertinent questions, and not be rushed. I had a break after the appointment so I asked the client if she was in a hurry. Even if I had the time, perhaps she didn't. However, she had no appointments to keep and so we were both able to relax and discuss her history in detail. 

During the past couple of years I've learned a lot about how pain works and have become convinced that pain education can make a valuable contribution to managing chronic pain. I thought this particular client might find this information helpful, so we discusses how pain works and how she might make use of that. 

Graded exposure can be a useful technique for persons living with chronic pain. Graded exposure is a method of finding movement that is pain-free and building on that. The idea is to break the brain's association between a particular movement and pain.

Got back pain? Call us!

Low back pain is one of the leading causes of disability in the United States. Everyone knows someone who suffers from back pain and most Americans will suffer from it some time in their life.  In spite of its prevalence, successful treatment of low back pain remains elusive. No one has consistently good statistics in the treatment of low back pain.

What can we offer you?

We cannot promise results. However, we can promise this:

Low back pain is one of the most common and persistent pain problems, affecting millions of people. Besides working hands-on with clients, I try to help them understand how pain works and to find ways they can continue to help themselves at home.

Cory Blickenstaff is a physical therapist in Vancouver, WA. My clients have found his videos on "edgework" and "novel movements" to be helpful and enjoyable.

"Edgework" is finding the point in a movement where it begins to transition from easy and comfortable to slightly guarded or painful. Movements should be done slowly, watching carefully for the first sign of holding the breath, muscular tension, or pain. The movement presented in the video is one possible movement. Other movements can be used as "edgework" using the same approach.

"Novel movements" are movements that are a little different from the way we normally move. As Cory says, they are movements about which the brain has not yet formed an opinion. By practicing novel movements, we can try to find movements that are not painful and break the association between movement and pain.

I've been learning a lot about the role of the brain and the central nervous system in our experience of pain. One of the people who studies this and writes about it is Lorimer Moseley, co-author of Explain Pain. His TED Talk explains, in 15 minutes, some important discoveries in pain research.