Pain is something we all experience from time to time, and pain relief can sometimes be elusive. One of the fundamental concepts within this article is the fact that the experience of pain is actually an output created by the brain. This may seem counterintuitive because when we are experiencing pain it certainly feels as if pain is happening to us.
As a physical therapist seeing patients struggling with musculoskeletal dysfunction, I feel it is empowering to know the truth held within the science of pain, and how the utilization of different input to our nervous system can be used for pain relief.
*Pain is produced by the brain
*Pain is a response to threat, any threat, whether it is truly a threat or not
*Pain is designed by the brain to protect us, even if we no longer need protecting
*Pain is a call to action, the experience of pain is present to change our behavior
*Pain is a personal, individual, experiential, emotional, and multi-system output
*Pain is a complex experience
When we experience an event that creates acute pain, stepping on a nail, breaking a bone, touching a hot stove, our nervous system does its job by changing our behavior. We pull our foot up off the nail, we brace to splint the area around the broken bone, and we remove our hand from the hot stove. We can all see how this response of pain created by our brain is present to protect us. The brain’s number one purpose is to make sure we survive to see another day.
Sympathetic Dominance and Pain
The sympathetic part of our autonomic nervous system is very active in this stress and pain response. This is the part of our nervous system that governs the alarm that sets off a cascade of physiologic changes (release of adrenaline, increased heart and respiration rate, shift of blood to our musculoskeletal system, etc.) required to fight, or to flee, or if the situation is so dire to feign, or play dead. This sympathetic response is designed to be self-limited to the imposed threat.
Once the threat or stressor is removed and the alarm quieted, our bodies are designed to shift back into a parasympathetic state. The parasympathetic state of the nervous system is one of rest, digest, repair, and restoration. But why, at times, do we not make this shift back? What happens if we live with the alarm stuck on and our sympathetic system dominant? And what can we do about it?
Stress is accumulative. We only have so much reserve. We can only take so much input whether this is work stress, emotional, physical, environmental, or nutritional stress. When stressors build, our resiliency to handling the next stress event becomes limited.
When our bodies are under an accumulation of stressors we tend to shift and stay in a sympathetic state and the trigger to our internal alarm becomes more sensitive. This may manifest itself in difficulty sleeping, muscle tension, short temper, digestive issues, slow healing, anxiety, immune system compromise, difficulty concentrating, and heightened pain response.
On the neuro-musculoskeletal front, as the cycle of muscle tension and pain response continues, our body changes the way it moves.
Thomas Hanna, in his book “Somatics – Reawakening the Mind’s Control of Movement, Flexibility, and Health”, uses the term sensory-motor amnesia. Our body literally forgets how to move correctly as our muscles compensate, we become more stiff, we notice another site of pain, we narrow the variety of movements we make, we compensate further, we move less, we weaken, and we blame all our ailments on the “fact” of aging.
This cycle of reducing the variety of our “movement diet”- pain, tension, compensation, inhibition, weakness, pain – creates a situation where movement in and of itself becomes fearful and threatening. Think about it, one of the most important things we require as physical beings – movement – keeps us in a stressed sympathetic state.
How can we break this cycle of being afraid to move the way we were designed?
Changing the Input
Since all of the components of the cycle above are “outputs” created by our nervous system, we can change the way we move by changing the “input” to our nervous system. Whatever has been learned can be unlearned and the body can remember what it has forgotten when provided the opportunity. This is an extremely empowering and exciting realization and one we have chosen to harness in our therapy approach at CHARM.
When we opened our doors in 2011, I felt there was a large gap in our ability to release the grip of muscle guarding and compensation so we could begin to re-pattern proper motor control. If a patient is experiencing pain, there is no way to get the right movement to happen, there will always be alteration in muscle coordination and firing, neuromuscular inhibition and over-activation. There is very little to no opportunity for the body to remember how to move properly again and find pain relief.
In 2012 we discovered and adopted a tool that has been instrumental in treating our patients experiencing both acute pain from a herniated disc or rotator cuff tear to ones in chronic multi-site pain and dysfunction. The Redcord NEURAC Method allows us to off-load a patient’s body weight for pain relief and to reduce fear and muscle guarding while then quickly increasing the opportunity and proprioceptive input to re-establish proper movement patterns while performing 1:1 guided closed chain functional exercises. This method produces rapid changes at a neuromuscular level as patients regain the ability to fire the right muscle, at the right time, and in the right amount.
You can learn more about the NEURomuscular ACtivation Method and pain relief here. https://www.youtube.com/watch?v=ltYyVOQqUZU
In 2020, CHARM added another tool that is proving to be every bit as game changing for pain relief as the Neurac Method.
The NEUBIE – NEUro-BIo-Electric stimulation and the NeuFit Method use direct current (DC) waveforms. Traditional functional electrical stimulation uses alternating current (AC) known to produce protective co-contractions when used at an intensity required to make changes to the nervous system. The direct current waveform used by the NEUBIE is recognized by the body as its own and through a scanning process a trained therapist can quickly identify areas of limited output (weakness/inhibition) or protection (guarding/over-facilitation) present in the neuromuscular system. We see clinically time and again when the brain imposes governors on the body limiting access to optimal muscle firing, strength, range of motion and performance.
NEUBIE Scan and Treatment
The direct current of the NEUBIE is interpreted as load through our neuro-musculoskeletal tissue receptors including but not limited to muscle spindles, Golgi-tendon organs, local sensitivity and inflammation of C-fibers, etc. A brain that senses instability or vulnerability when loaded will feel threatened and produce the sensation of discomfort or pain as discussed earlier. When these areas of neuromuscular dysfunction “hot-spots” are identified, we can more effectively and efficiently treat the source of the problem.
As we guide the patient through proper movement patterns while under progressive direct current input with the NEUBIE, the body-brain connection learns to no longer see this movement as threatening. With the combination of full kinetic chain body weight bearing exercise of the NEURAC and the targeted re-programming of the nervous system using the NEUBIE, we can quickly change the way the body moves releasing muscle tension, increasing range of motion, and balancing muscle firing for optimal access to strength and physical performance.
Function and Structure
As the neuromuscular re-education and functional restoration arm of CHARM, our physical therapists can utilize the NEUBIE to assist in discerning when the dysfunction resides outside of the functional aspects of the system and instead within the structural realm. Regenerative Medicine is the cornerstone of repairing and restoring the osteo-ligamentous integrity of the musculoskeletal system. If there is true structural (ligament/tendon/connective tissue) instability of a joint there with never be optimal neuromuscular control. Again, a brain that senses instability or vulnerability when loaded will feel threatened and produce altered neuromuscular control.
Before regenerative medicine the options were physical therapy (treating the function) and surgery (treating the structure). This is truly why we built CHARM, to fill one of the biggest gaps in musculoskeletal medicine and chronic pain relief – restoration of structural osteo-ligamentous integrity with the use of the non-surgical regenerative medicine approach.
Sympathetic Down Regulation
We began our discussion where I wish to end. CHARM tends to see patients who have seen multiple practitioners, maybe had a surgery or two, and are still struggling and searching for answers. We need to appreciate that chronic pain (no matter the cause) and surgery (no matter what the reason) are trauma and can be ongoing stressors upon the body. When you add on top any combination of the stressors of life discussed earlier, we can find ourselves with a nervous system possessing sub-optimal resiliency. We can find ourselves in chronic sympathetic up-regulation, fatigue, and pain. We discussed the impact of scars on our nervous system in a previous blog and that link is below.
Parasympathetic – Master Reset
Proper deep core stabilization, the neutral resting position of our rib cage, and thus the mechanical advantage of our diaphragm to produce an efficient breathing pattern throughout the day and night are all critical to maintaining autonomic homeostasis. The NEUBIE provides us another powerful tool to treat the entire nervous system using the direct current Master Reset.
The goal of this treatment is to improve the resiliency of the overall nervous system to input, so that the next stressor is not seen as threatening, and we can stay longer and more often in a parasympathetic state. After a few treatments with the Master Reset, we often hear patients report improved digestion, sleep patterns, decreased anxiety and pain relief.
Remember why this is so critical. We must be in a parasympathetic dominant state to unlock the body’s healing and restorative potential. You have everything held within you for pain relief and healing, but the barrier of sympathetic up-regulation must be addressed to optimize full potential.
Michele Zink Harris, PT, CNP, RAS Physical Therapy – CHARM