Pain: A Primer

As physiotherapists we encounter all sorts of pain and the people affected by it. Pain is a very complex thing and would require thousands of pages to properly explore, so instead I’d like to focus a bit more on how we as physios interpret your pain and the information it provides us. The hope is that after reading this article you have a better understanding of why we ask the questions we do and what that tells us about the pain you feel.

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Describe your pain.

What we’re looking for here is to be as descriptive as possible. We want to know if your pain is dull, sharp, tingly, burning, and/or all of the above. These adjectives give us clues as to what might be causing your pain. We also want to know the intensity of your pain. This is usually described on a scale from 0-10. 0 being no pain at all to 10 being the most excruciating pain you could possibly imagine. Although this is varies from person to person, it gives us a good idea as to what treatments are appropriate for you.

When does your pain occur?

I don’t mean at 9:45 on Tuesdays, I mean is your pain associated with a period of the day or activity. Is it worse in the mornings? Does it come on 2km into a jog? Is it the first few steps after getting up from your desk? Again, your pain pattern tells us a lot about the structures involved. Part of this line of questions involves giving us an idea as to how long you’ve been in pain and if it’s getting better, worse or staying the same. While the exact amount of time may not be important, a close approximation is. A 3-day old knee injury is very different from a 3 month or 3 year old one.

Where is your pain and is this your pain?

This tends to be a notoriously tricky question to answer and knowing that, as physios, we’ll try to help you answer with some tests. These tests may be uncomfortable but are very important in nailing down the specific structure involved in producing your pain. If a test elicits pain we need to know about it and we need to know if that’s the pain that’s brought you in to see us.

How does your pain change?

What we’re looking for here is how specific movements and positions change how your pain feels. When I press here does your pain get better or worse? If you’ve been popping an ice pack on your shoulder, does it help? If you bend forward, does your pain go away? While this can reaffirm the structure involved, it also gives us ideas as to how to help you feel better.

Basically, we’ve covered the how, what, when, where and it’s our job to tell you why. When we arrive at the why we can come up with a plan to sort out the pain you’re feeling. The take-away here is to be mindful of your pain and pass on as much information as possible to your physio. It might just save you some unnecessary pain.

 

Elliot Rechtin, MPhysio

Accelerate Physiotherapy

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Not just tennis elbow

Ah, finally, spring is in the air. While the warmth and beauty of spring brings about good feelings for most, there may be a small sense of dread for others. The weeds need to be picked, the roses pruned, and the backhand needs a bit of work if you’re ever going to beat the neighbour in the weekly tennis match.

So, what do you do? You get motivated and set aside a weekend to kick goals. While this may seem like a good idea, you may be setting yourself up for injury…Cue the dreaded Tennis Elbow (AKA Lateral Epicondylalgia)

Tennis Elbow is a painful condition and, as anyone who has been afflicted with it will tell you, is fairly debilitating. It affects the outer part of the forearm just below the elbow and can be characterized by a sharp pinch with certain movements and a dull ache when aggravated. Usually brought on by either a long history of intensive upper body workload or, as above, a sharp increase strenuous elbow usage, Tennis Elbow affects 40% of people at some point in their life. A full 50% of tennis players encounter this pathology at some point in their career and as many as 17% of upper body intensive manual labourers are affected with Tennis Elbow.  The scary thing about this condition is the disability and longevity of symptoms.

Diagnosis is straight forward. A physiotherapist taking a good patient history with a good knowledge of human anatomy can narrow down the diagnosis quickly. The trick is knowing what to do about it.

The best available evidence we have points to exercise and load management as the best treatment. Isolated, focused exercise can go a long way towards fixing the problem while investigation and treatment of the neck and back will help keep the issue from coming back.

Prevention, however, remains the best treatment. Enjoy the spring but increase activity gradually and incorporate lots of rest to smell the roses and banter with the neighbour about how good your backhand has gotten.

 What can we do for you:

-      Diagnosis

-      Education on pain management

-      Tailored exercise prescription

-      Global biomechanical investigation

-      Advice regarding injury prevention

 Author: Elliot Rechtin, MPhysio - Accelerate Physiotherapy

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