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‘Use it or lose it’ could be a key for persistent pain

Everyone is familiar with the phrase ‘use it or lose it’. Despite it being cliché it actually does apply well to lots of facets of our lives. If you don’t use your vacation days in a calendar year, they may go away. In some places, if you don’t vote for several years, you can be stricken from the voter rolls. And, of course, if you don’t use your muscles your body—greedy little energy saver that it is—will cause them to get smaller. But it’s not just your muscles that are negatively affected if you don’t move much. It is also your brain.

Neuroplasticity is the idea—now well-established—that your brain’s physical and chemical characteristics are changeable and are, in fact, constantly changing. The impetus for this constant adaptation is the signals transmitted to and within your brain throughout the day.

We know that repetitive use of a body part improves its representation in the brain. That knowledge forms the basis of stroke rehabilitation, for instance, where therapist and patient practice hundreds and thousands of repetitions of various arm movements to improve the representation of that arm in the brain. The result is that the patient gets better control of that arm, not just through muscular strength but also through brain-muscle connection.

Our brains have specific areas dedicated to motor control and sensation. Within each of those areas there are actually discrete sections for every part of our bodies and the size of each area is directly proportional to how well we can sense and how finely we can control that body part. For example, the area for the thumb is much larger than the area for the thigh. Even though your thigh is bigger than your thumb, your thumb is much more sensitive and dexterous than your thigh, so your brain has much more neurons dedicated to your thumb’s control and sensation.

The motor and sensory areas of the brain have specific regions that represent every part of your body.

Moreover, the finger representation in a violinist’s brain is likely larger than that of a truck driver’s since the violinist is constantly using her fingers in nimble and delicate ways. More practice makes the brain area larger. The brain is able to detect what is going on better and able to send signals to control it better.

The opposite is also true, and this may have big implications for persistent pain. If you don’t use/move a particular body part much, that part will lose representation in the brain. The brain will be less able to detect what is going on with that body part and it will have less ability to finely control what that part does. This is the essence of the “garbage in, garbage out” phrase.

How does that lead to pain? Pain is a sensation created by your brain (just like vision or hearing) when it perceives a threat based on information it gleans about the body. If the brain thinks a part needs protecting, you will probably feel pain in that area. If the brain isn’t getting good information about a body part because its representation is so small it may make mistakes and conclude that the area is in danger and needs protecting. This connection between persistent pain and body part representation in the brain has been studied and confirmed with back pain, neck pain, and complex regional pain syndrome.

So, if you rarely move your back except to bend forwards and spend the rest of your time with it still or resting on a chair or bed, the area of representation in your brain can start to get smaller. That can lead to subpar or garbled information about your back reaching your brain and increase the likelihood that your brain will perceive normal sensations as threatening. Voila! Back pain. (I use back pain as an example because it is so common, but this goes for pain in any body part.)

The more pain you have, the less likely you are to move, the smaller the back’s representation in the brain, pain increases in the back, you move less, etc. Breaking that cycle involves movement. Movement is the stimulus that helps redefine and enlarge the body part’s representation in the brain. That is why I advocate moving your back in all directions, not just bending forward. It is why I encourage the pelvis tilting exercise, because it makes you concentrate on movements of individual vertebrae rather than the whole back as a block. (Some people find pelvis tilting as difficult as wiggling their ears, evidence that their brain is not well connected to their back.) It is why movement therapies like tai chi and Feldenkrais that force you to move precisely and thoughtfully can help decrease pain and are often encouraged for people with persistent pain.

Todd Hargrove writes eloquently about this idea in his two books A Guide to Better Movement and Playing with Movement, but the crux of it is: we need to move often. It’s even better if we take some time to move certain body parts in novel ways. Try moving sideways or rotating, bending and twisting, moving fast or very slow. All of it will stimulate your brain and maintain or improve your virtual body’s representation within your brain, which will allow you to perceive it better and have better control over your body. And who doesn’t want that?

So, when it comes to your body and your brain, use it or lose it. The consequences may not just be that you get weaker or can’t play the violin as well as you used to. You may also be setting yourself up for pain in the future, or ensuring that it sticks around.

Safety Precautions for Our Patients During the Coronavirus Pandemic

From the outset, physical therapy clinics have been considered essential businesses during the pandemic. However, when New York City was first struggling with the coronavirus we determined that it was unwise and unsafe to remain open and perhaps risk adding to the burden on the healthcare system. Instead, we made good use of telehealth for those that still needed physical therapy.

With the number of new cases declining and the hospital system in a better place we have decided to begin a limited reopening of our in-clinic services. The safety of our patients and our employees is paramount, so we wanted to detail how we plan to keep you safe should you decide to come to our clinic.

We created this plan by consulting several expert public health guidelines including those of the CDC, the NYC Department of Health, the American Physical Therapy Association, and the New York Physical Therapy Association.

How will we identify possibly sick patients before they enter our clinic?

  • We will send patients automatic appointment reminders with a list of symptoms. By confirming your appointment you will be confirming that you do not exhibit the symptoms listed and aren’t sick before each appointment.
  • We will meet you in the building lobby and ask a series of screening questions to determine if you might be sick.
  • We will check your temperature with a non-contact infrared thermometer. Temperature must be below 100.4 degrees Fahrenheit or 38 degrees Celsius.
  • We will cancel your appointment if you show signs of being sick. We can always do an online visit instead.
  • We will waive your cancellation fee if either you or we cancel your appointment because you feel sick or might be sick.
  • All of our employees will complete the same screening before starting each day to ensure they aren’t sick.

How will we keep you safe when you’re in our clinic?

  • We will have plenty of hand sanitizer and facial tissues available.
  • We will continue to wash our hands between every patient encounter.
  • We will insist that you wash your hands immediately upon entering our clinic.
  • We will continue to sanitize the treatment tables with virucidal cleaner between each patient.
  • We will wear masks and gloves, and change gloves between every patient.
  • All patients will be required to bring and wear their own mask. We cannot allow you to enter if you don’t have a mask. Unfortunately, because of supply shortages we cannot provide masks for our patients.
  • Appointments will still be 45 minutes long, but we’ve added 15 minutes between each appointment to allow time for cleaning.
  • We will clean all of the treatment surfaces, the waiting area, the dressing area, and any items and equipment that were used. Our pillows have plastic coverings that will be cleaned each time and they will be covered with a clean towel or pillow case.
  • We ask that patients try to change and leave within 10 minutes of the end of their appointment so the next patient may enter 5 minutes early. Similarly, patients will not be allowed to enter more than 5 minutes before their appointment time to allow the previous patient time to change and leave. It’s recommended that patients arrive already wearing their workout clothes.
  • We will stagger our appointment start times by 30 minutes so that patients will not be in the waiting room or dressing area at the same time as another person.
  • We will only have two physical therapists working at a time. One will work in the front treatment room, and the other will work in the gym area to ensure the most separation between patients.
  • We will not re-use elastic exercise bands. We will give each patient their own and encourage them to bring it with them for each appointment.
  • All paperwork can be done online so you avoid touching high-contact objects like pens and clipboards.
  • We will encourage the use of contactless pay methods like Apple Pay, but we will also sanitize our payment tablet between each use.

We look forward to seeing you again in our clinic! We will also continue to provide online physical therapy visits to those who want them.

Is Back Pain Avoidable?

After people with back pain finish their course of care with us and are feeling a lot better, their next, logical question is, “How do I keep this from coming back?”

If you’ve never had back pain, you may wonder, “Is back pain avoidable?”

Ah, those are tough questions, indeed.