In a year pt spends 3 hrs with Health Practitioner and rest 8733 hours on their own.Pts need to be involved in their pain management as a TeamWe need to educate pts about pain
Fear to cause more damage . Fear Avoidance , Hyper vigilance, pain focus , memory and past Experiences, catastrophisation, feeling out of control, stress and low mood, anxiety and depression
CHRONIC PAIN and THE FEAR TO MOVE
OVERCOMING THE FEAR TO MOVE
12 YEAR CAREER - SPORTS MEDICINE
SPINE & SPORTS PHYSIO
OVER 30,000 TREATMENTS
SPORTS INJURIES & PERFORMANCE
OVERCOMING THE FEAR TO MOVE
Do you have a client who is in a persistent pain
Is your patient an over achiever
Does your patient work more on good days and
less on bad days
Is your client a people pleaser and finds hard to say
Is your client a Can’t Do Person
• More they understand
it is easier for them to
cope with pain
• Sensitized Central
• Soft Tissue healing 36months
Your brain has the final say about what is painful.
You do not feel pain in your tissues.
You feel pain in your brain.
“Are you saying that the pain is all in my head?”
Yep, no brain, no pain!
But, your pain is very real.
As your time living with pain increases, the
involvement of the tissues reduces and the
involvement of the nervous system increases.
Emotions – Fear, anger may amplify pain signal
Thoughts- Self defeating thoughts “I can’t stand this” –
Giving up make experience worse
Behaviours – feed back to brain about severity of problemEg asking help for simple tasks, giving up enjoyable activity
turning down invitations, staying in bed
Social Responses – negative messages “you are a burden”
extra help – if told sick, helpless difficult to not feel that way
After the age of 25, most of us
will have some NORMAL
degenerative changes. One
study showed that up to 35%
of people who have never
experienced low back pain
had herniated discs
(Weishaupt D et al). Instead
of dwelling on what was seen
on the image, we should be
more concerned about
dysfunctional joints and
muscles. Maybe it’s bad
posture, joint restriction, poor
lifting habits, or instability that
Acceptance of pain …… the moving on
Building a Support Group –
friends, family, Dr, PT, OT, Dietician, Psycologist, Pain
Being Patient with themselves
Learn to prioritise and plan out everyday
Activity – Exercises and Stretches
Dairy – Track progress
Have a set back Plan
Learn Relaxation Skills
, Distraction, Mindfulness, Cognitive Behavioural
Activity goals should be set in three separate domains.
The physical domain is the exercise program the patient follows
and includes the number of exercises to be performed, the duration
of exercise, and the level of difficulty.
The functional domain involves tasks of everyday living such as
housework or hobbies.
The social domain relates to pleasurable social activities (e.g.,
visiting friends, going to church or the movies, going for a walk).
Goals must be personally relevant, interesting, measurable, and
Goal setting should be a matter of negotiation between the
patient and the therapist.
The use of goal-setting charts is essential
Set a target for activities each week
Record your achievements on the chart,
Note the nature of any difficulties and how these will be
tackled next time, and make other comments.
For example, comment on your performance or on the
appropriateness of the goals you had set. In this manner
you and your PT can monitor your progress and improve
you accuracy in goal setting
• Pacing involves
a daily activity routine
that is easily achievable.
• Discuss activities pts
used to enjoy doing
but avoid due to pain
• Activities can be
gradually increased by
number of movements,
distance or time.
Gradual, controlled increases in general activity level will avert
triggering sudden increases of pain that lead to reduction of activity.
Eg. Can be used for any type of physical activity including specific
exercises, household tasks, hobbies or work duties.
Can do on a
Can do on a
Sitting at a
to mid thigh
Pain is not directly related
to strength of pain
signal, disease severity
and tissue damage
Don’t Use- no Pain no
Gain, let pain be your
PAIN so you don’t fear it
Hurt does not always
equal harm but doesn’t
mean you go do a
Too Much Activity
In order to catch-up
In order to recover
SET BACK PLAN
It is almost inevitable as CNS is so sensitive and trying to
Relapse may be due to an individual physical event or it
may result from cumulative physical and psychological
Patients must Discuss with GP, nurse, PT to help to
identify situations that are challenging and develop
strategies to cope with them.
Strategies may include setting criteria to visit health
professionals, to use pain medication, or to briefly rest
and relax, meditation.
SET BACK SELF-MANAGEMENT
Activity modification (e.g. changing the pacing
parameters, altering the time of day, even the room and
Active rest periods (breaking up activities into sections
including having rest breaks),
Relaxation (e.g. breathing, music, gentle stretches),
Mindfulness based stress reduction and distraction.
Remember : flare-ups end and more angst triggers further
physical responses and pain.
Short Term &
Butler, David S., and Mosley, C. Lorimer. Explain
Pain, First Edition. Australia: Noigroup
Doidge, Norman. The Brain that Changes Itself.
USA: Penguin Books, 2007.
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