Pain relief from manual therapy

Manual Therapists [physiotherapists, chiropractors, osteopaths, massage therapists, acupuncturists]  are genuinely intent on patients experiencing pain relief.  But patients with long-term pain need to realise that therapists can only relieve the pain – they cannot diagnose, fix or cure the whole chronic pain condition!

Therapists ask for and listen carefully to the current symptoms. They differ from most doctors in that they locate the area where the pain is stemming from and they work on the problem with their hands according to their specific discipline. It can really surprise me to find out that the source of my problem is in another part of my body. I often take a permanent marker and get them to mark crosses on my back so that when I get home I can see in the mirror where the offending sites are. Therapists also give valuable recommendations for managing the recovery from a painful episode – certain types of exercise, avoidance of certain activities, applying ice etc. Now that I have a proven way of treating pain with microcurrent therapy I still learn so much from them about the optimal site to place electrodes. This helps me to follow through on the pain relief I gain from an appointment. I highly recommend going to a therapist in times of dreadful pain as the information they supply will help you to manage your pain as much as the treatment they give.

I turned to a chiropractor in 1988 after my GP could not determine what was the matter with me and could only recommend paracetemol which seemed completely ineffective in diminishing the pain. At the time if felt like my right buttock and leg were on fire. In fact chiropractic treatment was the only thing that afforded me pain relief – not massage, not exercise, not tablets, not rest, not physiotherapy. It took years before it became clear that there was an underlying systemic condition and not just unrelated parts of my body breaking down. No wonder therapists would suggest conditions or injuries as they worked piecemeal on my body : whiplash, RSI, piriformis syndrome, sprained ankle, sciatica, stress, all-over muscle tightness, a very tight iliopsoas, tennis elbow and candida. This of course would lead to admonitions about having the correct posture, becoming more relaxed, changing my whole lifestyle, building core body strength, undergoing a course of dry needling, trigger point therapy or direct myofascial release, doing a detox, changing my diet, taking supplements, stretching and lengthening various muscles. I did all of this and more!

I should just say here that different therapists may describe my symptoms differently. Whereas the chiropractor may refer to the L5S1 joint, the physiotherapist will talk about the hip flexor muscle and pelvic girdle and the massage therapist might notice that the gluteus maximus is tight and another might talk about the need to strengthen weak abdominal muscles. I can always look up these terms under ‘Images’ on the internet to get a clearer idea when I get home from an appointment.

Appointments with therapists take time and money, and there can be one massage therapist, for instance, who really helps and another  who is useless. It will be a matter of trial and error. And money. There are additional things therapists may recommend such as taping a part of the body to immobilise it (absolutely the wrong thing for me!) or buying a foam roller (agony for my iliotibial band!) or a special BakBall (2 joined balls) to undo the nerve tension in my spine (too severe!). More money, appointments and frustration.

Examples of therapeutic aids that are ineffective for my condition

Examples of therapeutic aids that were ineffective for me

Here are some other things I spent my money on to no avail:

  • I really couldn’t tell if the Piezo  (needle-less acupuncture device) had any benefit.
  • Dry needling seemed to do nothing.
  • Cupping might have been slightly beneficial but I now steer away from glass fire cupping since I once got burnt – this meant I could not apply the electrodes to that area until the skin healed.
  • Ultrasound seemed to inflame the area and it took ages for the inflammation to subside.
  • Various back supports seemed to push into my spine at the wrong site and accentuate the pain.
  • Cranial osteopathy resulted in severe headaches.
  • Some acupuncture worked slightly and some was too strong and brought on headaches. A ‘course’ of acupuncture seemed to deliver pain relief in the lower half of my body but after I stopped treatment the pain simply regrouped and manifested itself with the same intensity. If I was able to have acupuncture every single day then perhaps …

Some things were worth the money:

  • I bought the Trigger Point Therapy Workbook to understand where pain might be radiating from.
  • A handheld Squirrel Massager for tight and aching muscles has been beneficial.
  • A new kind of tape – Kinesiology tape – which supports the problem area but does not restrict it.
Trigger Pont book and Squirrel Massager were beneficial

Trigger Pont book and Squirrel Massager are helpful for me

When I was still extremely confused about all the pain I was experiencing it was a physiotherapist who suggested that it was not normal for me to have such strong pain for the type of muscle tightness and joint restriction that kept recurring. I got a referral to a Pain Clinic in Auckland and this lead to an initial diagnosis of fibromyalgia. I now have doubts about this diagnosis but it was a help for me to understand that there was ONE actual syndrome to explain all the diverse ailments I was suffering.

In earlier years I would often feel frustrated and disappointed after a physical therapy treatment – either it stirred up the pain or it did not do enough to alter the pain. Now I have different and more reasonable expectations. Why should I expect therapists to make me better when doctors have not been able to? I have come to realise that I must not expect solutions to the pain but that I will probably get some pain relief which will gradually help me to pull out of a very strong episode of pain.

And nowadays I don’t enrol therapists in a detailed history of my chronic pain. I am the person who is most able to manage the different areas of my body that are involved.  I limit myself to the particular site that is giving me the most pain. I get as much information as I can from the therapist and then I go home and experiment with the Painmaster patches until I find the optimal site that will bring the maximum pain relief. See an earlier post on Mastering Pain.

Painmaster

Painmaster

You can also refer back to the Number 1 Principle For Reducing Pain which supports manual therapy if it brings you pain relief. Constant pain is the driver of chronic pain so if you can find any way to reduce pain by a therapist’s treatment then you are allowing your nervous system time to rest. It’s such a blessing to find a good therapist!

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Chill out!

If ever I get into a dreadful episode where one part of my body will not stop ‘burning’ then I can switch off the pain for a while by applying an ice pack.

Ice can be used if you twist an ankle, if you get a bee sting, after chiropractic treatment and after some operations. Many health professionals recommend alternating ice and heat for inflammation and only applying them for short periods e.g.http://thephysiostudio.com.au/health-tips/ice-and-heat-application/ . 

An eHow article identifies whether heat or ice or both are suitable for different types of medical conditions – and quotes orthopedic surgeon Dr. Stephen H. Hochschuler that ‘ice should… not be used for patients who have rheumatoid arthritis, Raynaud’s Syndrome, cold allergic conditions, paralysis, or areas of impaired sensation’. This article also says that heat is most often used for chronic pain conditions such as arthritis. So be warned by my Disclaimer as I want to explain what has been an effective tool in reducing my pain but it is outside the above medical advice. 

It started when I did not have access to any of the electrotherapy devices I will describe in other posts. I could sit in my own special chair (which I dragged from home to many social occasions) and in my own special seating in the car to keep my pain levels low. But holidays posed excruciating problems with seating on plane flights (I would stand up when possible), in motels, restaurants and hire cars. Sitting in these would set up an unremitting burning sensation in one buttock and leg. When we decided to fly to Queensland for a family holiday I became absolutely desperate. How could I manage the pain so that I wouldn’t spoil the holiday? The thought came to me to use an ice pack so that I could numb the pain. In this way a campaign began to freeze my butt off!

The ice treatment worked so well that when I returned home I started carrying a small esky wherever I went. The esky contained several icepacks and an ice brick with a tea towel or two for wrapping up the icepack. The tea towel meant that the ice pack didn’t directly touch the skin (or else you can get an ice-pack burn!). And the more I did this, the less I experienced pain – which lines up with the one principle for reducing pain : the more pain relief you can provide the more the nervous system is damped down and the pain levels are lowered. It felt like I was helping the entire buttock area go to sleep and forget the pain. 

old styrofoam esky complete with ice pack covers

old styrofoam drink cooler complete with ice packs & covers

Ice is never going to be a complete remedy. Sometimes the pain in my butt has been too strong for the ice to control. But it is a good way to help stabilise the area and to use in conjunction with other tools. I had already noticed years ago when swimming in the surf and diving under the waves that the chilly water soothed my headache. Sometimes I will tuck an ice pack up under the base of the skull on one side or drape it round the back of  my neck and shoulders and this can mitigate a few headaches. If you’d like to try a safe alternative you could consider rubbing something such as Mentholated Ice Gel (widely available in supermarkets and pharmacies) around your neck and shoulder tops. Of course if you wake up one day and your neck is stiff and you can’t turn your head then draping a hotpack around the back of your neck is best. Don’t use ice in that situation.

As a matter of fact, heat is one of the worst things that can really ramp up the level of pain I am experiencing – such as working out in the garden for a couple of hours in high heat and humidity. I can almost guarantee that I will activate high-level pain when I have a spa (buttock-ache) or sauna (headache). One musculoskeletal specialist said that this reaction to heat is just another indication of how my myofascial pain is intertwined with my nervous system.

You probably don’t have this sensitivity to heat but you can still trial this ice treatment – but only do it for 20 mins – and track whether cold (or heat) alleviates your pain. I know that my first instinct years ago was to reach for a hot wheat pack so I wanted to mention this basic type of pain relief in case you have never tried ice.  You don’t need to adopt my  practice of constant ice packing but I can say for myself that it has never given me an adverse effect in all those years. It has actually helped me to chill out mentally too – my mind can switch off from the pain for a while.  Many is the time I have gone to bed not with a hot water bottle but with an icepack wrapped around my buttock!

NOT snug as a bug

The one principle for reducing pain

One principle must be uppermost if you wish to reduce your pain.

To reduce your pain you must reduce your pain.

I emphasise this because although it appears to be a sensible and inherently obvious principle I have experienced a common attitude from others that I should carry on regardless of pain and ‘just get on with it’. There was a theory at one pain clinic that the more a person experienced the pain the more they would get used to it mentally and so be able to minimise the pain. Perhaps with other types of pain this works but in my experience this is completely the wrong approach.

Let me explain.

The more you experience chronic pain the the more pervasive. extensive, intensive and prolonged the pain will become.The longer the pain persists the more difficult it will be to get rid of it.

Number 1 Principle

Number 1 Principle

Calm down.

If medication cannot reduce the pain enough then you need to find out for yourself what does. Keep track of the things that seem to make your pain better or worse. Don’t think you are being a hero by ignoring the pain or pushing through the pain because you are actually exacerbating your condition. Of course there are certain situations beyond your control when you will simply have to endure pain. And certain occasions when it is worth enduring the pain. Otherwise, wherever possible you need to arrange your lifestyle so that you are not putting pressure on your nervous system.Or else you will pay for it later on.

So Fellow Chronic Pain Sufferers,

If this makes you feel like yelling at me,

‘I’ve tried everything I can and I still can’t reduce the pain’

then keep reading the blog

as step by step I will share things that have made a definite reduction in my pain.