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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The most difficult thing about chronic pain

I found the most difficult thing about chronic pain was that it turned me into something I didn’t want to be. Perhaps my personality type would always have meant that I was going to be super-organised and highly motivated but chronic pain resulted in me becoming very tense and angry as I attempted to control factors that I thought would minimise the pain. I lashed out at those I loved most and this only made me feel guilty that I was not the mother and wife I had dreamed I would be. This grew into a deep sadness about myself. As time went on and the pain only grew worse I felt trapped as all my efforts to overcome it were useless and the medical profession seemed to be at a loss to help me.

When I look back at myself now I am amazed that I managed to do as well as I did. I know that inwardly I was putting my children’s and husband’s needs before my own while all the time I was longing for someone to come and nurse me. Perhaps the pressure to keep caring for my family kept me grounded. I simply did not have the choice to cave in to sorrow. And anyway I did so love them! I did so want to care for them!

Certainly by the time I presented at the first Pain Clinic – after about 18 years of increasing pain – I think was showing the psychological strain of trying to rise above my condition. I was confused about what was wrong with me and I seemed to be hovering perpetually on the edge of break-down.

stretched to breaking point

stretched to breaking point

 

Recently I watched a program called *The Secret World of Pain, a documentary produced in 2011 by the BBC program ‘Horizon’. The thing that most stood out for me were the last 2 pain sufferers. One was crying almost continuously, as if begging for pain relief. The other was holding back a lake of tears but when she experienced pain relief she opened the gates little by little so tears could flow.

In an instant I recognised myself and what can happen to humans who are subjected to relentless pain from which their minds are unable to rest. When you are the person in pain it feels as if you are being heroic by not crying too much and yet the tears you do release seem to be too much for others to cope with. I’m not talking about feeling emotional after only several months of pain – in 1989 when one side of my lower back and leg first became inflamed I was the very picture of optimism. I soldiered on with 5 young children, a husband whose work was demanding and a faith that God would help me sort it out.

But when the pain has gone on for ages, when the pain is often strong and causes sleep deprivation, when no treatment seems to alleviate it and others have exhausted their efforts to help THEN it is extremely difficult to maintain emotional equilibrium. I have cried in all manner of ways– sobbing quietly on my own, hysterical crying, a few tears filling the eyes or sliding down the cheeks, crying in the morning, crying in the evening, crying at anytime – even in cafes because I’ve been beyond caring how I look or how it makes others feel.

And then I stopped crying (well almost)! Because it didn’t change the pain. And sometimes it even made the headaches a lot worse. Also, why cry, when the people who love you can’t do anything more to help. It seems better to spare them some of the agony. But at the back of my throat there was a hurting sensation as if I was holding back a river of tears.

I didn’t want to have the pain but I didn’t have a choice. I simply had to learn how to be a loving person as well as carrying the pain at the same time. My secret is that God kept speaking to me as I would read the Bible in the mornings – somehow I was able to draw strength through spending time with him as my friend. It wasn’t that he spoke to me a lot about dealing with the pain, rather that he was able to concentrate my mind and energy on other thoughts, hopes and plans. I still felt like I was pleasing him and this gave my life such meaning and purpose. And by daily experiencing his close presence it didn’t feel as if I was alone while in pain or that he didn’t care about the pain.

Nowadays he has given me so much to alleviate my pain that I can never be grateful enough. And I haven’t lost the love of my family as I have seen happen tragically to others when they have been overtaken by the misery of constant pain.

There is a time to cry and a time to refrain from crying. There is a time to push through for medical help and a time to wait. But there is always a time for meeting with God. And God will give me what I need today to deal with this day.

Two pale-headed rosellas enjoying the blue berries on a dianella.

2 pale-eahed rosellas enjoying the blue berries on a dianella

Look at the birds … your Father in heaven feeds them day by day (Matthew 6:26)

 

*  The Secret World Of Pain, a BBC documentary which can be watched at

https://www.youtube.com/watch?v=75wkm9NTOb8

 

Microcurrent units

If you have discovered that Painmasters deliver the pain relief you need you might like to consider a more permanent form of microcurrent therapy. Here are 4 units I have some experience with: Micro 300, Micro 400, Micro 850 and MicroPlus.

different microcurrent units

different microcurrent units

In 2004 I went back studying after a very long break. I had no means of pain relief other than exercise and low-level medication. The few years in Auckland when I was able to purchase a continual supply of Painmasters had long faded away. I realised that attempting the course might bring about a nightmare of pain (mostly from the need to sit at computers) and so I went to the internet and typed in ‘micro current’ in the wild hope that there might be something out there that mimicked a Painmaster.

I was thrilled to discover on http://www.medcareservice.com a device called a Micro 300. This website no longer leads to the page on the Micro 300  device but the same unit can be seen at

http://www.3dhealthstore.com/micro-current-300.html

It was going to cost me more than $100 as well as postage from the U.S. It was a big event 10 years ago to order something online and arrange payment for it while living a whole ocean away from the source. I don’t know how many times I read and reread all the information on the site before I took the plunge – a plausible explanation was given on the website as to how microcurrent could address pain. When the case arrived I was nervous all over again in considering how to adjust the settings to achieve something similar to the Painmaster device. After reading the Micro 300 booklet I chose some settings and switched it on. After only a couple of days of experimenting I found the optimal settings and I was in business! All the different seats in lecture halls, tutorial rooms, library and cafeteria as well as computer chairs no longer seemed an insurmountable problem.

trying to make sense of technical specifications

wondering which technical specifications would match a Painmaster

When you remove the settings cover there are a number of choices to make. I can recommend the following selection however you could track some different settings to come to the optimal solution for your own pain condition. Just note that the MicroPlus has a second dial on the outer surface which I generally set in the range of 0.5 to 1.3 ( the lower end of the spectrum).

different settings to suit chronic pain

examples of settings that suit chronic pain

The Micro 300 model has now been replaced by the Micro 400 model. However Medcare Service no longer sells those models or posts to Australia. This forced me to search again and I found Llhasa OMS, a company which has always provided a very good service and you can arrange by email to have the unit posted to Australia. The units themselves come in hard black cases and mostly seem to be made in Taiwan even though they are sold globally. The case also comes with a battery and lead wires  as well as electrodes – I have not found these electrodes to be very durable. All the units have a small flashing light to show the battery is working.

The one which has become my main backstop is the Biomedical Life Systems Micro Plus which I have ordered from Allegro Medical – https://www.allegromedical.com– in the electrotherapy menu. I emailed them and they arranged to post it economically to Australia using DHL.

Lhasa OMS offers the Micro 850 (http://www.lhasaoms.com/Microcurrent-Units.html) at a very reasonable price. In many years of ordering I have only hit one snag  because there are 2 different models of the Micro 850, one offering a 10, 20, 40 minute length of current, another one providing a C(Continuous) 20, 40. The timer needs to be Continuous to address chronic pain so check this out when you email your order.

chronic pain requires the C (Continuous) setting on the Timer

chronic pain requires the C (Continuous) setting on the Timer

Of course whichever microcurrent unit you purchase there are still going to be occasional dramas and costs. You will regularly need to purchase new electrodes and lead wires as well as 9V batteries. You can try buying a recharger for a rechargeable 9V battery but I found that they never lasted more than 12 hours which was too troublesome. Eventually any microcurrent unit will expire after a few years of continuous use. The hard plastic cover for the settings and battery may also fall off.  Not to mention dropping the whole unit onto concrete floors! As a woman, I found I needed to dress in skirts or pants which ideally had a pocket so that the unit could rest in the pocket while the lead wires were threaded under the clothing. Although a microcurrent unit is a health device I always feel it is better to remove it before passing though airport screening and then reapply it before boarding. I just don’t want to make public explanations as to why I’m wearing something that looks like I’m wired to explode.

Purchasing the accessories can be time-consuming but here are a few tips for electrodes and leads if you don’t want to order them from overseas.

Alpha First Aid – in booths at Westfield shopping centres – sell the most common lead wire which fits into the Micro 400 and Micro 850

http://physioworks.com.au/online-store – under TENS Machines – sells electrodes.

http://whiteleyallcare.com.au sell PALS Valutrode Electrodes as well as less expensive AllCare Electrodes as well as the Lead for Allcare TENS (Product Code: ACTENLEADMK5) which is compatible with the Micro 400 and the Micro 850. The way to order to order these products is via www.myphysioshop.com.au.

By searching for a good price I have most recently ordered replacement electrodes from OPTOMO at https://www.optomo.com.au/category/tens-machines/

At the moment I have put the units into a cupboard and am enjoying the freedom of using Painmasters after a gap of 15 years (See  Mastering pain (part 1). No longer do I need to fiddle with settings, check the battery, purchase accessories online or deal with long wires bunched up underneath clothing. I can wear dresses! I can travel! I have proven to myself over and over that the level of microcurrent in a Painmaster – the original model provided up to 20μA (microAmps) and the latest model says 2.7 vDC @ 49μA  –  is a perfect match for removing the sensation of pain. I am so convinced about this Painmaster MCT patch that if I am not experiencing freedom from pain then I only need to move the patch to a slightly different place on my body. Maybe if I have strong pain occurring in a number of places – my shoulder as well as my buttocks – or if I cannot afford to use more than 2 Painmasters at a time, I will get out one of the above microcurrent units and use it in conjunction with a Painmaster.

Buying one Painmaster is a simple investment in finding out whether your pain responds to microcurrent. If it does then you can consider buying one of the microcurrent devices I have described.( Disclaimer) If it doesn’t work then you may not have the same kind of chronic pain as myself. But you have not wasted your money as it doubles as a device for sports injuries, for tennis elbow, for lower backs that ache from lots of lifting or for necks that ache from working at the computer…

Some doctors are sceptical that such a small current could make any noticeable improvement.

I am not saying that it cures chronic pain.

But I am saying that as long as I am wearing the patch in the correct site then it will render the pain negligible.

Doctors may want you to increase the settings on a microcurrent unit to milliamps in the belief it will give you a better outcome

BUT

 the use of a microcurrent for reducing pain is a surprising and wonderful example of how

less is MORE!

Exercise works

Exercise may be the last thing you feel like contemplating when your body is in pain. So let me tell you I would be one of the last people on earth to recommend exercise UNLESS I had found that it really reduced pain. Exercise on its own will never be enough but it can make significant inroads into your pain levels.

Strangely enough I can now remember the different types of exercise I have tried according to places I have lived. In Whyalla, South Australia I began with walking. I would get up before the children were awake and walk a number of blocks. My husband persuaded me to go to circuit classes at a local gym and there I found that the cool-down stretches made a big difference to the pain I was experiencing. This was followed by freestyle swimming at the Whyalla Recreation Centre. I would pay a babysitter to come at dinnertime and off I would go to swim a number of laps. By the time I got home the children were in bed, I would eat dinner and take some Mersyndol (Codeine plus antihistamine) – otherwise I would develop excruciating headaches in the night. I kept up with the swimming regime because it really reduced the pain in the lower half of my body. Much later I learned to swim with a snorkel and mask because this stopped the need to turn my head which brought on the headaches.

Some memorable backdrops to exercising have been

  • Mt Victoria in Devonport, Auckland, NZ.  Walking the dog on the circuit of this mount with panoramic views of Hauraki gulf and the green-blue waters of the harbour.
  • A small secluded beach near Whyalla. Watching multitudes of rainbows fragmenting in the sea around me.
  • A heated olympic outdoor pool in winter in Perth, W.A.. Getting there early to watch the rising mist as the pool covers were removed, breathing in the clean crisp air.
  • The bush pathways around Claremont, Perth.
  • The pathways around the New Farm Park, Brisbane which connect to paths along the Brisbane River.
local landscape whilst walking

enjoying the local landscape whilst walking

Somehow these surroundings have the added dimension of improving my mental state which can be overloaded with pain management.

Altogether, as well as walking, swimming and going to the gym, I have tried PUMP™, Pilates, Yoga, Jogging, Power Walking and Denise Austin aerobic videos – now replaced by other exercise DVD’s such as Increase Your Flexibility with Hun Yuan Tai Chi Chan Si Gong Foundation Exercises (see http://www.taichiacademy.com.au/products.php). Lately I have improved my backstroke swimming and I am currently learning more about Walkactive™.  (Learn about Joanna Hall’s method at walkactive.com)

I have found out for myself that Pilates and Yoga are too difficult for my body and instead of getting a nice deep stretch I can easily strain the muscles resulting in  a long episode of pain. Likewise jogging is too jarring for my body and can leave me with terrible headaches. Conversely ordinary gardening and housework are insufficient to bring about pain relief.

Another important tip I have learnt regarding myofascial pain is to stretch my muscles after the exercise not before. If you want to walk or jog or swim just start off at a slow to moderate pace and gradually build up speed and intensity. Then your body will be ready for deeper stretching at the end of your session.

Let me give you an example regarding the benefits of exercise. Twenty years ago I was attending a *fibromyalgia support group which a rheumatologist had recommended. A speaker talked about the idea of helping this condition by resting. It sounded quite attractive so I put it into practice.  I was running a household with 5 children, and my husband and I were preparing to go away for his long service leave. A few weeks had passed without exercise and I now felt I needed to clean the house  for my mother who was coming to mind the children. After a couple of very intensive cleaning days (barely sitting down) the bottom of one of my feet started to burn. Whenever I put my foot to the floor I experienced significant pain to the extent that I got myself some crutches. I was now forced to spend quite a bit of time resting on the bed. A couple of good friends came and helped with the chores til my Mum arrived. But the more time I spent lying down the worse my whole leg became – sometimes feeling a bit cold or heavy.

I realised that I needed to do something or I would not be able to go on this trip of a lifetime. So I began swimming in a heated pool at Takapuna (I hope those damp change rooms have been upgraded!). This was the best strategy – not to keep staying on my feet as that only made the pain in my foot worse but to keep the leg moving and active in another way. I kept this up for a few days more when my Mum arrived and thankfully I was able to get on that plane. [Years later I learned that the foot pain was stemming from the buttock/pelvis area and the swimming had mobilised that area.]

Obviously the lesson I learned from this was to KEEP on exercising, forget resting – and now if a certain part of my body gets stirred up I still need to keep it in motion but not with the activity that caused the area to malfunction. For instance I currently need to do gentle exercising of my shoulder but I mustn’t keep pulling out weeds as this caused the shoulder to flare up – admittedly we live on a large property and I have been pulling out thousands of weeds so that the land will return to native bush. I have also had to switch the arm I use for the computer mouse as that also fires up my shoulder even through it wasn’t the original cause.

Another lesson I have learned is to take medication with breakfast and wait an hour or so for it to take effect before I start exercising. And I exercise most days of the week.

Over the years I have settled into moderate exercise with many repetitions of the same movement for a number of different muscle groups, while maintaining a good posture. I suppose this is best described as exercises that tone and stretch. I am grateful in particular for  a DVD that provides 10 minute workouts to shape and strengthen the abdominals, the thighs, the buttocks and the arms & shoulders. I find that most exercises therapists recommend for me after treatment are already embedded in routines on this DVD.

Cindy Whitmarsh will be forever young to me. XXX

Cindy Whitmarsh will be forever young to me. XXX

All exercise DVD’s come with a disclaimer and I stress that I am passing on what works for me but you need to work out for yourself what type of exercising suits you best (Disclaimer). You need to find ways of exercising that you actually enjoy and that suit your own temperament or else you won’t be motivated to keep exercising. So don’t be afraid to gradually build up an exercise regime – it will give you pain relief and also stamina to cope with the condition. You may as well have the benefit of looking fit!

* Other doctors have since dismissed the diagnosis of fibromyalgia.

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