patient empowerment

I believe that it is important that we take a collaborative approach to your well-being. I’ve focused my post-graduate learning on pain science (there is a lot of fascinating current research illuminating the role of the nervous system and the brain on pain perception) and persistent (AKA “chronic”) pain (that is any pain that persists beyond 3-6 months) . This path of learning has led me to understand that a model of healthcare that usurps your own control over your body is likely actually harmful to your wellbeing. I aim to place control of you firmly back into your hands. 

I am one of an increasing number of manual therapists who are embracing a growing body of evidence that indicates that variations in the body’s structure and tissues (ligaments, muscles, bones, joints) correlate very poorly to pain that is felt. Fixating on diagnoses like “tight muscles”* ; “postural strain”; “improper alignment”; “fallen arches”; “degenerating discs”; even  “torn rotator cuff” and other such structural “faults” is likely unnecessary at best and harmful at worst. As Greg Leman explains in his free online book Recovery Strategies Pain Guidebook “you may have been told that your spine is out of alignment, that your muscles don’t work properly or turn on in the correct order, that your posture is horrible, your glutes don’t fire and you have a weak core. The proposed treatment is then about ‘fixing’ all of these things and until you ‘fix’ those things you can’t get back to being you and being out of pain.” However, there is mounting evidence that what causes persistent pain is actually quite a bit more complex than just what’s going on in the body’s tissues. Many factors contribute to pain including inaccurate, negative perceptions of what is wrong in your body (often espoused by well-meaning healthcare professionals); stress; poor sleep; worry; fear; anxiety; past experiences of pain; expectations of pain; perceptions of the body being broken/needing fixing; general health status; nutrition…  the list goes on. 

A useful analogy of what causes persistent pain is that of a cup.  Your body has resilience and can deal with many things that can contribute to the emergence of pain without pain actually manifesting. Each of the things that might contribute to pain (stress, poor sleep, expectations of pain etc.) add a little bit more water to the pain cup. Only when the pain cup overflows is pain actually experienced. 

When we reconceptualise persistent pain in this (more accurate) way it becomes clear that it is imperative that we let go of outdated ideas of bodies needing fixing by manual therapists (an approach that creates a reliance on manual therapists) and instead embrace the new way of understanding pain which puts patient empowerment at the forefront. While passive manual therapies like chiropractic, massage, dry needling etc. can play an important role in reducing your pain, what you do every day is what will have a long-term effect (and the great thing is you have control over that).

What about the pain you feel when you break your arm or sprain your ankle or strain a muscle, for example? Acute pain occurs when there is an injury (though interestingly it doesn’t always occur when there is an injury) and in the absence of systemic conditions or medications that might hinder it, tissue healing follows a very predictable path. Pain that persists beyond normal tissue healing is considered persistent pain and no longer should be treated as “an issue with the tissues”. 

So what do I do to help you with pain?

1. Listen to you. Have you gone through an arduous journey with your persistent pain? I’m here to listen to your story and remind you that regardless of the underlying cause (or more likely causes) your pain is real and pain is HARD. I want to hear your story and I respect your ideas. Or alternatively have you had an incredible experience with for example a chiropractor who’s explained your alignment troubles to you and helped you with your back pain and has asked that your RMT treat your tight pectoral muscles? I respect your views on what is going on with your body and I’ll treat you accordingly.
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2. Help you understand that your body is resilient, and that movement and exercise are often some of the best things for your body in terms of long-term reduction in pain.

    

3. Help you find ways to move your body without causing more pain.

    

4. Provide you with massage therapy treatments for what they’re really good at: helping to reduce pain over the short term and helping your body and mind to relax via an interaction with your nervous system (really powerful, important things).
   
   5. Using the above outlined approach I aim to help you both remove things from your “pain cup” and also build a bigger cup (i.e. greater resilience). 

Here are some really great online resources that delve deeper into the ideas presented above:

The Live Plan Be website (created by Pain BC). 

Dr. Greg Lehamn’s Recovery Strategies Pain Guide Workbook

Dr. Lorimer Moseley’s Why Things Hurt TedTalk 

Understanding Pain in Less than 5 Minutes educational video 

Retrain Pain Foundation

Government of Western Australia Pain Health website “Movement with Pain” 

*“Tight muscles” are something that only you, the patient, can perceive; there is no such thing as an objectively “tight muscle.. If it feels tight to you that’s what’s important and that’s what we’ll work on!