Tag: Pain

Now Offering Occupational Therapy!

Admin Good Health

At Good Health Physical Therapy & Wellness, we believe in a holistic approach to rehabilitation. We’re committed to providing comprehensive care tailored to your needs, so we are thrilled to announce that we now offer occupational therapy (OT) as part of our services. By integrating occupational therapy into our practice, we can address a wider range of needs and better support your healing.

What is Occupational Therapy?

Occupational therapy is a vital health profession focused on helping individuals regain independence in their everyday life activities, or “occupations”. This includes any meaningful activity that a person wants to accomplish, including caring for yourself or your family, managing house chores, working, going to school, sleeping, and participating in hobbies, among many others. Occupational therapists assess and treat a range of physical, emotional, cognitive, and social challenges to improve your overall quality of life.

Meet our Occupational Therapist, Emily Randall, OTR/L!

My name is Emily Randall and I am a practicing Occupational Therapist at Good Health. In this post, I want to share with you my qualifications as well as insight into my treatment style.

  • Master of Science in OT from San José State University
  • Bachelor’s degree in Spanish and communications from UC Davis
  • Experience in inpatient rehabilitation treating patients with stroke, traumatic brain injury, amputations, COPD, and post-orthopedic surgery.
  • Experience in inpatient behavioral health administering cognitive evaluations as well as providing group and one-on-one treatment.
  • Believes in mind-body approach to care. Trained as a mindful movement and dance group facilitator and led classes at hospitals, treatment centers & jails.
  • Passionate about providing treatment for adults in habit training, chronic pain and fatigue management, cognitive therapy, neurological rehabilitation, sensory integration, ergonomics, and adaptive equipment evaluation.

Through a combination of mindful movement techniques, neuromuscular movement re-education, health promotion, nervous system regulation, and therapeutic activities, my evaluation and treatment approach centers around improving body awareness and increasing independence in daily activities. In treatments I address physical, cognitive & emotional symptoms to support patients in establishing healthy functional habits and building skills to better manage chronic pain and illness.

I collaborate closely with patients to create a comprehensive care plan that aligns with their goals. If you are curious, you can learn more about occupational therapy and the services OT offers on this page.

Get Started Today!

If you believe you could benefit from my services, please don’t hesitate to call us at 503-292-5882. Occupational therapy appointments are available with Emily at our Northeast and Southwest Portland locations.

Hours: Tuesdays 8:00am-6:00pm | Fridays 9:00am-6:00pm at NE Location – 4943 NE Martin Luther King Jr. Blvd, Portland, OR 97211

Hours: Wednesdays 8:00am-6:00pm | Thursdays 8:00am-6:00pm at SW Location – 4475 SW Scholls Ferry Road, Suite 258, Portland, OR 97225

Taming the Zebra Excerpt 3

Admin Good Health

Website: tamingthezebra.org

Mailing List: https://www.tamingthezebra.org/join-the-email-list

Excerpt from: Taming the Zebra – It’s Much More than Hypermobility: The Definitive Physical Therapy Guide to Managing HSD/EDS, Volume 1 Systemic Issues and General Approach 

(Due out Winter of 2023)

CHAPTER 5

 HSD/EDS and the Skin: Presentation and Management Strategies in Rehab Settings

 As with all EDS presentations, skin involvement varies from person to person and may change in severity throughout one’s life. For this reason, the patient and practitioner need to consider some factors when approaching rehab strategies to avoid exacerbating existing issues. Not all patients with HSD/EDS will present with the issues depicted in this chapter. If a patient or practitioner feels that one of the issues may be present, this is an area to explore individually with appropriate members of the medical team.

 Different classifications of EDS and HSD may have different qualities of skin presentation. Skin hyperextensibility is seen across many different classifications of EDS and more often include cEDS, clEDS, cvEDS, aEDS, dEDS, kEDS, spEDS, mcEDS, pEDS, AEBP1 variant, hEDS, and HSD. Skin fragility (skin that is more easy to tear) is more commonly seen with cEDS, cvEDS, aEDS, dEDS, kEDS-PLOD1, mcEDS, pEDS, AEBP1 variant, and hEDS. Poor wound healing is seen in a variety of severity, more commonly with kEDS-PLOD1, pEDS, AEBP1 variant, and Mast Cell Activation Syndrome (MCAS). Easy bruising is more commonly seen with cEDS, clEDS, cvEDS, vEDS, aEDS, dEDS, kEDS, pEDS, and sometimes with hEDS. Easy bruising that is cyclical (comes and goes) may be more related to systemic flare-ups, such as MCAS reactions.

This chapter presents the different types of skin involvement that might be seen in the clinic and if that issue is present, how to modify treatment or interventions as needed for better outcomes. The individual presentation should always be considered with modifications implemented as needed for the best outcomes in therapy.

 Unusual Skin Presentations

 There are certain skin presentations in HSD/EDS that do not have a major impact on rehabilitation outcomes. For example, the presence of soft, velvety, doughy skin texture does not usually impact therapeutic outcomes but may change manual therapy approaches. Other similar skin presentations are detailed in Figure 5.1.

Skin PresentationDescriptionTypical Location
Molluscoid PseudotumorsAreas of fat tissue herniating through atrophic scarsHigh pressure areas, such as the back of the elbows and front of the knees
Subcutaneous SpheroidsAreas of fat that have lost their blood supply and become firm areas of calcification, moveable under the skinLegs and arms
Piezogenic PapulesSoft, fleshy nodules caused by fat herniating through the dermis (skin layers)Heels and wrists
Hemosiderotic PlaquesDiscolorations of the skin generally found in areas of atrophic scarringShins of those with Classical and Periodontal EDS

Figure 5.1 Common skin presentations, description, and typical location.

While these skin issues more typically present in HSD/EDS are not necessarily something to treat in the rehab setting, it is important for the therapist to note the level of skin involvement and adjust treatment methods as needed to protect the skin from trauma and tearing, and to avoid tissue scraping over these spots as it will inflame, not improve these lumps and bumps. Many will not be able to tolerate tape without a protective barrier applied first. 

Taming the Zebra – Excerpt 2

Admin Good Health

Website: tamingthezebra.org

Mailing List: https://www.tamingthezebra.org/join-the-email-list

Excerpt from: Taming the Zebra – It’s Much More than Hypermobility: The Definitive Physical Therapy Guide to Managing HSD/EDS, Volume 1 Systemic Issues and General Approach 

(Due out Winter of 2023)

Fibroblasts and the ECM (Extracellular Matrix)

Those patients with a structurally-compromised ECM – whether from collagen or proteoglycan
abnormalities – often demonstrate the impaired connective tissue function that we see in
connective tissue disorders (Hypermobility Spectrum Disorder, EDS, Marfan’s Syndrome, etc).
Recent research has proposed that different types of EDS can be attributed to different disorders in the ECM. This research has further identified a common cause of fibroblast dysfunction amongst all subtypes of HSD/EDS. Fibroblasts synthesize collagen, create the architecture of the ECM, and play a role in regulating inflammation. So, if fibroblasts do not work properly, neither will the ECM or any system that depends on the ECM.

For example, Malek and Koster (2021) proposes three factors contributing to the connective
tissue dysfunction: receptor interaction, integrin switch abnormalities, and fibroblast dysfunction.

The first issue is a failed interaction between collagen and its receptor, which seems to be
dictated by what type of subgroup of EDS the patient may have. For example, classical EDS is
associated with dysfunction in the type V and I collagen components of the ECM.

The second factor, the integrin switch, is common in other HSD/EDS subtypes. Here, when a
system recognizes the dysfunctional collagen-ECM adhesion, in response, fibroblasts may
compensate by encouraging the cell to adhere to different structures, like fibronectin rather than collagen, as it goes into “survival mode”. This will, unfortunately, feed into the dysfunctional fibroblastic activity.

The third factor concerns dysfunction found within the fibroblast itself. Not only is there an issue
with the fibroblast itself due to the genetic variation suspected, but HSD/hEDS is proposed to
additionally have issues with cell adhesion in the ECM due to the dysfunctional fibroblasts.
Impaired cell-ECM adhesion further impedes the fibroblasts from being able to regulate
homeostasis within their environment (the ECM and connective tissue).

A newer body of research offers that the pathomechanism of the HSD/EDS spectrum as
a whole may be linked to three stages of dysfunction. First, the specific type of EDS or
HSD will dictate the cause of failure between collagen and its receptor. Second, the main
types of HSD/EDS show a response of the integrin switch that recognizes the faulty
collagen-ECM connection and goes into survival mode, binding other ECM ligands
rather than collagen in an attempt to maintain homeostasis and prevent cell death. The
last stage is dysfunction within the fibroblast itself in hEDS, causing abnormal
connective tissue make-up.

Mechano-Sensitivity and Load Tolerance

There are downstream effects on the ECM structure and function due to altered signals when
cells cannot adhere in the usual way or when the structure of collagen is altered. One
downstream issue is increased “mechano-sensitivity”, which is a response to a mechanical
stimulation on the structure.

The ECM in those with EDS has been found to tolerate much lower loads before cells separate
compared to normal ECM. In normal conditions, the ECM responds to loads by becoming
stronger. More research is needed on how the ECM responds to loads in patients with EDS.
Strengthening studies on patients with HSD/EDS report improved strength, pain, proprioception, perceived function of daily living, and stiffness of joints and tendons, indicating that those with HSD/EDS can benefit from strengthening exercises (see Chapter 19). There is a relatively high dropout rate in the studies and we cannot rule out discomfort with the prescribed exercise program as one of the challenges. It is possible that new parameters for strength exercise progression will need to be created that are specific to HSD/EDS, recognizing the difference in ECM response to load. At this point, anecdotal evidence suggests starting with lighter loads/weights and progressing more slowly than standards set out by the American Academy of Sports Medicine with a lower maximum load at the end of the progression to prevent iatrogenic injuries. This may show a more positive response to a strengthening program as there is less load imposed on the ECM with a slower acclimation period, allowing the compromised ECM to adapt more efficiently.

Basics of EDS – Part 2

Admin Good Health

2022.11.10
Basics, Part 2


Hello, Zeborah Dazzle, PT, WWF here. I am the spokes-zebra and patient educator for Good Health Physical Therapy and Wellness.


As some of you know, while I am a physical therapist who treats all kinds of problems, including all kinds of bone and muscle problems, my special interest is Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD). Sometimes it is wise to pause and go back to basics. That is what I will focus on with this post.


By the way, in the last post while considering the types of Ehlers-Danlos, I forgot to mention that it occurs across all ethnic and racial backgrounds. And for some patients, inheritance is dominant, meaning that only one parent can pass it to the kids (autosomal dominant) and in some recessive, meaning both parents would have to have the gene to pass it on (autosomal recessive).


What is Hypermobility Spectrum Disorder and How is it Different from Ehlers-Danlos?

In the last post, we talked about how 12 of the 13 types of Ehlers-Danlos Syndrome have genetic tests, but that the most common, hypermobile Ehlers-Danlos Syndrome (hEDS, 80-90% of all EDS) does not. This diagnosis is done by a set of criteria. However, there are many patients who may be generally hypermobile but do not fit the formal criteria for hEDS. These patients are then diagnosed with Hypermobility Spectrum Disorder (HSD), which it should be noted does not mean that they have less pain or fewer symptoms than someone with the diagnosis of hEDS – but more on that later.


At this point in writing this, I see that I have already used the word “hypermobility” many times and used it many times in the last blog post too. So, I think it would be wise to consider what this means.


A joint that is too flexible without adequate soft tissue support is hypermobile.


All joints in the body exist in a balance between flexible and inflexible, or said another way, stable and unstable. Some joints are naturally more stable than others with each joint having its own best level of stability. There are a number of factors which hold the bones together so they can do their job. One factor is the shape of the bones. For example, the bones of the skull are shaped like puzzle pieces which fit together closely. A slight suction between smooth joint surfaces which are lubricated with joint fluid (“synovial fluid”) is another factor which holds bones together — like a suction cup on a windowpane but less strong. By far though, the greatest support to the joints is the soft tissue support around it such as the ligaments and the surrounding muscles. Therapists think of the optimal state of a joint as being flexible and strong.


When a joint is unstable because the soft tissues are broken (such as a severe sprain) or too stretchable or too fragile, this leads to too much mobility at the joint surfaces. This is not just a problem of HSD and hEDS. Even in people with normal connective tissue, sprains, strains and sometimes aging can leave joints too mobile. And weak muscles can also cause local problems to joints. Working with this kind of problem is daily fare for physical therapists. But in HSD and hEDS multiple joints of the body if not all are affected by faulty connective tissue not just one or two localized joints.


So, HSD is an umbrella diagnosis for all patients who are excessively mobile in most or all joints of their body. Like hEDS this is thought to be inherited, but no specific genetic mutation is known. hEDS is under the umbrella of the hypermobility spectrum disorder diagnosis, just more specific.


What does the word “spectrum” mean in Hypermobility Spectrum Disorder?


We say that patients with HSD and hEDS are on a spectrum because of the huge variation in symptom levels they can experience. Thinking back to high school, you may remember a thing called a “bell curve”, also sometimes called a normal distribution. This is a graph of how often something happens or how often a specific variable shows up in a data group. With HSD and hEDS, some patients have very few or even no symptoms. In a graph of how many patients with HSD or hEDS have symptoms of different severity, these people would be on the left, mild, side of the curve. Where patients with many or severe problems would be on the right, severe side. Those with moderate problem levels would be the greatest in number and near the average center.

According to the Ehlers-Danlos Society, the occurrence of HSD in the population is about 1/500. This means that out of 332 million people in the US, about 664,000 or .2% are hypermobile. I suspect this estimate is low due to under diagnosing.


I am trying to keep these blog posts bite-sized, meaning about two pages. So, I will continue in the next post and consider the kinds of symptoms that HSD and hEDS can cause, and also what some of the principles of treatment are.


Until then, Cheers! Zebbie


P.S. More information is available at the Ehlers-Danlos Society website. I particularly like this downloadable PDF overview: https://ehlers-danlos.com/wp-content/uploads/EDS_Awareness_2017_v3_img_2021.pdf


Thanks to Dr. Mark Melecki, PT for his assistance in writing this blog. (It is very challenging to type with hooves rather than fingers. Thanks Mark!)

Taming the Zebra

Admin Good Health

Website: tamingthezebra.org

Mailing List: https://www.tamingthezebra.org/join-the-email-list

Excerpt from: Taming the Zebra – It’s Much More than Hypermobility: The Definitive Physical Therapy Guide to Managing HSD/EDS, Volume 1 Systemic Issues and General Approach 

(Due out Winter of 2023)

CHAPTER 2

 Understanding Connective Tissue

The Ehlers-Danlos Syndromes (EDS) are described as a group of heritable heterogenous connective tissue disorders, meaning different genetic variations are present with different classifications of EDS. EDS is not simply a diagnosis of joint hypermobility, but a reference to a connective tissue disorder throughout the body, involving many different systems. Presentation with each patient will be determined by the type of genetic variation identified along with genetic expression, which is further discussed below.

The human body is made up of nervous, muscular, epithelial (skin), and connective tissue. Connective tissue can be found in the nervous and muscular tissue and adjacent to the epithelial tissue. Connective tissue plays many different roles for us within our bodies (Figure 2.1). It helps package and compartmentalize areas of the body by providing support or protection. It can bind and separate organs or other tissues. Connective tissue also plays a role in protection, defense, and repair. It aids in scar tissue formation, inflammation, and defense against invading bacteria or other substances through some of its molecular components. It acts as insulation, storing energy as adipose tissue (fat). It also assists in transportation throughout the body. Blood is a connective tissue that delivers oxygen and nutrients throughout the body. Blood is considered a connective tissue because it consists of blood cells surrounded by a fluid matrix called blood plasma. Fascia is a connective tissue creating a continuous system throughout the body, becoming a means of directing and transferring mechanical forces within the body. If, however, the connective tissue is dysfunctional, this can lead to the transfer of inefficient forces and lead to imbalances and/or restrictions. It is thought that the connective tissue is the medium for acupuncture treatment and explains how needles affect organs from afar. Myofascial release experts purport that memory can be stored in the guarding patterns of the tissue, explaining some chronic, non-responsive fascial dysfunction. Connective tissue is complex and expansive within the human body.

Roles of Connective Tissues Throughout the Body
Packaging and Compartmentalizing
Protection, Defense, and Repair
Insulation
Transfer of Mechanical Forces Throughout the Body
Figure 2.1 Connective tissues assists with many different functions and roles within the human body. A connective tissue disorder can cause issues in any of these roles listed.

Connective tissue is the most abundant tissue in our body, found just about everywhere. It is found in fibrous tissues, fat, cartilage, bone, bone marrow, tendons, the wall of the gastrointestinal system, skin, and blood vessel walls. It also encloses the brain and spinal column. Connective tissue is made up of many different components, primarily elastin, collagen fibers, ground substance (gelatinous material that fills the spaces between fibers and cells), and immune cells. Those collagen fibers along with proteoglycans (protein) and glycosaminoglycans (polysaccharide compound) together make up the extracellular matrix along with other compounds. The distribution and ratio of each of these in a particular make-up of connective tissue will determine what the connective tissue looks like (i.e. fibrous versus ligamentous). The function of the connective tissue is determined by the protein composition of the extracellular matrix (ECM). The immune cells reside in the extracellular matrix. 

Figure 2.2 Connective tissue within the human body makes up cartilage, tendon, bone, adipose tissue, and ligaments. Connective tissue surrounds the blood vessel walls, muscles, and nerves, also influencing these systems as well.

Basics of EDS

Admin Good Health

2022.11.10
Basics
Hello, Zeborah Dazzle, PT, WWF here. I am the spokes-zebra and patient educator for Good Health Physical Therapy and Wellness.


As some of you know, while I am a physical therapist who treats all kinds of problems, including all kinds of bone and muscle problems, my special interest is Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD). Sometimes it is wise to pause and go back to basics. That is what I will focus on with this and the next post.


What is Ehlers-Danlos Syndrome?
Ehlers-Danlos Syndrome (EDS) is a group of inherited connective tissue disorders. At present, there are thirteen variations of the disease. All involve fragility of one or more of the 28 types of collagen which is the major part of connective tissue.


Connective tissue supports, protects and holds the tissues of our bodies together. It includes tendons, ligaments, blood and the support structures for arteries, veins and muscles as well as internal organs. It is very important in the body, and it is EVERYWHERE. A colleague of mine likes to tell patient’s that if he was an evil wizard and waved a wand that took away all other cell types in your body other than connective tissue, there would still be a perfect three dimensional you remaining. (You would be dead though and we could probably shine a flashlight through you – bad wizard.)


Among the thirteen different types of EDS are types which predominantly affect different parts of the body especially the heart, the blood vessels, the eyes, skin, gums and bones/ joints. Here is a list of the names of the thirteen.


How Common is Ehlers-Danlos Syndrome?
The different EDS types range from uncommon to very rare in the general population. The single most common type of EDS is Hypermobile Ehlers-Danlos Syndrome (hEDS). The prevalence of this condition is estimated by the Ehlers-Danlos Society as 1/3500 to 1/5000 people. That means that out of the 332,218,200 people in the US there may be 94, 919 (0.02%) of the population with hEDS. The other kinds of EDS are much less common ranging from 1/40,000 (about 8,305 people, .003%) to 1/1 million people (about 332 people). I believe these estimates are low due to under diagnosing.


How is Ehlers Danlos Diagnosed?
Of the thirteen different types, there are genetic tests for all but the most common, hEDS. As a result, the diagnosis of hEDS is performed by evaluating a patient through three criteria levels. In the first level, hypermobility, or excessive stretch/ flexy/ bendy-ness is screened for. In the second level, physical characteristics commonly associated with hEDS are screened including some physical characteristics, skin texture and stretchiness and common medical history indicators. In the last criteria level, a physician must rule out other conditions which can mimic the symptoms of hEDS. It is common for patients to come to see me and want me to diagnose hEDS. Physical therapists are trained to evaluate and diagnose movement disorders and to correlate these with medical problems which sometimes means screening for problems. So, as a PT, I can diagnose hypermobility but only screen for hEDS. I cannot not diagnose it formally because I cannot rule out other conditions. Patients who are hypermobile but do not fit the diagnostic criteria of hEDS are diagnosed with hypermobility spectrum disorder (HSD). More on this in a later post.


Why Do People with Ehlers-Danlos Syndrome Call Themselves “Zebras”?
In the next post, we will go into more detail about the kinds of problems that EDS can cause, but for now let me simply say that they are multiple and often appear to be unrelated – joint pain in many areas of the body, bruising, strains, sprains, subluxations or dislocations, gut problems, dizziness and many more. For this reason, people with EDS do not fit in to a quick common pattern for diagnosis.
When medical students are trained, they spend a great deal of time learning about different conditions and the symptoms they can create. Because common symptoms can so often be caused by different underlying conditions, this makes diagnosis hard. Almost all medical students are taught this aphorism: If you hear hoofbeats, think horses, not zebras.


This is a good thing overall. Afterall, if Mrs. Smith comes in to see the doctor complaining of a sore throat, the most probable cause is something common. Perhaps she was shouting at a football game or perhaps she has a cold. Throat cancer is much farther down the list.


The problem for EDS patients though is that we are actually zebras (or in my case a zebra-zebra). Beginning medical training in anatomy is changing in medical school these days, but traditionally anatomy was taught by cadaver dissection. During this process, connective tissue is commonly the stuff put in the container under the table while the student is looking for another structure like a nerve or a blood vessel or an organ or a muscle. Is it any surprise, that a connective tissue disorder is often not on the doctors mental list of potential diagnoses? I am hopeful that this is changing, but in the meanwhile, it is up to all of us with HSD or EDS to educate ourselves so we can partner with our providers in the most positive way.


In the next post, we will look more closely at hypermobility spectrum disorder and the symptoms that HSD and EDS can create as well as an overview of treatment principles.


Until then, Cheers! Zebbie


Thanks to Dr. Mark Melecki, PT for his assistance in writing this blog. (It is very challenging to type with hooves rather than fingers. Thanks Mark.)

Pain Education Series #5

Admin Good Health

Hello, Zeborah Dazzle, PT, WWF here — spokes-zebra and patient educator for Good Health Physical Therapy. We have been talking about pain over the last four posts, and specifically how, in some situations, the nervous system can become sensitized to keep pain levels stirred up. In these instances, the nervous system itself can be as much or more of a cause of the chronic pain than any tissue damage. When the spinal cord and brain become sensitized, this is called central sensitization.  So, our question is how to calm the sensitized nervous system? The model we use is the Calm Nerve House and the basic pillars supporting the house are Pain Education, Sleep, Exercise and Pacing. However, inside the Calm Nerve House there are a number of other self-care techniques which can be calming. Here are a few: 

MASSAGE

There are many kinds of massage therapy. It is wisest to seek out a licensed (which means trained) massage therapist. As a general rule, massage that hurts is NOT helpful for a sensitized nervous system. Firm but gentle massage though, a session aimed at relaxing you can be very soothing. 

SMOKING CESSATION

 

There are several ways in which smoking can increase pain levels. First, smoking floods the lungs and the blood stream with nicotine which is a stimulant. This leads to a nervous system even more on edge. Additionally, besides the damage done directly to lungs which most people are aware of, smoking floods the lungs and blood with carbon monoxide. This compound attaches to the red blood cells whose job is to carry oxygen to every part of your body. So, besides the risk of cancer and lung disease, smoking has the negative effect of depriving vital oxygen to bone, muscle, connective tissue and nerves. 

DIET

While we will not attempt to give specific rules about diet here, it is very wise to remember that the health of the nervous system depends on good nutrition. There have been some powerful studies done over the last few years looking at what the best diet is for humans, and a good general rule is the adage coined by popular author John Robbins: Eat food, not too much, mostly plants.

Another tip is to decrease caffeine consumption. Caffeine is a nervous system stimulant and will tend to turn up the volume on a sensitized nervous system. 

MEDITATION

In 1975, Herbert Benson MD published “The Relaxation Response.” Dr. Benson showed that relaxation techniques such as meditation have immense physical benefits, from lowered blood pressure to a reduction in heart disease. In his book “Full Catastrophe Living” Dr. Jon Kabat-Zin describes positive results achieved with chronic pain sufferers employing mediation and mindful techniques. Virtually every religious tradition teaches a meditation technique as a form of prayer, but meditation does not need to be a religious practice. (And you don’t have to sit cross legged.)

SELF TALK (THOUGHTS AND BELIEFS) 

Our thoughts, and what we choose to believe, have a strong effect on our nervous system and can either increase or decrease stress leading to increased or decreased sensitization. One of the most single toxic beliefs you can take on is: “This pain will never get better.” A trick is to say “cancel” whenever you think this or any other negative declaration. Then work to replace this thought with a positive one such as: “This will pass.”, “I can handle this.”, or “I am getting a little bit better each day.”.   A counselor or trusted spiritual advisor is often an extremely important part of your care team and can help with beliefs and self-talk. 

HUMOR

Have you ever noticed that you cannot simultaneously feel depressed or anxious or overwhelmed by pain and having a good belly laugh? This is because laughter floods the brain with natural pain killing chemicals (neurotransmitters). So, we recommend that you make funny movies, people who make you laugh, funny stories, jokes and stand-up comics a regular habit. Humor helps, and that’s no joke. 

In coming posts, we will look at other topics including exercise and hypermobility spectrum disorder/ hypermobile Ehlers-Danlos Syndrome. 

I would like to thank Dr. Mark Melecki PT for his assistance with this series which relied heavily on materials he compiled for his physical therapy doctoral project.

Until next post, Cheers! 

Zebbie 

Pain Education Series #4

Admin Good Health


Hello, Zeborah Dazzle, PT, WWF here —

Spokes-zebra and patient educator for Good Health Physical Therapy. We have been talking about pain over the last three posts, and specifically how, in some situations, the nervous system can become sensitized to keep pain levels stirred up. In these instances, the nervous system itself can be as much or more of a cause of the chronic pain than any tissue damage. When the spinal cord and brain become sensitized, this is called central sensitization. So, our question is how to calm those sensitized nervous system?
The best results in therapy often happen when multiple approaches are used in a coordinated plan. The model we use is the Calm Nerve House and the basic pillars of the house are Pain Education, Sleep, Exercise and Pacing. Today, let’s talk more about pacing and exercise – which go hand in hand for us zebras.


PACING
Before we even begin to talk about exercise, let’s stop to consider a question: if the nervous system is sensitized and now a significant part of the pain problem, how did it get that way. The answer to this could be made technical and confusing, but it is basically simple. The brain is a learning organ and it learned to sound the pain alarm from repeated injuries, stress, old traumas, and other factors. So, as we try to calm the nervous system, what we are really saying is that we are trying to help the brain learn something new once again.
In helping the brain to learn something new, the key is pacing. By this is meant, enough movement to push the nervous system and muscular system up to the edge and then back away. We do not want to drive the nervous system up to the point where it sounds the pain alarm. To help to do this, there are three pain rules that are very useful.

  1. No sharp pain. Do not intentionally do anything which causes sharp pain, do not try to push through a sharp pain.
  2. Rule of 2-20. Before you start an activity, ask yourself what your pain level is from 0 to 10 (0 is no pain and 10 means call 911). As you perform the activity, if the pain level goes up 2 points or more above the starting level, stop and take a break for 20 minutes. If after 20 minutes, your pain goes back down, you can do a little more of the activity, not a lot more. If it does not go back down, you are done with that activity for that day.
  3. Above 5. If you are getting ready to start an activity, and your pain level is above a 5, it would be
    wise to seek coaching from your physical therapist about how to proceed. If your pain is right at 5,
    proceed slowly and cautiously and see how your body responds. Apply the rule of 2-20 as needed.

EXERCISE

For physical therapists, exercise means movement. That movement could be lifting weights or jogging or playing basketball for some, but that is certainly not where most people with chronic pain start. Overall, physical therapists working with patients having chronic pain apply gentle stretching and strengthening exercises, building gradually, to help the patient re-establish the foundations of movement. In other words, we want to get you feeling well enough to do the stuff you want to and need to be able to do, like: walk through the grocery, stand at work, dust the book shelves, fold the laundry or whatever basic things your life requires of you.

This means that we look for joints that are moving too much or too little, muscles that are weak or too strong relative to a tight muscle, connective tissue that is too tight. The goal is always to establish strong plus flexible plus minimal or no pain. With a sensitized nervous system, this means finding movements that do not overstress the system (see pain rules above) and then consistently and persistently working toward comfortable movement.

A special word here for zebras like me, meaning those with hypermobility spectrum disorder or Ehlers- Danlos Syndrome. Special attention for us must be paid to building the muscle around joints that are too loose, especially those that pop out. This is the way we will work our way back to comfort. Now that we have described the pillars of the Calm Nerve House, in the next post, we will discuss some additional approaches inside the House that help to calm the nerves.

Until next post, Cheers!

Zebbie