Musculoskeletal

Physical Therapy

How do distant areas of the body affect each other, and how can this understanding be used to address pain and improve movement?

Uncover the Hidden Connections: How Distant Areas Impact Pain & Movement

Our body is a fascial chain. I'm a physical therapist. So if we start at the foot, it's very simple to understand. Your foot should pronate, which means go down, and it should supinate. It should be able to have both of those movements. If your foot pronates, your tibia is going to rotate inwardly, okay, toward the midline, which is also going to rotate the knee and hip, and that's going to affect the pelvis. Okay, it's healthy for the foot to pronate, and it's healthy for the foot to supinate. You want both of those movements. So let's say you have a patient that comes in and they have knee pain. You want to look always at the joint above and below the joint that you're addressing. So if they have knee pain, you want to look at the ankle and the foot, and you also want to look at the hip. What does their mobility look like? What is their range of motion at the hip? Do they have adequate internal rotation and external rotation at the hip? Do they have a rigid arch, a flexible arch? Do they have a strong arch? What's their ankle mobility? What's their dorsiflexion look like? Because that's going to affect how the knee moves, even though the knee theoretically is a simple joint that bends and straightens. It does have a little rotational component to it. So you need to address the joints above and below the joint that you're addressing, always.

When addressing knee pain, it is important to look at the mobility of not only the knee but also the ankle and hip. The foot should be able to pronate and supinate to ensure that the tibia, knee and hip can move properly. It is important to assess the range of motion of the hip and the strength of the arch in the foot.

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Our body is interconnected through a fascial chain, and understanding this can help address pain and improve movement. Let's start with the foot as an example. The foot should be able to pronate (go down) and supinate (go up). When the foot pronates, it causes the tibia to rotate inwardly, which in turn affects the knee, hip, and pelvis. Both pronation and supination are healthy movements for the foot.

When addressing pain in a specific joint, it's important to consider the joints above and below it. For instance, if a patient has knee pain, we should also examine the ankle and foot, as well as the hip. Assessing mobility and range of motion in these areas is crucial. Look at the hip's internal and external rotation capabilities, as well as the foot's arch (rigid, flexible, or strong). Additionally, evaluate ankle mobility, particularly dorsiflexion. These factors can impact how the knee moves, even though it may seem like a simple joint that only bends and straightens. Always address the joints above and below the one you're focusing on.

By understanding the interconnectedness of different areas of the body, we can better address pain and improve movement. Taking a holistic approach to treatment ensures that we consider the entire fascial chain and its impact on overall function.

Can you discuss the role of the brain in pain perception and how it can be influenced by both physical and psychological factors?

The Brain's Role in Pain Perception: Influenced by Physical & Psychological Factors

My name is Emily. I'm a physical therapist and I work with patients that have chronic pain. So this is something that I talk about frequently. The central nervous system, which is the brain and the spinal cord, is like an electrical system. So it's kind of constantly on buzzing along, okay? The brain's job is to perceive, I mean aside from many other things, but in regards to perception of pain and it also perceives other sensory information. Okay, so our body doesn't perceive that information and our body receives the input and it travels via our nervous system to our brain and our brain perceives what we are experiencing in time. So specifically speaking to pain, which can be a number of different things, hot, cold, sharp, any of those things, is if I were to step on attack, I'm gonna go from buzzing along to hitting a threshold in which my brain says, that hurt, ouch, and pulls away. Because it's a noxious enough stimulus that it doesn't want the body to be there anymore. It pulls it away very quickly and that happens like that. So if we talk about pain, if let's say a person has been in an accident and it's a traumatic accident and they have remaining pain left over from that accident, back pain, neck pain, headaches, whatever, they're more likely to be buzzing along closer to that threshold for a number of different reasons. They may be perceiving that pain over and over with different movements, keeping them closer to that threshold, because over time you should drop back down, but if they're getting pain, pain, pain, they're not gonna drop down as quickly as if I pulled my foot away from the tack and recovered and nothing else happened. Now they also have the emotional trauma from that accident and the body is going to remember that as well and it's gonna hold on to those tensions. So they're going to be more likely to hang out closer to that threshold. It doesn't mean that they have a low threshold of pain. It just means that their central nervous system is activated more than we would like it to be.

The central nervous system is like an electrical system, and the brain perceives sensory information. When someone experiences pain, their brain perceives it and pulls away from the noxious stimulus if it is strong enough. If someone has had a traumatic accident, they may be more likely to experience pain because the body and mind remember the trauma and keep them closer to the threshold of pain than normal.

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The brain plays a crucial role in pain perception, which can be influenced by both physical and psychological factors. The central nervous system, consisting of the brain and spinal cord, functions like an electrical system. It constantly processes sensory information, including pain.

When we experience pain, such as stepping on a tack, the sensory input travels through our nervous system to the brain. The brain then perceives the pain and generates a response, like pulling away from the stimulus. This happens quickly because the brain recognizes the pain as a noxious stimulus that should be avoided.

In cases of chronic pain, such as lingering pain from an accident, the brain may be closer to its pain threshold. This can occur due to repeated exposure to pain through different movements or the emotional trauma associated with the accident. The body holds onto these tensions, keeping the central nervous system more activated and sensitive to pain.

It's important to note that having a lower pain threshold doesn't necessarily mean someone has a low tolerance for pain. Instead, it indicates that their central nervous system is more activated and responsive to pain signals.

As a physical therapist working with patients experiencing chronic pain, understanding the role of the brain in pain perception is crucial in developing effective treatment strategies.

How does aquatic therapy benefit those with chronic pain and disability?

Aquatic Therapy: A Game-Changer for Chronic Pain Relief

I'm Emily, I'm a physical therapist and I actually work a lot with chronic pain in my clinic. So aquatic therapy is a very beneficial environment for individuals with chronic pain. Maybe they have polyneuropathy because being on land and having the weight bearing through those joints and those muscles oftentimes isn't well tolerated by those patients. They've tried a lot of traditional therapy already and oftentimes by the time they get to me they've already failed several episodes of therapy. So when we get them in the water, the buoyancy of the water helps to take off their body weight from those joints. So it can take up to 75% of the body weight off their joints depending on the depth of the water obviously. And then they can more freely move, they don't have to be afraid of falling because they're going to generally float. We use a little bit warmer water at our clinic which usually feels good for those patients and it's giving them a constant hug because of the viscosity of the water. So they have less pain because they become desensitized a little bit. You can also use jets in the water like you would in a hot tub to give them kind of soft tissue mobility. You can work on mobility that they may not otherwise tolerate on land because they can move within ranges of motion that are comfortable and not painful. And you can more gently work on strengthening than against gravity which most of them start with and feel really good doing.

Aquatic therapy is a great way to help people with chronic pain. The water provides buoyancy and viscosity which reduces the patient's body weight and gives them a gentle hug, allowing them to move comfortably without pain. Jets can also be used to give them soft tissue mobility, while they can work on strengthening without gravity.

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Aquatic therapy is highly beneficial for individuals with chronic pain and disabilities. When traditional therapy methods have failed, the buoyancy of the water in aquatic therapy provides relief by reducing the weight-bearing load on joints. Depending on the water depth, it can take up to 75% of the body weight off their joints. This allows patients to move more freely without fear of falling, as they generally float in water. The use of warmer water in aquatic therapy clinics provides a comforting sensation akin to a constant hug due to the water's viscosity. This helps patients experience less pain as they become desensitized. Additionally, jets can be used in the water to promote soft tissue mobility, similar to those found in hot tubs. Aquatic therapy also enables individuals to work on mobility that may not be tolerable on land, as they can move within comfortable and pain-free ranges of motion. Furthermore, strengthening exercises can be performed more gently against buoyancy rather than gravity, which often feels good and allows for better progress in rehabilitation.

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Emily Hill, DPT answers your Physical Therapy questions. See all the advice Emily Hill, DPT has and get answers to your own Physical Therapy questions.

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Physical therapist specializing in sports medicine, women's health, orthopedics, Parkinson disease/Parkinsonism and multiple sclerosis.