Many people use the term Chronic to convey just how excruciating a pain is. However, what the term really means is simply that the pain has been there for longer than three months, even if it’s not very bad. The distinction is made after three months because most injuries to tissues, either muscle, bone or joint has had a chance to heal and resolve by this time.

Why make the distinction?

The difference between pain that has just happened and pain that has been there for a long time has implications for treatment and the way you approach it. Chronic pain requires different management and is likely to be caused by more than one thing where as short-term pain (also known as acute pain) often has a distinct cause, such as a fall.

What are some examples of acute conditions?

A sprained ankle, torn muscle, a bruise and even a broken bone are all examples of injuries that occur suddenly and usually follow a typical pattern of healing. They usually go through an inflammatory reaction with the area being red, hot, swollen and painful to touch. This period usually lasts for a few days and is a normal part of the healing process as the body works to remove damaged tissue and repair the affected area. Different tissue types take varying amounts of time to heal. The severity of the injury will also affect healing times.

Some acute injuries can become chronic if something goes wrong in the healing process. Some acute injuries are so bad they won’t heal without medical care. For example, fractures need to be kept as still as possible to allow the broken bones to heal together in the correct position.

Some pain and illnessnes develop over time and are chronic in nature, usually starting insidiously and becoming progressively worse. Osteoarthritis, multiple sclerosis and rheumatoid arthritis are all examples of chronic conditions that cause chronic pain.

For some people, even though their injury has healed and no significant cause can be found, pain persists. This type of pain can be particularly distressing and requires a holistic approach to treatment, particularly addressing the emotional costs that come with suffering from long-term pain.

Certain factors will predispose someone to developing this type of pain including recent or past emotional trauma, anxiety and depression. Unfortunately chronic pain often causes people to adopt a vicious cycle of rest, which causes more stiffness and pain, which then leads to more pain and so on.

Your physiotherapist is well trained to help you cope with chronic pain and get you back to a more functional level and doing the things you love.

Chronic Pain Project

Sometimes the internet can be a confusing place, full of misinformation, particularly from people trying to sell you things. A recent website developed by the Department of Health in Western Australia aims to provide evidence-based support and education to pain sufferers.

Have a look here at painhealth.csse.uwa.edu.au

For many of us, a typical day can involve hours of sitting in front of a desk. When you have a seemingly never-ending list of tasks to complete, your long-term health can be the last thing on your mind. However, we know that prolonged sitting, especially in a poorly set-up workspace can have a huge impact on your body in the long term. Below are some tips that can help you set up your workstation properly.

Chair Setup

The height of your chair should be adjusted so your feet are flat on the floor and your thighs parallel to the floor. Your arms should be able to rest comfortably at the height of the desk. Arm rests should be low enough that elbows can be bent between 90-110 degrees and not winged out. Hands, wrists, and forearms should be in a neutral position and parallel to the floor. A cushion (like a rolled towel) may be added on the chair to add support for the lower back. If the chair is too high, you can use a footrest to make sure your feet are rested comfortably.

Desk Setup

A 20-to-40-inch distance of the monitor from your face is advisable to reduce eye strain. Place your keyboard at the center of your desk, which should be 1-2 inches above your thighs. You want the monitor and keyboard to be directly in front of you. Keep the mouse within easy reach of your keyboard. The top of the screen should be slightly below eye level..

Other tips for setting up your workstation include:

• Put everything you need within easy reach.
• Don't slouch. Practice moving in and out of a good posture.
• Stand up to reach anything that can't be comfortably reached while sitting.
• Take active breaks from sitting every half hour or hour. Set an alarm that reminds you get up and stand and stretch for ten seconds then sit back down.

Transitioning to a standing desk:

Even better than all these tips is to set up a standing work desk. Many people are making the switch to a movable working desk that allows you to spend periods of your working day on your feet with great results. Here’s some advice to make the transition a smooth one.

• Get in the habit of standing for certain tasks and sitting for others. For example, complete repetitive tasks, phone calls or data entry while standing and more complex tasks while sitting.
• Reconsider your footwear. When standing, your feet and their support become more important than when you’re sitting all day. More comfortable shoes might be a worthy investment.
• Slowly increase the amount of time you spend standing to allow your body to adjust.

Travel has almost become a necessity of modern life. Many people travel for work, and most of us travel for pleasure at least once per year. Unfortunately, the hours of sitting involved in travel often also result in a stiff lower back, neck pain, and headaches. Below is a list of tips and tricks to avoid travel-related aches and pains:

Lower Back:

Lower back pain is the chief complaint of most car and plane travellers. To avoid low back pain, try the following tips:

1) Adjust the seat angle. If you are able, tilt the seat slightly down towards your feet, not towards your hips. Ideally, your knees should be level with your hips, or even slightly lower. A footrest to lift your knees can also help.

2) Adjust the seat back. To avoid compression through your lower back and pelvis, your seat should be upright, not tilted backwards. This will be more comfortable with implementation of tip #1, and aligns your whole spine.

3) Lift the height of the whole seat. This will assist with tip #1 by lifting the whole body away from the floor. When your hips are less bent, it is easier for your back to sit comfortably in an upright position.

4) Use a lower back support. Many cars nowadays come equipped with in-built lumbar supports. Often this support is a generic design and not fitted for your specific shape or height. A proper lumbar pillow, or even a rolled towel in the small of the back, can be more effective in maintaining the natural arch of your spine. This relieves pressure through your intervertebral discs, spinal ligaments, and spinal muscles.

Neck:

Neck discomfort is easier to improve when tips for lower back are implemented first. Some very easy tips to reduce neck pain are as follows:

1) Use a travel pillow. If travelling on an airplane, try wearing the pillow backwards or sideways. This assists in supporting the head in a slightly better position when you rest or sleep, which helps to reduce the stress placed on the muscles, ligaments and joints within the neck.

2) Every hour, perform 10 chin retractions (also called chin tucks). This is easiest to perform correctly if you sit tall and press your chin straight backwards, lengthening the back of your neck. Do not tuck the chin to the chest. This exercise stretches the small postural muscles at the base of the skull, relaxing them.

3) Keeping your eyes on the road, rotate your head side to side gently. Then tilt side to side gently. Performing any neck movements helps reduce the tension within the muscles from holding still for long periods of time.

The tips above are only suggestions. If you find they are helpful, continue performing them throughout your travels. However, if any of the above tips cause you pain or discomfort, it is advisable to seek your physiotherapist’s opinion. It is also advisable to stop for 15 minutes to stretch your legs and walk around every two hours when driving. When on a plane, refer to the guidelines written by the airline for prevention of deep vein thrombosis.

For someone suffering from pain, to be told “It’s all in your head” can be a frustrating experience. What many people don’t understand is that pain is a complex process and the mind plays a role in the perception of pain for everyone.

All pain, no matter the cause, must be recognized by the brain and processed for you to be aware of it. Pain is actually an important part of human survival, letting you know which activities are dangerous and encouraging you to rest and in many cases to protect damaged tissue. When the body loses the ability to perceive pain, this can lead to further injury and even death.

There is a famous condition where people don’t feel any pain at all, known as “congenital analgesia”. This is actually a very dangerous condition and these people are at risk of dying young. They have no warning system letting them know that they need to seek treatment. It can be hard to get your head around the idea that pain helps you survive, but it really is an important strategy of our bodies to keep us protected.

Pain isn’t always associated with tissue damage.

Even though pain is an important part of human survival, sometimes things go wrong. A famous example of this is phantom limb pain, where amputees continue to have severe pain, sometimes for decades after the limb has been removed.

Sometimes pain can even be felt on the injured side when looking at a mirror image of their uninjured limb moving.

The amount of attention you give to pain and how you feel about it will also change how severely you experience that pain.

Have you ever noticed a bruise and couldn’t remember how you got it? That is an experience of tissue damage without much pain. On the flip side, if you have suffered recent emotional trauma or are grieving you might find a small injury very difficult to deal with. Some people believe the best way to deal with pain is to ignore it and push through with all activities. Other people believe that the best treatment for all pain is to rest and stop all activities.

What you believe about pain and how you react to it can have a big effect on how your brain interprets pain signals. Feeling in control of your pain is also very important. For people who are experiencing pain for long periods of time without any way to reduce symptoms this can be very distressing, particularly if this pain is impacting their ability to participate in activities.

Your physiotherapist is trained to help you deal with pain in the best way possible. This may involve counselling and education about how to deal with your pain and not just physical treatment of your injury. Don’t hesitate to ask us more next time you come in.

What is Ankylosing Spondylitis?

Ankylosing Spondylitis, a type of inflammatory arthritis, causes inflammation and pain in the spinal column as well as other joints in the body. The classic marker of Ankylosing Spondylitis is involvement of the sacroiliac joints, which are large joints connecting the pelvic bones to the sacrum in the lower back.

In many cases of Ankylosing Spondylitis, inflammation within the spinal column can cause new bone to begin forming between the vertebrae. Vertebrae are the individual bones that compose the spinal column. This leads the vertebrae to fuse in various areas, typically fusing the spine in flexed forward, immobile postures.

As Ankylosing Spondylitis progresses, other areas of the body may be affected. These areas include the smaller joints within the hands and feet, as well as the ribs and shoulders. In some instances, the disease can affect other systems of the body such as the skin, lungs and eyes.

The cause of Ankylosing Spondylitis is not clear, however there are markers and predisposing factors that may contribute to the development of the condition.

Genetics, environment and frequent gastrointestinal infections are among the pre-disposing factors. Men are more commonly affected than women and diagnosis tends to occur between the ages of 17 and 45 years.

What are the signs and symptoms?

Back pain and stiffness are the two most common symptoms of Ankylosing Spondylitis. Other symptoms include neck and buttock pain, as well as pain in the smaller joints of the hands and feet. Tendons and ligaments may also be affected. Symptoms tend to be worse following periods of rest, and better following periods of activity. It is common for people to experience “flare-ups” and “remissions” of symptoms.

Severity of disease is patient-dependent. Some people with Ankylosing Spondylitis may experience discomfort in the spine from time to time, while others experience severe and debilitating symptoms at frequent intervals with minimal time in remission from symptoms.

Many people with ankylosing spondylitis do not seek medication attention, especially if the symptoms are mild. In these cases, the disease is not diagnosed until it has progressed, leading to increased pain and disability for the patient.

How can physio help?

Ankylosing Spondylitis responds well to physical activity. Your physiotherapist will assess your spinal movement and posture as well as strength and overall movement ability. They will assist you with performing appropriate stretches and strengthening exercises to maintain your posture, spinal strength and mobility. If your hands, feet, hips or shoulders are involved, they will also provide you with specific exercises to help maintain mobility and strength in those joints.

In many cases, people can participate in group exercise programs in a pool and on land. Exercising in a pool is beneficial due to the buoyancy factor; people do not have to weight bear on sore and inflamed joints, however are still able to stay physically active. Many studies have proven the positive benefits of exercise for those with Ankylosing Spondylitis, such as improved rib cage expansion when breathing, and improved posture of the upper back and neck. A physiotherapist is also able to implement other pain relieving treatments that can help to manage symptoms.