Introduction: 

Chronic pain is a debilitating condition that affects millions of people worldwide. Whether it’s back pain, neck pain, headaches, or any other type of chronic pain, it can be frustrating when the pain keeps coming back despite our best efforts to manage it. In this blog post, we will explore why chronic pain persists and what can be done to manage it effectively, with a focus on physical therapy as a viable treatment option.

What is the number one cause of chronic pain? 

Since chronic pain can be brought on by a number of different circumstances, there is no one main element that causes it. An accident, an underlying medical disease like fibromyalgia or arthritis, nerve damage, or other physiological, psychological, or social factors can all contribute to chronic pain. Many times, chronic pain is a multifaceted, complex problem that necessitates an all-encompassing approach to diagnosis and treatment. To identify the underlying cause of chronic pain and create a personalized treatment plan, it's crucial to engage with a healthcare professional like a physical therapist or pain management specialist.

Why Does Pain Come Back? 

There are several reasons why chronic pain persists or keeps coming back, even after treatment. Pain is a complex phenomenon that involves both physical and psychological factors, and often it's a combination of these factors that contributes to the persistence of pain.

Factors Contributing to Chronic Pain

A. Physical Factors

Physical factors that can contribute to chronic pain include underlying medical conditions such as arthritis, fibromyalgia, and nerve damage. Injuries, accidents, and surgeries can also cause physical damage that may result in chronic pain. Poor posture, muscle imbalances, and weak core muscles can also contribute to chronic pain by putting unnecessary stress on the body.

B. Psychological Factors

Psychological factors such as anxiety, depression, and stress can also contribute to the persistence of chronic pain. Chronic pain can lead to feelings of hopelessness, helplessness, and isolation, which can worsen psychological distress. Research suggests that emotional stress can amplify the intensity of pain, making it harder to manage.

C. Social Factors

Social factors such as lack of social support, poverty, and social isolation can also contribute to the persistence of chronic pain. Chronic pain can disrupt our ability to work, socialize, and engage in hobbies, leading to a sense of isolation and loneliness. This, in turn, can exacerbate feelings of stress and anxiety, further worsening the pain.

How Physical Therapy Can Help Manage Chronic Pain

Physical therapy is a non-invasive treatment option that can be effective in managing chronic pain. Physical therapists are experts in diagnosing and treating musculoskeletal conditions that contribute to chronic pain. It can also address psychological and social factors that contribute to pain.

Physical therapy treatment for chronic pain may include manual therapy, therapeutic exercise, and modalities such as cupping and dry needling. Manual therapy techniques such as myofascial release, joint mobilization, and soft tissue mobilization can improve joint range of motion, reduce muscle tension, and improve circulation. Therapeutic exercise can strengthen weak muscles, improve posture, and reduce the risk of further injury. Modalities such as cupping and dry needling can help reduce pain and inflammation.

Physical therapy also addresses psychological and social factors that contribute to pain. Physical therapists can teach relaxation techniques, stress management skills, and coping strategies to help patients manage the emotional distress associated with chronic pain. They can also provide support and guidance to help patients engage in social activities and regain a sense of purpose and meaning in life.

Why does chronic pain come back shortly after discharge from physical therapy?

For several causes, chronic pain might return soon after being released from physical therapy.

First off, it's crucial to realize that physical therapy does not treat chronic pain. Instead, by treating the underlying physical, psychological, and social aspects that contribute to pain, physical therapy is a therapeutic option that can aid in managing chronic pain. It is essential for a patient to carry on using the exercises and skills they learned in physical therapy after being discharged from the facility. The physical variables that contribute to pain can get worse if a patient quits doing these activities or doesn't keep up an active lifestyle, which can cause pain to return.

Second, social and psychological factors may also play a role in the recurrence of pain. Physical therapy-discharged patients who have anxiety or depression may experience increased discomfort that is more difficult to manage. Similar to how social isolation or a lack of social support for the patient once physical therapy is over can intensify stress and anxiety symptoms, making the pain worse.

Last but not least, it's critical to remember that chronic pain can be a complicated and multidimensional condition, and there may be underlying illnesses or injuries that demand continuing care. To effectively manage their chronic pain, a patient may need to keep working with their healthcare professional, which may include a physical therapist.

In summary, a number of factors, such as the failure to maintain an active lifestyle, psychological and social issues, and underlying medical disorders, can cause chronic pain to return soon after physical therapy is finished. In order to effectively manage their chronic pain, patients must continue to use the exercises and strategies they learned during physical therapy and closely collaborate with their healthcare professional.

Conclusion

Chronic pain is a complex phenomenon that involves physical, psychological, and social factors. Effective management of chronic pain requires a comprehensive approach that addresses all of these factors. Physical therapy is a non-invasive, safe, and effective treatment option that can help manage chronic pain. If you are struggling with chronic pain, contact a physical therapist to learn more about how physical therapy can help.

External Resources and Links for Managing Chronic Pain:

1. American Physical Therapy Association (APTA) - Chronic Pain Management
2. National Institute of Neurological Disorders and Stroke
3. "Physical Therapy for Pain Management: What You Need to Know" by the Cleveland Clinic: https://health.clevelandclinic.org/physical-therapy-for-pain-management-what-you-need-to-know/
4. "Physical Therapy for Chronic Pain Management: The Benefits, Techniques, and More" by Verywell Health: https://www.verywellhealth.com/physical-therapy-for-chronic-pain-management-4157647

All right, so hey guys. What's up? It's Stephen Dunn, I'm a holistic physical therapist here in Westlake Hills, Texas. We're about three or four miles from downtown Austin. 

Today, I want to go over a knee injury that was sustained in the national championship game between Georgia and Alabama a couple days ago by a guy by the name of Jameson Williams, who was definitely an impact player. 

So we're going to watch this video and I'm going to explain what happened and how it happened and a little bit of that so let's watch the video.

Okay, so here we are at the video. What we're going to watch is a live version and a replay version of #1, the receiver for Alabama catching the ball. When he catches the ball he places his left foot down to plant, to cut to the right.

He's going to try to make a juke and when he makes that move, it's a non-contact injury, meaning no one touched him. It injured in the position that he was in and what happened is his knee goes into this angle called a valgus angle. This means his knee is coming in and his foot is going out and I'll explain that in a little more detail in a moment.

Let's watch the play and let me warn you if you're squeamish and don't like to see injuries or nasty things, then don't watch this part of the video. It can make you have a little bit heebie jibbies...There's the catch, plant, boom. Down. Done and it’s his left knee... now watch in slow motion and you'll be able to see very clear when he injure it. 

When I was watching this live I knew he was out with significant injury and slow motion confirmed it. And by the way, I'm a huge LSU fan, Geaux Tigers! I was born in Georgia so I've always been a Georgia fan and super happy the dogs won, but I feel sorry for this kid, Williams, because he was a pretty special player.

So here's the play again. He's going to catch the bomb, he's wide open. If it's a good pass from the QB, it's a touchdown without him breaking his leg, breaking his knee, right there... and I can't watch anymore. I've seen it enough. That's it. 

So now let's explain that. Let's break it down a little bit from there. So what happened?

This is a right knee and his was a left knee so there's a little bit different but what we're going to do is show you the same angle. So this is the right knee. Right here this is the medial collateral ligament (MCL), it's on the inside. This is the lateral collateral ligament (LCL), it's on the outside. 

This is a little fibula bone and this is your kneecap right here. The kneecap is sitting in the patella tendon and the quadriceps tendon. The meniscus are right here between the knee and the ACL is inside the knee and the PCL is inside the knee. 

Now what we can also see is a little shift that occurs in there, like this. That shift that occurs is where the ACL tore. So what the ACL does is it keeps this bottom bone from shearing forward on the top bone and if you didn't have an ACL when you walk, your knee would be unstable and it would typically give out.

So that's what I think happened. I haven't seen or read any reports it's been about 48 hours since, it's been two days since the game now so I'm not exactly sure. But what has more than likely happened is that he's already had surgery, and if not he's having it within the next 48 hours. I can guarantee that. And with that surgery let's talk about that.

What's going to happen?

Well, he's going to be out of commission for a little bit of time and with it being January, the typical ACL repair and then the typical ACL rehab... so after he has a surgery that's where he's going. 

He's going to physical therapy. He'll be doing lots and lots and lots of physical therapy and what he'll do from there is for about seven to nine months will be all about getting him back to football performance.

Now, within seven to nine months he will be back. So will he be back for the start of the season in September? He could, he definitely could but more than likely it's going to be like mid-season to where he'll be fine-tuned and ready to go.

Now, I will say this, Jerry Rice came back from an ACL surgery really fast back when he was playing in the NFL, and he kind of set the precedence for moving that rehab and recovery faster than normal.

Back when I was in PT school in the 90s, it was always a year. You're out, done. One year. ACL, done, you won't be back on the field for one year. No questions asked. It's changed. Now, nine months is pretty common but it can also be quicker.

Are you have any trouble with your knee? Is your knee clicking or are you having trouble walking? Do you have knee pain?

If so, then reach out to us. I'm the guy that can help you. Our clinic is here, set up, designed to help those people with those kind of problems. We look forward to talking to you. 

Reach out to 512-215-4227 and we'd love to help you. Well, that's our message for today guys be on the lookout for more videos breaking down injuries. Y'all take care.

Have you been told you have Banana Knees?

What the heck is a hyperextended knee?

Do you have hyperextended knees?

What about Banana Knees?

By the end of this video you will know the essential exercise to do at home and the best awareness tips to help improve your hyperextended knees.…  

We’ve helped hundreds of patients with Banana Knees over the past two decades. I've had hyper extended knees since my early days of competitive gymnastics and can’t wait to share my tip.

Why are my knees hyperextending?

Genu Recurvatum. Quad set. Standing awareness tip.

Check out our hyperextended knee blog for more great tips at How To Strengthen Hyperextended Knees? Standing Awareness Exercises  and check out our free membership site with 10 minute training videos for a holistic approach to fitness at www.PilatesToThrive.com

Introduction: The Cold Season and Arthritis

The transition from warm to cold weather is often accompanied by a surge in arthritis symptoms. As temperatures drop, those with arthritis can attest to the increased stiffness, pain, and soreness in their joints. The combination of cold and humidity can be particularly challenging, making it essential to understand and manage arthritis effectively during these months.

Understanding Osteoarthritis

Osteoarthritis, often dubbed "wear and tear" arthritis, is a degenerative joint condition. As we age, the protective cartilage that cushions the ends of our bones wears down, leading to pain, swelling, and reduced joint mobility.

This degeneration can be observed through medical imaging, like x-rays, and is a natural part of the aging process. However, understanding its progression can help manage its symptoms better.

The Importance of Motion in Managing Arthritis

"Motion is lotion" is more than just a catchy phrase; it's a fundamental principle in arthritis management. Active motion, even simple daily activities, can slow down the degenerative process. By ensuring a regular flow of nutrients to the joints, movement promotes healing and recovery.

In today's digital age, where sedentary lifestyles are common, the importance of regular movement cannot be overstated.

Personal Experience: A Reminder of the Aging Process

Aging is a universal truth. Even in our 30s, the signs of aging can manifest, as Andy's experience illustrates. However, by embracing an active lifestyle and understanding our bodies, we can mitigate many of the discomforts associated with aging.

What Helps Arthritis from Getting Worse?

1. Regular Exercise

Activities like swimming, walking, or cycling not only maintain joint flexibility but also improve overall health.

2. Weight Management

Extra weight, especially around the midsection, can strain joints. A balanced diet and regular exercise can help with weight management.

3. Physical Therapy

Tailored exercises can strengthen muscles around the joint, improving stability and function.

4. Diet

Foods rich in omega-3 fatty acids, antioxidants, and other anti-inflammatory compounds can help manage arthritis symptoms.

The Fastest Way to Treat Arthritis

1. Medication:

NSAIDs and other pain relievers can offer temporary relief. However, it's crucial to consult with a healthcare professional before starting any medication.

2. Hot and Cold Therapy

Alternating between heat and cold can alleviate pain and reduce swelling.

3. Joint Injections

Corticosteroid injections can provide relief for some, though they're not a long-term solution.

Foods to Avoid if You Have Arthritis

Diet plays a significant role in managing arthritis. Some foods can exacerbate inflammation, leading to increased pain and stiffness. Here are some foods that arthritis patients might consider limiting or avoiding:

• Processed Foods: These often contain trans fats, which can trigger inflammation. Check labels for terms like "partially hydrogenated oils."
• Red Meat and Fried Foods: High in saturated fats, these can increase inflammation.
• Sugar and Refined Carbs: High sugar intake and refined carbohydrates can trigger the release of inflammatory agents called cytokines.
• Dairy Products: Some people find that dairy products exacerbate their arthritis symptoms due to the type of protein they contain.
• Alcohol and Tobacco: Tobacco and alcohol can lead to inflammation and also weaken the immune system.
• Salt and Preservatives: Excessive salt consumption can cause inflammation in the joints. It's essential to be wary of the salt content in processed foods.
• Certain Vegetables: For some people, vegetables like eggplants, peppers, and tomatoes can exacerbate arthritis pain due to a compound called solanine.

How to Calm Down Arthritis Flare-Ups

Arthritis flare-ups can be painful and debilitating. Here are some strategies to manage and reduce the severity of these episodes:

• Rest and Elevation: If a particular joint is affected, resting and elevating it can help reduce swelling and pain.
• Cold and Hot Packs: Cold can numb the area and reduce swelling, while heat can relax and soothe muscles and tissue.
• Gentle Exercise: While it might seem counterintuitive, gentle movements can help reduce stiffness. Consider exercises like tai chi or yoga.
• Compression: Wearing a compression garment can provide support and warmth, reducing pain.
• Over-the-Counter Pain Relievers: NSAIDs can help manage pain during a flare-up. Always consult a doctor before starting any medication.
• Mindfulness and Meditation: These practices can help manage the pain and stress associated with flare-ups.

What Not to Do When You Have Arthritis

1. Avoid Repetitive Strain:

Activities that strain the same joint repeatedly can exacerbate symptoms.

2. Don't Ignore Pain

Pain is the body's warning system. Continuous pain or a sudden increase in pain should be addressed immediately.

4. Avoid Smoking

Smoking can complicate arthritis and its treatments.

The Psychological Impact of Arthritis

Living with chronic pain can take a toll on mental health. Feelings of frustration, sadness, or even anger are common among arthritis patients.

It's essential to address these feelings, seeking support from loved ones or professionals. Joining support groups, practicing mindfulness, and engaging in hobbies can also provide emotional relief.

Conclusion: Embracing Motion for Joint Health

Arthritis might be a common ailment, but it doesn't have to dictate the quality of one's life. By understanding the condition, staying active, and seeking timely interventions, one can lead a fulfilling, active life despite arthritis.

Remember, motion truly is the best lotion.

Learn more about knee arthritis at Osteoarthritis: 10 Tips for Self-Care at Home.

Try the exercises in this blog to strengthen your knee.

Struggling with Knee Pain? 

If getting up from a chair, walking, or navigating stairs has become a challenge due to persistent knee discomfort, don't wait any longer. Your mobility and quality of life matter. Call us now at 512-215-4227 and let's take the first step towards a pain-free life together!

See what our physical therapy and Pilates client had to say about how we helped her knee problems… 

It is Stephen Dunn from CORE Therapy and Pilates. I am a Pilates physical therapist in West Lake Hills, TX, and I have been serving the people in the area with knee pain, knee arthritis and post op total knee replacement since 2005. I want to present a series of knee exercises designed to prepare individuals for knee replacement surgery and to aid in post-operative recovery. These exercises are not only beneficial for those undergoing surgery but also for those experiencing knee pain or stiffness.

What exercises should I do when I get my total knee replacement?

Essential Equipment:

• A rolled-up towel
• A foam roller

Exercises to Strengthen Your Knee:

Recommendation:

• Aim for about twenty repetitions for each exercise.

These exercises are foundational for anyone looking to maintain or improve their knee health, especially before and after surgery. Remember, always consult with a specialist before starting any new exercise regimen.

For personalized guidance or further inquiries, contact a client specialist at 512.215.4227.

What exercises to avoid after total knee replacement?

After a total knee replacement, it's essential to follow your surgeon's and physical therapist's advice on which exercises to avoid to ensure proper healing and prevent complications. While the specific recommendations can vary based on individual circumstances, here are some general exercises and movements that are often advised against during the early stages of recovery:

• Running or jogging
• Jumping or any plyometric exercise

• These can put excessive strain on the new knee joint.

• Rotating the knee, especially under weight or resistance, can be harmful.

• This can be uncomfortable and might be discouraged, especially in the early stages after surgery.

• Using heavy weights can put undue stress on the knee joint.

• Sports like basketball, tennis, or soccer which involve rapid changes in direction and the potential for collision.

• While stairs are often part of the rehabilitation process, excessive stair climbing can be strenuous on the new joint.

• Such as sitting cross-legged, squatting, or any activity that requires bending the knee more than 90 degrees.

• It's essential to listen to your body. Mild discomfort can be expected, but sharp pain is a sign to stop and consult your therapist or surgeon.

• Especially in a manner that puts significant stress on the knees.

It's crucial to remember that as you progress in your recovery, some of these restrictions may be lifted, and you might be able to gradually reintroduce certain activities with the guidance of your healthcare professionals. Always prioritize safety and ensure that you're following the prescribed rehabilitation program to achieve the best outcomes after your total knee replacement.

What helps knee replacements heal faster?

Recovering from a total knee replacement requires patience, but there are several strategies and best practices that can help expedite the healing process:

• Engage in prescribed exercises to strengthen the muscles around the knee and improve flexibility.
• Attend all physical therapy sessions and follow the therapist's advice.

• Take prescribed pain medications as directed.
• Use ice packs on the knee to reduce swelling.
• Elevate the leg to help decrease swelling.

• Eat a balanced diet rich in protein, vitamins, and minerals to support tissue healing.
• Stay hydrated.

• As mentioned previously, avoid activities that put excessive strain on the new knee joint.

• These can help reduce the risk of blood clots and decrease swelling.

• Keep the surgical site clean and dry.
• Follow your surgeon's instructions regarding wound care and when you can shower or bathe.

• Engage in low-impact activities like walking, as recommended by your therapist or surgeon.
• Avoid sitting or lying down for extended periods. Move around periodically to promote circulation.

• Initially, use walkers, crutches, or canes as advised to ensure you don't put too much weight on the new knee too soon.

• A positive mindset can significantly impact recovery. Understand that healing is a process and celebrate small milestones.

• Smoking can delay bone and wound healing.
• Excessive alcohol can interfere with medications and the healing process.

• Ensure you get adequate sleep, as the body heals faster when well-rested.
• Take short naps during the day if needed.

• Drink plenty of water to support cellular functions essential for healing.

• Attend all scheduled check-ups with your orthopedic surgeon to monitor your progress and address any concerns.

• Understand the do's and don'ts after surgery. Being informed can prevent actions that might hinder recovery.

Remember, every individual's healing process is unique. Always consult with your healthcare professionals to ensure you're taking the right steps for your specific situation.

Learn more about exercises after a total knee replacement here.

Check out our blog offering tips for knee arthritis HERE.

Take the Next Step Towards a Pain-Free Life! If you're scheduled for a total knee replacement or have been diagnosed with knee arthritis or osteoarthritis, don't navigate this journey alone. Call us at 512-215-4227. Our team is here to guide, support, and provide the expert care you deserve. Make the call today and invest in your mobility and quality of life.

What is Foot Drop or Foot Drag? Why Am I Dragging My Leg While Walking?

Foot drop or foot drag is when a person is walking and they lift their leg to swing it forward and the toe or foot drags against the ground. This can be a serious issue because it could lead to a fall or alter the mechanics of a person’s gait.

This will eventually cause more dysfunction due to the person compensating with other muscles and or joints. 

What Could Be Causing My Foot Drag?

There are several different possibilities on what could be causing it. The first scenario is that it could be originating from the back. The nerve coming out of the spine could be compressed due to a disk injury which would cause weakness in the muscles in the leg and ankle.

Therefore, the muscle that allows your ankle to lift, the anterior tibialis muscle, does not have the strength to appropriately clear the ground.

Another option is that there could be restrictions in the ankle itself. If the ankle joint does not have enough range to allow the ankle to lift, or what we call dorsiflexion, then the foot will drag while lifting the le

Could It Be a Leg Length Discrepancy?

One of the most common things that I see what is called a leg length discrepancy. This means that one of the legs is longer than the other one.

It can come in two instances: it can be a true leg length discrepancy, where one of the bones is truly longer than the other, which is typically from a growth plate fracture as a kid or something like that. 

The other type of leg length discrepancy is called a functional leg length discrepancy, which is the more common reason. This means that there’s a shift in the pelvis where the pelvis is twisted forward or down and it’s not level with the other side of the pelvis.  

This asymmetry causes the foot to drag when walking. 

What Can Be Done to Help Foot Drag?

Depending on where the issue is, whether it is coming from the back, if it is a nerve issue, restriction in the ankle, or if it is a leg length discrepancy, or combination; will determine what type of treatment needs to be done.

If it is a leg length discrepancy, adjusting the pelvis by working on the hip flexors and increasing the core strength to even out the pelvis and legs, or treating the back or ankle to alleviate the pressure on the nerve or improve the motion of the ankle.

Check out this blog on Foot Drop from WebMD. Click here to Learn more about nerve anatomy.

Wobble boards are a great tool to help the mobility of the ankle… get one here!  

Wobble Board Exercise for Foot Drag / Foot Drop

Sit in a chair and place the wobble board directly under your knee. Now, put your weak foot in the middle of the wobble board and your other foot in full contact with the ground just to the side.

Point your ankle and toes and touch the front of the wobble board to the ground. This is called plantar-flexion and should not be a problem.  Next, drive your heel towards the ground as your ankle and toes come up towards your nose.

The foot should not leave the wobble board, it should stay flat on the board the entire time. This motion is called dorsiflexion and will stretch the calf. The anterior tibialis is the muscle in the front of the leg that could be weak and this is the muscle we are trying to activate with this exercise.  

Again, the pointing will be easy and the dorsiflexion will more than likely be a challenge.  Do 10 repetitions in each direction and do your best to get that heel side of the wobble board down to the ground.

Do 3-5 more sets of 10 reps as you are able. This will also loosen the ankle joint as we discussed earlier as a possible problem.

Neuromuscular electric stimulation is similar to a TENS unit but is designed to stimulate a muscle contraction instead of help with pain. The anterior tibialis muscle can get stronger with use of this electric stimulator to help with foot drag.

By placing the electrodes over the anterior tibialis muscle and setting the neuromuscular electric stimulator to perform a gentle contraction while attempting to lift the foot on your own. This can be used in conjunction with the wobble board exercise we just discussed above. 

How to Fix the Foot Drop or Foot Drag?

My BEST recommendation is to visit your local physical therapist for a detailed assessment and individualized plan of care to help your foot drop or dragging the leg while walking.

Call 512-215-4227 if you are in the Austin | Westlake Hills area.