You Can Break the Cycle of Chronic Pain!

It’s All In Your Head: Your Brain & Pain

Many of us who experience pain might feel very offended if we were told that this pain was all in our head. However, all pain, as well as any other sensation, is created by the brain. This is because pain is a perceptual process- the experience of the pain is not actually happening in the part of your body that hurts, but rather it is happening in your brain. Sometimes this perception of pain can be a very useful process (Ouch, I just touched a hot stove, let me move my hand away as quick as possible!), but when it comes to chronic pain, this process can severely impact our quality of life.

In cases of chronic pain, the brain tends to get hypersensitized to the pain until we are in a constant state of high alert. A learning process occurs in which neural pathways involved in pain perception of a certain area (the low back, for example) become strengthened. The neural pathways responsible for chronic pain experience go far deeper than our acute pain pathways, such as in the stove top example. This is because over time, the neural pathways related to the chronic pain will be embedded into the memory and emotional centers of our brain, making chronic pain far more complex than pain from acute injuries.

As with any learning process, we form associations, such as... sitting = pain, long car rides = pain, exercise = pain. These associations can contribute to a self-perpetuating cycle in which we avoid certain activities because of the fear of pain, which decreases our quality of life, thereby contributing to depression, inactivity, limited social participation, and other factors that will actually make our pain worse over time.

How do we break this vicious cycle?!?

Pain is our brain's opinion of how much danger we are in, and we have to change that opinion. Our brain was capable of establishing these detrimental neural pathways that contributed to the chronic pain, and it is just as capable of creating new pathways that will help us get out of this situation. This is because our brain remains plastic for our entire lives, meaning we are always capable of learning. We must learn that we are safe, and that movement of the affected body part is safe and beneficial.

At The Wellness Station, we help those in chronic pain learn that they are safe.

By creating individualized movement programs, we help our clients learn ways of moving and relating to the body in a manner that will drive neuroplasticity. We will help to teach the little person in the control room (aka your brain) that movement can be associated with calm, pleasure, and ease, rather than movement = pain. The movements lessons are designed to help our clients move with greater efficiency to make movement easier and to decrease tension and tissue strain. We will also help with self-care tools necessary to calm down the nervous system to decrease pain sensitivity, and provide guidance regarding management of the psychosocial aspects of living chronic pain.

Do not let pain stop you from living life to the fullest. It is never too late to learn!

Written by Jacob Tyson, DPT - Physical Therapist, RYT-200- Yoga Instructor and The Wellness Station Team

Giving Your Body What It Needs: Finding Your Flow

What is it to be in flow?

Flow is when our minds are fully immersed in an activity. A sense of complete focus, engagement, and pleasure. We have all felt this sense, perhaps when performing well at our job, playing a favorite sport, or feeling fully present while interacting with a loved one. The ingredients for finding flow include undivided attention, intrinsic reward, and the perfect balance between challenge and ease.

What does this mean when it comes to yoga and movement?

If you have ever participated in a Vinyasa style class, Vinyasa means flow- flowing between different postures, synchronizing this movement with breath. However, how often is it that you truly felt like you were “in flow”, with your attention fully in that moment? Or do you notice your attention elsewhere… anticipating what is next? Looking at the screen or the instructor? Comparing yourself to others, or judging yourself in some way?

Participating in yoga classes is a truly invaluable practice that can benefit everybody- an excellent method for learning the foundational postures and how to navigate between them without injury. However, merely following someone else’s teachings would be selling ourselves short. Each of our bodies/nervous systems have unique needs to be addressed. By taking time on the ground to explore what has been learned and add to it with creative variations, we can induce neuroplasticity and learning

This will help us get the greatest benefit out of our movement practice. Finding flow in our movement will stimulate our intrinsic reward system, which will keep us coming back for more! With the intention of being patient and kind to yourself, you will begin to unlock the inner wisdom of what your body needs.

Here are some ideas for finding a "flow". The instructions are left vague on purpose in order for you to learn your own way:

1. Lie on your back and hug your knees into your chest. Roll like a ball, and try to find a way to come up to sitting.

2. Find the easiest possible way to transition from lying on your back to lying on your front, and vice versa.

3. Pick two of your favorite yoga poses- then, find a way to transition between the two of them, even if it involves many steps in between. Continue to transition back and forth between the two, seeing if you can find the easiest possible way. (E.g. Child’s pose to down dog)

4. Take five minutes the next time you are in the kitchen cooking or cleaning, and try to notice your “flow” of movements. Is one activity moving fluidly to the next? Are you staying mindful and present in what you are doing? Try to create a sense of flow and presence during this task. Music might help!

Written by Jacob Tyson, DPT - Physical Therapist, RYT-200- Yoga Instructor and The Wellness Station Team

Core Strengthening: The Wellness Station Way!

What is our core, what does it mean to have a strong core, and what are the best methods to achieve this?

Many of us associate the idea of having a strong core with the ability to stay active and independent as we age, maintain our balance, avoid injury, ease back pain, or perhaps maintain a trim waistline.

Although the idea of core strength is popular and highly sought after, what we are really after is core responsiveness: how efficient and with how much precision are our core muscles able to respond to the needs of our environment and our intentions. In other words, how well are our bodies able to do what we want them to do in a given situation?

This responsiveness depends on our neuromuscular system- the intricate connections between our brain, spinal cords, and muscles. It is crucial that this responsiveness includes all of the tiny muscles that connect each of our vertebrae, which are vital for dynamic stability, proprioception, and the ability to "change shapes" depending on the needs of the situation.

In the world of traditional physical therapy and fitness, the idea of core strength is often reduced to "core stability", and focuses on the ability to brace and hollow the abdomen. The general notion is that we must be able to keep our core very tight and rigid during movement, lest we injure our spines. This rigid stability utilizes the large, long muscles that travel up and down the spine, neglecting the tiny muscles in between each vertebrae. This is not how we function as human beings!

As we live in a three-dimensional world, our bodies need to be able to efficiently change shapes based on the situation we are in. By only training ourselves to keep our cores tight and thus restricting movement, we are behaving in a linear manner that is not conducive to our dynamic, three-dimensional world. Although this type of core engagement can be helpful in some situations (perhaps if a pet or a baby decided to crawl on our stomach!), far more often this approach is selling ourselves short and could actually put us at a higher risk of injury, pain, or limited function.

   Consider the example of a stack of blocks connected by elastic bands as referenced in our Ehlers Danlos blog post, illustrating the difference between segmental vs. rigid core responsiveness. The traditional approach to core stability is similar to the example in which the blocks are connected only by four long rubber bands, in which the vertebrae (like the tower of blocks) are undifferentiated and controlled using the large, long muscles of the spine. This would neglect the small muscles of the spine that allow us to move with efficiency, fluidity, and balance. Our approach at The Wellness Station reflects the example in which the tower is connected by smaller rubber bands in between each block, allowing the structure to form a variety of complex shapes and forms, representing segmental spinal responsiveness.

Our core is our spine- we need to be able to move our spine in the three dimensions. Flexion and extension, side bending, and rotation. Each of our many vertebrae are capable of movement, and our deep spinal muscles (including the transversospinales and the segmental muscles) allow this movement.

By engaging in mindful movement practices to target these muscle groups, we can strengthen our mind-body connection to these areas, thereby improving responsiveness of our core.

This is truly what core strength is- our ability to move our spines into different shapes efficiently, mindfully, and powerfully depending on our intention and the circumstance we find ourselves in.

Here are some examples of mindful movement drills that engage the body in three-dimensions, and target segmental movement of the spinal column. Enjoy!

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

How Do People Heal?

Although many aspects of healing remain a mystery, we believe that the nature of the patient-provider relationships has a significant impact on the healing process.

We highly recommend Daniel Siegel’s book The Mindful Therapist which highlights additional (paraphrased) elements of healing.

Presence:

“…Our presence as medical clinicians…, the way we bring ourselves fully into connection with those for whom we care, is one of the most crucial factors supporting how people heal.”  Our presence, with others and with ourselves, promotes empathy and self-compassion, which both cultivates well-being in our mental lives and in our bodily health.

Resonance:

The physiological result of presence and attunement is the alignment of two autonomous beings into an interdependent and functional whole, each person influencing the internal state of the other. With resonance we come to “feel felt“ by the other. 

Trust:

Trust is a state of receptivity, akin to the notion of love without fear. Presence, attunement, and resonance are the ways we clinically create the essential condition of trust. 

Written by Paul McAndrew, PT, GCFP & The Wellness Station Team

Calm Your Nerves, Heal Your Gut

It may come as a surprise that at the Wellness Station, we are able to help with the gastrointestinal condition known as Irritable Bowel Syndrome (IBS).

While we do not claim to directly treat the gastrointestinal system, many of our clients with IBS and related conditions have found great relief from our approach. IBS is closely related to stress and anxiety- what is going on in the mind and in the gut have a bidirectional relationship. In fact, one study found that 44% of people with IBS had a comorbid anxiety disorder, compared to 8% of people without IBS.

This poses the chicken or the egg question: is my IBS causing me to have anxiety, or is my anxiety triggering my IBS? Regardless of the etiology, finding appropriate ways to manage stress and anxiety can help people avoid flare ups and find relief from the painful symptoms of this disease.

We understand the connection between mental and physical health. There is no clear division between the two, as we are deeply integrated organisms with a variety of systems that depend on each other. In fact, our gut has its own nervous system! The intestines contain around 500 million neurons, which are connected to the brain through a vast network of nerves, including the large vagus nerve which is extremely important for modulating digestions, heart rate, mood, and inflammation.

By calming down the nervous system, we help to shift ourselves into a more harmonious state, which supports long-term health, decreases anxiety, improves digestion, and fosters feelings of well-being. This is a function of the parasympathetic nervous system, which is known colloquially as the "rest and digest" system, as opposed to a highly aroused "fight or flight" state, which is a function of the sympathetic nervous system, the latter of which can trigger IBS flare ups.

We provide interventions to help our clients achieve a parasympathetic state, which may include body scans, meditation, mindfulness, breath work, and gentle movement.

A client of ours (we will call her Tonya to maintain her anonymity) shares the following from her experience with our work together-

"Instruction in meditation and breath control can help turn down the volume on pain by focusing the mind elsewhere. There seems also to be a long-term beneficial effect."

Movement and exercise can be extremely helpful for those suffering from IBS. Regular physical activity decreases stress, promotes healthy bowel function, and certain movements can further assist peristalsis (wave-like muscle contractions that push the contents of the digestive tract towards the exit). This is very useful for those suffering from constipation and difficulty clearing gas.

Tonya shares regarding a movement lesson that has been particularly helpful for her

painful symptoms-

"The move where you lie on tummy and drift legs to side is one of the most consistently gas relieving postures I've ever tried... that whole sequence, from lying prone to massage the belly to drifting legs to thread the needle. Very helpful!"

Here is a video showing the particular movement sequence Tonya is referring to, as well as another movement that has been helpful for people with digestive issues:

In addition to providing strategies to calm the nervous system and engage in mindful movement practices, we can also provide abdominal massage, as well as resources for dietary management based on the current best evidence. Don't let your IBS limit your quality of life any longer- we can help you move past it!

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team