Movement Is Medicine
By Dr. Lynn Kotlicky, PT, DPT, CIDN
Pain is a feeling that is part of the human experience, despite poor understanding of our expectations of treatment and experiencing it. As a panelist on the Nevada Humanities Nevada Humanities Salon: Pain and Healing in March 2018, this topic was explored by a variety of clinicians with different perspectives and treatments around chronic pain.
As a physical therapist, I encounter a wide variety of individuals on a daily basis. People of all ages and functional levels seek care in order to improve daily function, return to sport, decrease fall risk, and to decrease pain. The group of people that I consistently see struggling the most and feel the least understood are those suffering from chronic pain.
After 25+ years of working in health care, I have seen a shift in the paradigm of treatment. Initially, there was poor understanding of chronic pain, but more recently there is a large and growing body of evidence that supports physical therapy (PT) for treatment of chronic pain. According to the Physical Therapy Guide to Chronic Pain, it is defined as “a condition that occurs when the brain concludes there is a threat to a person’s well-being based on the many signals it receives from the body.” What this means is that pain that occurs for greater than three months after injury and continues to hurt even after the tissues have healed.
I often see people present to the clinic feeling overwhelmed or hopeless. It is not uncommon for them to state that their family or doctor tells them that there is nothing wrong with them. They often present with life stressors, such as emotional or physical stress. In addition, they may have difficulty with their job or finances. These issues are documented to increase the neurological sensitivity that can cause an increase to a person’s response to pain. Often, they have tried PT, chiropractic, injections, or acupuncture in the past without any relief.
Initially, I educate them that physical therapy treatment for chronic pain is different than treatment they may have experienced in the past. I explain that their neurological system has become hypersensitive and the key is to try to calm it down. The “no pain no gain” attitude has no benefit. In addition, I discuss the importance of seeking a psychologist in order to assist with the emotional stressors that they may be experiencing and the role it plays in their unrelenting pain. The majority of treatment focuses on the down-regulation of the nervous system which includes, graded exercises, activity tolerance tracking, re-establishing expectations of activity, and positive reinforcement of pain free activities.
Chronic pain can be debilitating to many individuals, but movement is a key component to recovery. The movement may be different than what was performed prior to their pain, or it may not be as intense, but that is the crux of success. Movement may consist of as little as diaphragmatic breathing exercises or extend to complex exercise programs. When we move our bodies (even in small, modified and controlled increments), we remind our brain that movement is important and should not be fear based. Movement is medicine and when we embrace the treatment of the whole person, not just the body, then success is possible.
Photo courtesy of Dr. Lynn Kotlicky.
Dr. Lynn Kotlicky holds a doctor of Physical Therapy degree from Boston University and has been practicing for over 25 years. When she isn't working, she enjoys spending time with her family, distance running and riding her Peloton bike. She also was a guest panelist at the Nevada Humanities Salon: Pain and Healing.