PEACE out of Pain: Address ALL the Reasons why People Hurt

I consider myself an evidence-based case study in Physical Therapy.  I developed pain in college and many times was selected as a “model” in PT labs.  My fellow students would analyze my movement and come up with suggested treatments to decrease my “mechanical” pain because that is all we knew in the late 80's. At that time physical therapy was moving from treating pain as a sensory experience with heat, ultrasound and massage to correcting biomechanics with manual techniques and therapeutic exercise.

I believed in this approach whole heartedly and had success treating many patients over many years.  I also taught this strategy to the best of my ability for many years to both students and other PT colleagues.

However, despite taking my own advice, I continued to have pain.  And it spread…from low back pain to neck and shoulder pain to hip pain, headaches, etc.

And as the knowledge of the PT profession changed, my approach to treating myself changed.

I studied pain science and implemented psych strategies (CBT and ACT) to both alter my perceptions and accept the pain that I experienced.

I work to modify motor patterns with repetition.

I focus on other lifestyle factors to manage my pain: sleep, nutrition and regular physical activity.

All of these strategies have helped…somewhat…

What I have also learned is that my movement system is affected by much more than external forces.  My movement system, yes, even my motor patterns, is affected by something deeper within me…

I’m not even sure that this deep force has a name, but just for ease of understanding I will call it my Spirit.

Let me tell you how my Spirit developed and then you might understand how it affects everything that I do.

I was born to a teenage mother who never held me.  After birth I was transported to a nursey and cared for by nurses for nearly 3 weeks.  I was adopted into my forever home to amazing parents along with an older brother where I lived happily ever after…

…and developed chronic pain.

What I have come to realize is that in the first 6 months of my life, I cried.  I’m pretty sure that I was scared and wanted someone to listen to me…to attend to me as any infant would.  You might imagine that in a hospital nursery, I didn’t get quite enough attention from the same person and that this was confusing.  So I cried.  In my new home, I also cried and because my parents were told to adhere to the Dr. Spock method…I still did not get the attention that I so desired.

As a child I had stomach aches.  As a teen I had growing pains.  As a young adult, I had back pain and neck pain and the cycle continued.  Each pain treated as though it was new and unrelated to the other.

As a child I became a performer in many ways: dancing, baton twirling, singing, and playing instruments.  You see, I was able to get the attention that I “needed”.

In school, I excelled which again gave me the attention that I “needed”.

The pattern continued.  I enjoy teaching and presenting because it provides the attention that I “need”.

Or does it?

In my late 40’s when my career wasn’t going so well.  With young children, my priorities were changing, and the best laid plans were not working out as intended.  I was taking care of aging parents, not sleeping well and not feeling supported by my husband.  You might say I was having a mid-life crisis.

Thankfully, I was having a mid-life crisis!

And thankfully, the practice of yoga was a part of my life!

The practice of yoga helped me turn inward to discover the true source of my pain…

My Spirit.  The Spirit of an infant that did not get what she needed and instead looked everywhere outside of her to find it.

When I turned my focus on healing my Spirit…my chronic pain began to dissipate.

A rise in pain without mechanical stress or injury, is a sign to turn inward and care for my Spirit.

When I care for my Spirit, all of the tools from Physical Therapy work wonders.

Now I can see very clearly why Physical Therapy doesn’t work 100% for some patients. 

It is not the body that needs to heal.

So as a Physical Therapist, what do you do?

In reading this article, you have taken the first step.  Now to take a few more steps in a process that I call PEACE:

• Awareness. Mindfulness. Meditation. Slow Down.  Remove the distractions that keep you from attending your patient.
• Pain science. Neuroscience. Even as specialists in musculoskeletal and orthopaedic physical therapy, you must diversify and continue to educate yourself on ALL of the factors that can affect the experience of pain, especially chronic and persistent pain. Educate yourself on all the resources that will help your patients.
• Yes, take a full history of the injury but also of “what else is going on”.  My story took years to uncover.  A patient may not be able to articulate the trauma of their life.  But it is your job to recognize that not every ache or pain experienced in the body is FROM the body.  When your examination reveals inconsistencies, that is the evidence you need to go deeper into the story of the patient and look for ALL the source of pain.
• Create a therapeutic alliance that allows the patient to feel safe. That is your #1 goal. The person with chronic pain has gotten many conflicting answers about the source of their pain and she/he is scared (period).  This fear is keeping her/him in pain.  You can objectively assess this fear AND you can very clearly observe the fear.  You cannot help your patient unless you use strategies to decrease the fear.  Create a team that can help you treat all the reasons people hurt.
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PEACE: Strategies Blending Physical Therapy and Yoga