The Science of Pain

 

by Meg Crowley, PT

A muscle cramp, a paper cut, a bumped shin. We experience pain every day to varying degrees, but we may not have ever given thought to how it works. Like many sensations we experience, pain is a signal our body sends to our brain to keep us safe.

There are receptors in every area of the body that assess things like temperature, pressure, stretch, and vibration. These receptors are in constant communication with the brain, and when they sense that the body has passed a threshold that could lead to damage, your brain interprets that message as pain. The brain then sends messages back down the body to move accordingly - for instance, pulling a hand away from a hot stove or shifting weight off a sprained ankle.

Now, the body is a complex machine, so the brain receives hundreds of thousands of signals at any given moment. That’s a lot of information to pay attention to, so the brain prioritizes the most urgent messages and leaves the rest to the subconscious. For example, do you usually feel the sensation of your clothes on your skin? You probably do now because I drew your attention to it, but you likely don’t feel the light pressure of your clothes on your body the majority of the time. This doesn’t mean the pressure goes away: your brain usually decides you have more important things to pay attention to (like reading this blog). This filtering of information can lead to you experiencing tissue damage, but not feeling pain associated with it. Remember that bruise you got that you can’t for the life of you remember how it happened? You may have been balancing a tray full of food, or grabbing your toddler’s hand as he ran into the street, or running to the train because you were late, and those immediate situations took precedence over registering the tissue damage.

The opposite can also be true: you can have the sensation of pain without correlating tissue damage. So how does that happen? If our bodies are generally well - meaning we are sleeping enough hours at night, eating a balanced diet, getting enough activity and exercise, and not experiencing unusual stress - then our thresholds will be at their normal levels. However, if there is an imbalance in any of those areas of our life or if we have been in pain for a prolonged period of time, then the threshold lowers. With the lower threshold, something that usually would not be painful sets off the brain’s alarm system and we feel pain. It’s like the alarm system in a house: usually, someone has to break a window or break in through the door for the alarm system to go off. When we have a lower threshold for triggering the pain response in our body, it’s as if the alarm system is set off every time a leaf brushes the window. A very common instance of this is when we do a stretch or movement that we’re not used to: there isn’t a risk of causing tissue damage, but our brain interprets it as painful because our system isn’t calibrated optimally.

If you are experiencing pain, physical therapy can help to recalibrate the system. There are many layers to pain, so a thorough evaluation is needed to determine your specific plan. Often treatment involves desensitizing the system with graded exposure to the perceived “threat” and re-educating the brain on how to interpret the stimulus. If you are having chronic pain or feel like your pain system is off, we can help!

Running: All You Knee-d to Know

by Kate Marconi, PT

Running is one of the most popular forms of exercise in the United States, with over 60 million people participating in some way. Each year the number of running events, from 5Ks to marathons, increases due to popularity. The majority of people begin running to improve their health, but many runners have also been told that they’re ruining their knees or that they should stop when they get older to avoid arthritis.  

So will running ruin your knees? A study by Lo et al. (2018) looked into just that, following individuals over the age of 50 with current osteoarthritis in their knees. Their findings were clear: through over 48 months of regular running, none of the individuals had worsening osteoarthritis, increased knee pain, or new onset of knee pain.

Here's what we do know about injury prevention in running:

• There is a significant correlation between glute medius weakness and knee pain in runners (Wilson et al. 2011) (Dierks et al. 2008)
• Running 1-3 times per week with cross training has less incidence of injury and an equal cardiovascular benefit as those that run 5 times per week (Yeung et al. 2001)  
• Stretching and proper shoes had less of an effect on injury prevention compared to strengthening and adjustment of training schedule (Yeung et al. 2001) 

Whether you’re a new or seasoned runner, you should be doing regular strengthening exercises for your glute medius. But where to start? Stastny et al (2016) looked into hundreds of exercises and measured which had the most glute medius activity that would be most beneficial for runners. Below are a few to start with:

Side plank with hip abduction: Position yourself in a side plank with your elbow under your shoulder. Feet can be stacked, one in front of the other, or bottom knee can be bent on the ground for support. Take the top leg and keeping your toes forward, raise it keeping it in line with your bottom leg. Don’t let the top leg come forward and work on keeping your hips slightly forward.

 

 

 

 

 

Clamshell with foot elevation: Lay on your side with your knees bent to about 45 degrees. Roll your hip forward, then keeping your feet together raise both feet. Then lift your knees open and closed, keep your feet raised and your hip forward. Add a band above your knees for a challenge!

Single leg squat: Standing on the edge of a step, sit back into your heel and complete a squat by moving your hips back. Your knee should stay in line with your ankle. Tap the floor with your heel and return up focusing on keeping your weight in your heel.

 

 

 

 

Contralateral lunge: Holding a weight in the opposite hand, step forward into a lunge. Make sure you keep your knee above your ankle. Push off your heel to return back to standing.

If you’re a new runner getting started or a runner with knee pain and you’re unsure of where to start, you can always ask a physical therapist! Our therapists are always happy to offer their expert opinions to help you continue your running journey.

 

 

 Bibliography  

Dierks, Tracy A. “Proximal and Distal Influences on Hip and Knee Kinematics in Runners with Patellofemoral Pain during a Prolonged Run.” Journal of Orthopaedic & Sports Physical Therapy, vol. 38, no. 8, 2008, pp. 448–56. 

Lo, Grace H., et al. “Running Does Not Increase Symptoms or Structural Progression in People with Knee Osteoarthritis: Data from the Osteoarthritis Initiative.” Clinical Rheumatology, vol. 37, no. 9, Sept. 2018, pp. 2497–504. DOI.org (Crossref), https://doi.org/10.1007/s10067-018-4121-3. 

St
astny, Petr, et al. “Strengthening the Gluteus Medius Using Various Bodyweight and Resistance Exercises.” Strength & Conditioning Journal, vol. 38, no. 3, June 2016, pp. 91–101. DOI.org (Crossref), https://doi.org/10.1519/SSC.0000000000000221. 

Willson, John D., et al. “Gluteal Muscle Activation during Running in Females with and without Patellofemoral Pain Syndrome.” Clinical Biomechanics, vol. 26, no. 7, Aug. 2011, pp. 735–40. ScienceDirect, https://doi.org/10.1016/j.clinbiomech.2011.02.012. 

Yeung, E. W. “A Systematic Review of Interventions to Prevent Lower Limb Soft Tissue Running Injuries.” British Journal of Sports Medicine, vol. 35, no. 6, Dec. 2001, pp. 383–89. DOI.org (Crossref), https://doi.org/10.1136/bjsm.35.6.383.

 

We Turned 10!

by Sally Fansler PT

Is there anything more gratifying than knowing you’ve made a difference in someone else’s life? Honestly, we can’t think of anything, which is good news because it confirms we’re still in the right industry!

For the past 10 years, the staff at Lakeshore Physical Therapy has strived to provide one-on-one physical therapy care to our patients with a unique individualized approach. What we discovered was that this business model was equally positive for our patients and for us. With extra treatment time in each visit, successful communication and listening fosters a solid base to build on for our care.

Lakeshore PT is thankful to the Chicago community for 10 years of doing what we love to do!