5 Things to Know about Pain


Pain is one of the most complex topics we deal with in physical therapy and life. Most of the people I work with in my clinic have pain. That’s one of the main reasons they come in to see us. It hurts when they work, or run, or sleep, or all the time. This is true in all of health care. Pain is the number one reason to see a doctor, and it is where the most money is spent in the US in healthcare. More than heart disease, cancer, and diabetes combined.

Remarkably though pain can be poorly understood, both by people in pain, and by people trying to help the people in pain. The science of pain, the nervous system, and the brain and body is ever evolving, and not everyone understands it well.

We as a culture and as health professionals continue to treat the body as a machine, like a car for example. A part is broken. We fix it, or replace it, and the pain goes away. Right? Of course if you have pain, you know this doesn’t always happen. Sometimes we repair things and the pain doesn’t go away, or maybe even gets worse. What’s going on?

In this space I haven’t posted in a bit. I am going to talk about pain and injury and rehab more consistently in the future hopefully. Today we will talk about 5 misconceptions about pain.

  1. Pain equals damage. This is the most important thing to understand. Yes you can have pain with damage, of course. But pain is an output of our nervous system. Our body senses damage or stress of various types, this is called nociception. These signals are sent to the brain and are processed with many other inputs, other senses, memories, experiences, thoughts, and beliefs for example and then decides what the response will be. This can be pain. Or not. Or another response. If you ever have had a bruise or cut that you didn’t know about until you saw it, you had damage without pain. Sometimes we can have pain, or amplification of pain without damage.
  2. Pain means something hasn’t healed properly in your body. This is the same principle as above. We can have an injury that our nervous system responds to with pain.  But in most people our healing response is amazing. Tissues respond and heal very well in a few weeks to a few months. If you have ever had cuts you can see this. They close well and in a short period they disappear. If pain continues longer term, changes in your nervous system may be contributing to this. We, of course, must rule out sinister things such as things not healing. But, pain is used by the nervous system like an alarm. Sometimes the system stays very protective and the alarm is very sensitive. This allows it to go off very easily, even if proper healing has happened.
  3. Pain is 100% physical and real or “in your head”.  This is a huge misconception. Pain is real. And no pain is 100% anything. It is a  biological response from our nervous system and our brain. But the inputs include biological or physical components, along with psychological components and social components. These can be factors like sleep, stress, fear, thoughts, beliefs, and how pain is affecting your work, family and social life. When pain doesn’t make sense we tend to focus primarily on the physical. Something must be terribly wrong in my body to hurt so much. But sometimes, the body is healing well, but these other factors begin to play a bigger role.
  4. If I have pain my body must be fragile. This is understandable. People when they are injured are told to be careful, don’t bend, don’t twist, don’t do too much, take it easy. And sometimes we need to protect an injury. But we probably should be told to be careful or not do things for a little while. Once the body heals it is very strong and resilient, but it may be sensitive. So, if you do too much too quickly it may respond by telling you to slow down a bit. Pain problems can occur when we interpret every pain as not slow down a bit, but as stop don’t ever do it you are injuring yourself. Our system can continue to sensitize as new memories, thoughts, and beliefs are integrated into our nervous system and we get into a negative cycle.
  5. If you have chronic pain, you will never overcome it. I hear this a lot from people with longer term pain. They feel lost and hopeless that they can never get better and live how they want to live. We know now of a concept called neuroplasticity. This means that our nervous system can continue to change. It changed in a way to get someone in a chronic pain state, it has the potential to change in other ways and help your situation. Sometimes pain will not fully resolve and sometimes it may. But, using neuroplasticity can help your system become less sensitive and allow changes to how you live.

Pain and our bodies is always a complex topic. And every person with pain is unique with different challenges. Hopefully, learning about pain can help you move forward.

If you have further questions about pain, we would love to hear from you. Go ahead and post them here.

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10 Reasons to Get PT 1st

Today is get PT 1st social media day.  In honor of that here are 10 reasons to think about either getting PT first for your pain or injury problem, or using PT in conjunction with other treatment such as surgery, medication, injections, or further testing.

Green Road Sign - Right Decision

  • PT is Effective: Research clearly shows that things like exercise, manual therapy, and education are effective for recovery from pain and injury.  These are right in the wheelhouse for physical therapists.  Research is now also showing that for things like menisectomies with knee pain, rotator cuff repairs for shoulders, back surgery, and injections, 1 year after people having therapy are at the same functional and pain levels as the people who have surgery.
  • PT is Cost Effective: Not only is PT being shown to be as effective as surgery in many cases for common orthopedic injuries, it is much less expensive.  Surgeries generally cost in the tens of thousands of dollars, where in Colorado you can easily get a full course of therapy for less than a thousand dollars, even longer courses of therapy will be less expensive that imaging, surgery, or injections.  One recent study shows that people with back pain will spend on average $4700 less if they 1st use PT rather than starting with an MRI.
  • Time:  Despite being considerably less expensive, you generally get to spend a lot of time with your therapist.  This allows your therapist to fully understand you and your situation, gives you time to ask questions and learn about your problem. You most likely will see your therapist more frequently than your a doctor.  This allows your progress to be monitored, questions to be answered, and situations dealt with more quickly between dr. appointments. Do I need the medicine? Its hurting more did I damage it? Can I go back to work yet? How am I doing with my progress?
  • Access: From my experience as a therapist, we tend to be very accessible to our clients.  We answer phone calls quickly.  We can generally schedule people reasonably quickly.  If you are in pain before the weekend we can get you in, not 2 weeks from Thursday.  If a situation comes up post surgically and you aren’t sure if it is a big deal or not we can talk to you on the phone or take a quick look on short notice.  This can either give you peace of mind or catch something before waiting too long.
  • Direct Access: In Colorado and many other states PTs have had direct access for many years.  This means we can see people without referral from a doctor.  If you have pain or injury that doesn’t require an ER visit we can save you the time and expenses of scheduling a doctor appointment for them to just send you to therapy.  If you have had a therapist help you before, he/she is probably the best place to start with a recurrence or new injury.
  • We Treat the Whole Person: In today’s medical system everything seems to be specialized. One person treats some of your issues, while another treats others.  Frequently, especially with pain problems, multiple areas of your body may be an issue, along with multiple systems, muskuloskeletal, nervous, immune, cardiovascular, sympathetic etc…Therapists are trained to work with all of these systems and how to evaluate how they may be influencing each other and your problem.
  • PTs Can Be a Bridge Between Conventional and Alternative Medicine: PTs are educated with an evidence based approach in a conventional medicine model.  But because of our unique place in medicine, many of us work with people in alternative and ancillary wellness fields such as massage, accupuncture, yoga, trainers etc.  We can help people understand how those fields can assist in your recovery in an evidence based way and help transition people to those areas as they are ready.
  • PT is an Active Approach: Research shows that people who are active copers and who take an active approach will recover from injury and pain better than people with a passive coping approach.  Many treatments commonly used are passive, such as surgery, medications and injections.  These obviously have there places, but adding an active approach to these passive ones will help recovery. PTs work in an active recovery model.  We use education for self care and management and exercise as primary components.  We want to get people moving and understand their problem better to be able to recover faster or self manage as best they can.
  • PTs Work With Everyone: Many people are aware that a PT might see you after surgery, but the list of areas we work is much bigger than most people are aware of.  We may see you after knee surgery.  We can work with people after a whiplash injury in a car accident or a back strain at work.  You might see us on the side of the field during a high school football game.  Therapists work with people after suffering strokes.  We work with people the day of an injury, getting people out of bed and ready to return home after surgery in the hospital or with months or years long chronic pain after a failed back surgery.  We can assess a factory for proper ergonomics or your mom’s house for safety when she is returning home after surgery.  Some therapist manage weight loss fitness programs or cardiac rehab programs.  Others work with kids with developmental delay.  You will see therapists in clinics, hospitals, people’s homes, rehab centers, on the side of sports fields, using horses for equine therapy, in pools doing aqua therapy, in burn units, fitting an amputee with a prosthetic and many other places.
  • PTs Want to Work With You: PTs get into this profession because we love to help people.  We spend many years working on our degree and a lot of time doing continuing education and reading to keep up with science to help people the most effective ways we can.  PT does not always seem like the easiest or simplest way to get better.  Passive treatments seem like less effort, but in the long run working with a PT can be a great way to recover.  And we love to help.

I hope this lets you know a little bit more about why getting PT 1st might be the right choice for you.


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Survey on Pain Just One Question


I have been writing off and on about pain for a while and trying to get the word out in our community about the new thinking in pain science, why pain experiences occur, and how physical therapists can help people become empowered and live better lives whether by reducing there pain or managing it better.

In talking with people in the community at large, medical practitioners, and other health and wellness people, I have come to realize what a huge job we have in getting people and the world in general to reconceptualize pain.  Tightly held beliefs, fears of not being listened to, and a large shift in perspective are all obstacles to overcome.  Of course we see this everyday in any kind of large change.

So today I am doing a one question survey..Just answer in the comments for anyone who works with people in pain or is having pain.

What is your biggest frustration in working within the medical system if you are healthcare provider when dealing with people with chronic pain? And if you are a person with long term pain what is your frustration with the system?

I will start the 1st response.

My frustration is how few people in our current system can get past there compartmentalized box of their specialty and treat a person as a whole person, and not a back or knee or a pain patient.  Having empathy and being able to relate a person’s history, and experience and overall physical and emotional state to their pain problem seems to be lacking.

I look forward to hearing some more responses.

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Pain Link

Here is a link to some great pain education.


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12 Things to Help You Get The Most Out Of Your PT


When we are working with clients with pain or injury, they sometimes become frustrated with the pace of their recovery.  Everyone in our culture seems to want a quick fix, which sometimes therapy provides.  But sometimes things take longer.  To reduce your time and expense in therapy here are some things to take note of.

  1. Take responsibility for your recovery.  Even if the injury or pain is not “your fault” you are the one who gets to live with it.  People who become invested in their health and take an active approach will get better results than people who want a passive “fix”.
  2. Get the answers to 4 basic questions you need from any health care provider. What is happening? How long will it take to get better? What can you as a therapist do to help me? and What can I do as a patient to help myself?
  3. There are 168 hours in a week. Are you hoping the 1 or 2 in therapy will fix you, or are you using some of the  other hours in the week to reinforce what you are doing in therapy?
  4. Pain is not a result of ibuprofen deficiency.  It is a threat response.  Help your therapist understand what is going on by being concise it what your body thinks is a threat.
  5. Motion is lotion…Movement is life…Exercise is the one thing that research consistently helps the most health conditions.  Have your therapist help you plan out what movement and exercise you can continue to safely do.
  6. Listen to your body.  It knows more than you think.  But, sometimes it gets confused.  Have your therapist help you sort out what your pain may mean.
  7. Pain and inflammation are a normal response in an injury situation.  Would you call 911  and not tell them where you are?  Have your therapist help you understand pain responses and healing times of injuries so that you can figure out what the proper amount of activity is. Knowing that the pain is a normal response can also help keep your nervous system from getting sensitized.
  8. Learn as much as you can about pain and injury, but don’t believe everything you read on the internet.  Knowing what can and should happen will help in your recovery.  If you learn something you are not sure about ask your therapist.
  9. Life is a series of choices.  You get to decide who you want to see.  If your therapist is not listening or hearing you, spending time with you (rather than an aide), answering your questions, or putting their hands on you, go see to someone else even if your doctor or insurance said so.
  10. Set realistic goals and communicate these with your therapist.  Every person we see has different wants and needs from therapy.  If your goals and the therapists goals don’t match someone ends up unhappy. Talk about it.  It is your body.
  11. Be upfront and honest with your therapist. ” I did everything you said and I am no better” provides a different path than “I didn’t do any exercises and continued to do the things you suggested I not do and am not any better” If you are honest we might get on you a bit, but we do things for a reason.
  12. Remember your therapist wants to help you. We could have made a lot more money doing other things with the amount of education we have.  We ask questions for a reason so give us the best answers you can. Be honest and upfront with what you are doing.  And if you never agree with what is being said let us know so we can explain it better.

These are a few things to help you get the most out of your rehab. Get better and get out there.

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Pain Myth #2

A few weeks I posted about 5 common myths about pain.  Over the next few posts I will try to explain why each is a myth.  Here is that list again if you didn’t see it or don’t remember it.

  1. Pain comes from a specific structure in your body, for example a joint, bone, or muscle.
  2. The amount of pain some is experiencing is directly related to the amount of structural damage or seriousness of an injury.
  3. Pain signals are sent from the body to the brain
  4. Pain is a completely physical experience, separate from thoughts or emotions
  5. Pain is in your head or psychosomatic if no physical injury or signs are present, for example negative scans or no obvious injury

We tackled the 1st myth (actually #3 on the list) in this post https://ascentpt.wordpress.com/2015/03/11/pain-myth-1/

Today I will talk about #1 on our list.  Pain does not need to come from one specific area.  And if it does, that specific structure is our brain.  Many people when they present for therapy want to know exactly what physical structure is the problem.  Is it a herniated disk? My worn out knee joint? Which tendon?  As I wrote about last time if a structure is injured, damaged or inflammed the body will send nociceptive signals on to the brain.  If the brain perceives this as a threat it can respond by giving you a pain experience.  You may, for example, injure an ankle ligament when you step in a hole.  When the ligament has enough stress placed on it, it will send nociceptive signals onto the brain.  The brain then decides whether pain is an appropriate response and for how long.  So, a specific tissue is sending signals and pain may be a response.  But this is not always the case.

In some situations people have what is known as phantom pain.  People have lost a limb to an accident or other amputation, but they can continue to feel pain in the limb despite it not being there anymore.  If there are no sensors to send signals to the brain, or nerves to send signals back to the limb how can there be pain?

Our brain has an area in it called the homunculus And in this area we have neurons that are devoted to specific parts of our body.  This can be thought of as a “virtual body”.


When people have persistent pain, brain imaging has shown that this part of the brain can change.  The areas of the brain can become less clearly defined and may leak into one another.  This is called “smudging”.  When an area has an initial injury but stays painful for a long time, pain may spread or even seem to jump around.  To many people this seems like the structures must be becoming more injured, or new structures are being affected.  But, in many cases this may mean there is a change in how we are processing the information.  No new specific structures are injured or damaged, the nervous system is responding differently as it changes.  The longer pain persists the more changes happen.

So, as you can see pain is more complex than a tissue becoming damaged and pain responding.  Many things happen through our nervous system that can make things complicated. But, you can experience pain from a response to a specific tissue, or get a generalized response that may seem to affect many different areas, or in some cases experience pain in a part of the body that no longer is present.

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Ascent PT in the Vail Daily Today



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