Chronic Pain

Chronic Pain
by Laura Helsel

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Working with clients in various levels of pain over the past 15 years, I’ve developed an understanding, a respect, of the specific challenge that is coping with chronic pain.

Fluctuating in intensity but always present, the pain is frequently without obvious cause. Something definitive may have triggered the acute onset initially but that doesn’t explain the ongoing, chronic pain years later.

Comprehension of this is challenging on a lot of levels and there are two common frustrations that constantly arise.

1.  Hearing the phrase “but you look fine.”

Having real, intense pain that is not categorized by a disease or something that we can easily grasp can result in a lack of empathy and social support.

2.  Fatigue

It’s exhausting to modulate activities, check in with pain levels and adapt constantly. Many sufferers are more annoyed with the fatigue than with the pain itself.

Why? Why? Why?

Chronic pain research has zeroed in on the central nervous system. Pain is designed as a warning system.  Alert! Danger! Alert!  And then it should subside. Research is looking at how this warning system can switch to overdrive - overreacting and becoming hypersensitive long after a danger is removed. To have someone suggest that it’s all in your head can sound hugely dismissive. However the fact is that all pain is in the brain, regardless of the cause.

What to do?

There is no cookie cutter approach and individuals respond very differently to treatments. Studies consistently point to three helpful activities.

1.  Cardiovascular exercise

It can be hard to muster up energy for cardio but if you can get high level cardio several times per week it has been shown to effectively lessen pain in Fibromyalgia patients. This may be easier said than done as it has to be a significant amount of cardio (not 10 minutes of walking) to see a difference. Aquafit in warm pools, rebounders, and variety may be better options than running.

2.  Visualization

We are naturally good at describing negative physical sensations. We can go into amazing amount of detail to describe pain.  Get better at describing positive sensations. This stretch feels nice, I feel a little more relaxed etc. It sounds simplistic but brain training matters and initially it can be harder than expected.

3.  Positive Movement Experience

If you can find exercise of any type that feels good to you and you can enjoy do it! Frequently. Whether it’s deep breathing with shoulder shrugs, Feet in Straps or Spinal Rotation. Pilates (particularly with equipment) offers vast options. We can always find something that’s possible.

And two last things…

I have the privilege here of presenting an essay by our own Pilates Process teacher Beatrice Politi. Bea’s essay reflects on her personal struggle in coping with chronic back pain. Revealing and inspiring, it is not for the faint of heart.

Thanks Bea!

Essay on Chronic Pain

Also of interest is this short Ted Talk on the science of pain. This clip titled “Why Things Hurt” was shown at a recent therapeutic course that I attended. A neuroscientist explains the pain response. Keep in mind, it’s not saying that pain isn’t real, just that it is complex.

If we can better understand the mechanics of pain we can better understand how we might affect our pain response.


Essay on Chronic Pain

The following is an essay by Beatrice Politi on her experience with chronic pain.
Beatrice is a teacher at the Pilates Process studio in Toronto.

It’s what I’d been waiting for.  To see one thing.  If only I could fix that one thing, the pain would go away.  Laying the blame.  It makes for an easy target.  It gives us clarity, purpose, a reason. At least it had for me.  Because when you’re in pain, the question you ask is “why”?  In the beginning you ask “why me”?  Then as you begin to learn more about it, you ask “what part is that”, “why does it hurt” and as the months and years go by, “why does it STILL hurt”?

I’m into my 20th year of back pain.  I don’t remember what it means to live without it. It started with some kind of pull or strain as a teenager.  It was exacerbated by a weight-lifting injury.  Over time, it’s as though it spun a wider and tighter web, wrapping itself around not only my lower back but my upper back, my neck, my legs.  It became chronic pain.  There have been times I could not find a single position where I felt comfortable.  My back would spasm in my sleep. 

In. My. Sleep.

Over the years, the pain can be consuming.  It’s the first thing you consider when you open your eyes in the morning.  It’s the last thing you feel before you close your eyes at night.  Sleep so welcome because it may be the one time you’re not thinking about the pain. 

I. Tried. Everything.

Or so it seemed.  Some things worked.  Some things didn’t.  And when there was success, it was incremental. When I say incremental, I don’t mean over days or weeks.  I’m talking years.  Eventually, I shifted from a person who could not walk 10 minutes without pain, to someone who works out every day.  That doesn’t mean I don’t have pain.  I have a level of pain every day.  But it also means it is far less frequent and I am able to help myself through it. 

The back pain closed so many doors in my life.  It also opened so many others I would otherwise have been blind to.  It brought me to pilates and to The Pilates Process (Riverdale Pilates at the time).  I thought I knew something about how bodies moved.  I thought I knew how mine moved.  Turns out my perception and proprioception were more than a little off (props to Emilie McCabe without whom I would not have made it this far).  I loved pilates because it was hard.  I really had to think about what I was doing.  I was creating new neural pathways.  I started to watch how others moved.  After 2 years as a complex rehabilitation client, I pursued a pilates certification and now try to help others move with more ease, fluidity and strength. 

Pilates is the reason I found myself in an anatomy lab at New York’s Mount Sinai Hospital in December 2014 as part of the FAMI Workshop (Functional Anatomy for Movement & Injuries).  The highlight of the course was spending time looking at actual cadavers – knees, shoulders, feet, the pelvis, the glutes and of course, the back.

As fascinating as every body part was (I held a human lung in my hands…and for the record, it has the “give” of a mushroom), there was one thing I wanted to see more than anything else.

She was slight and small-boned and lying on her belly.  I could see what might have been moles on her skin.  I lifted the layer of skin and traced through the trapezoid muscles, the rhomboids and the deltoids on her right side.  Then I moved to her left, tracing the deeper back muscles including the spinalis, longissimus and iliocostalis.  My gloved fingers came to rest on her iliac crest and her gluteus medius, examining all the fibers attaching to the bone, mirroring the structures of my own body, which, for whatever reason, seem to tighten as though they have to hold up the Golden Gate Bridge. 

I reached over and around and held between my fingers that ab muscle that everyone is talking about – the transversus abdominus.  For all its importance in stability and intra-abdominal pressure, it’s really just like a thin sac and seems rather unassuming.

And then, there it was.  The one thing I really wanted to see.  The quadratus lumborum or as I like to call it, the “evil QL”.  It’s a muscle which seems to tighten almost inexplicably in my case.  It’s always seemed a bit of a mystery.  Sure, you can look it up in anatomy textbooks (and believe me, I have looked up a ridiculous number of muscles and attachments and structures over the years to try to get a better understanding of what was happening in my body) but it’s just not quite the same as having it laid bare right in front of you.  It felt like soft leather.  I traced it from the iliac crest to the front of the spine, reaching into and under the cadaver in front of me.  It’s one of the structures that holds us together, providing a bridge from the iliac crest to the spine.  At various times in my rehabilitation, it’s felt as though it was on permanent vacation or tight as a piano wire.    

I half expected the muscle to talk to me in some way. I thought maybe if I saw it, I would in some way feel a sense of relief or calm or peace or deeper understanding.  Not quite.

When you experience pain, you look for answers.  You want to find the reason and fix it.  And when you’ve experienced pain for a very long time and tried many things, you’re always looking for the one thing you’ve missed that you need to do to make yourself better. It’s this never-ending checklist in your head.  You wonder if you did this therapy for long enough or if you had just not tweaked that at that particular moment, how far ahead would you be now?  It’s an endless game.

In that lab, that day, it all felt a bit like a show down. It’s as though I felt that QL “owed me” for all the years of pain.  I was looking for some kind of revelation.  I got one.  But not the one you think.

The QL is just one piece of an incredibly complex puzzle that is the beauty and the frustration of the human body.  It really is quite remarkable how we’re built and how we work (or how we are supposed to work).  How every breath, every rhythm, every lift and bounce, pull and push, compression, extension, every rest is part of how and why we work and don’t work. 

One irony?  Sitting in lectures and then standing in that cold anatomy lab was not great for my back.  Then there were the shin splints from walking around New York City.

But there was a time, not too long ago, I would never have signed up for a course like this because I would not have made it through.  My pain level would have ratcheted up and it would have set me back several steps or weeks or even months.

Many of you come to pilates for particular problems, things that continuously give you trouble or discomfort or areas that you want to strengthen.  All of those things are good goals.  But what I’ve come to realize is that laser focus on one muscle for example, probably won’t get you to where you want to go.  Nothing operates in isolation.  We’re a system.  When one part of us breaks down, the system weakens.  We may still “work”, but not nearly as well as we used to.  Focusing on getting better and stronger overall will. Healing is a complex art requiring patience, faith and determination. 

The reality is most of us “work” until we don’t.  It’s only then we realize that an inefficient biomechanical pattern, repeated over years, landed us right where we are.

When you care for your body, when you’re curious about it, when you’re self-aware about it, you’re giving yourself an incredible gift.

There is no fairy tale ending to my story.

Back pain is still the first thing my brain registers when I wake up. 

But these days, my body is “working” more often than not. 

I’m a work in progress.  Aren’t we all?




Pelvic Floor Health - it’s all the Rage.

Of late, pelvic floor function is a hot topic.
Not the coolest of topics I would have thought ... but so very important to lower body function that it is often the missing link in addressing low back, pelvic, hip or knee pain.

Anyone working in therapeutic movement in the last 15 years has known how significant PF function is for healthy movement. What seems to have changed is the fitness and clinical world’s acknowledgment of the critical difference between PF strengthening and PF function. As many people frustratingly discovered: strengthening the PF can lead to greater dysfunction of the PF.

First of all, what is the pelvic floor?
Muscles spanning the base of the pelvis that form a diamond shape connecting the tailbone, pubic bone and sit bones.

What is healthy function?
Contraction of the pelvic floor muscles results in a scooping under of the tailbone and sacrum (the full triangular bone that the tailbone is attached to). It is critical that the sacrum can glide between this scooped under position and a release (tailbone out) position. There is not a lot of movement here but like many parts of the body it’s these micro movements that help to transfer load and avoid too much compression.

How can strengthening lead to greater dysfunction?
If we focus on simply strengthening the PF through kegels (PF contractions) we risk drawing the sacrum further and further into a scooped under (counter nutated) position where is doesn’t release to a full range the other direction (tailbone out). This can be particularly true if the kegel exercise is practiced in poor posture and when the release element isn’t given adequate focus.

What’s so bad about a constantly scooped under sacrum?
Instability of the lower back vertebrae and SI Joints, poor position of the hip sockets resulting in tight (hypertonic) hip flexors a that can affect patella tracking at the knee.
To name a few. :)

Yikes!  What to do?
A few simple things.

  • Here is a link to PF awareness.  A good place to start.
  • If you do kegels and don’t want to give them up pay attention. Can you allow the pelvic floor to fully release each time?  
  • Squats can be a great way to lengthen PF muscles but you need to be able to release the PF first.
  • The Franklin Method approach offers some great imagery and awareness techniques. Register for our next FM Pelvic Workshop in the fall. 

Contact me directly with questions or for referrals to Pelvic Floor specialists.