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  • Writer's pictureAdam Holzwarth

Benefits of physical therapy for chronic pain

Updated: Feb 1

 Explore the game-changing benefits of physical therapy, unraveling the secrets to lasting relief and a pain-free tomorrow.

The most effective way of managing chronic pain is to build a toolbox of techniques that you can call upon depending on your individual needs. Chronic pain generally begins when there is a sustained tissue injury that, because it is around for so long, creates a neurologic or sensory pathway change  (neuroplasticity) inside your brain.

Pain, in essence, is our body's alert system. It detects threats and makes us aware of threats, or what we may consider as threats, so that we can act accordingly. 

 Our bodies are very adaptable and the one consistent factor in those adaptations is we like to conserve as much energy as possible. So if we have a source of pain that lingers around for generally more than a couple of weeks, two to three weeks is average here, we will notice that we are expending too much energy sending these electrical impulses all the way from the tissue, along the peripheral nerves, up into the spinal cord, through the brainstem and up into the brain for processing. Pain truly is a processing reaction. We take these information signals and our brain DECIDES if we need to register that as pain/a threat and then respond accordingly. Some examples of information our brain may take into account when making this split second decision are: memories of previous pain, fear of future pain, emotional state, anxiety, beliefs of disability etc.

What happens in many chronic pain conditions (neuroplasticity/adaptations) is our body wants to cut out the middleman. When that happens, we create this closed loop of sorts up in our brain so that when the tissue injury or irritation itself resolves, we don’t even know! Our body has adapted to a more energy efficient means of alerting us to this threat and we need to repurpose these synaptic pathways. In other words, we still have to break the closed loop that has been established in our brain (supraspinal regions). 

The steps and interventions that a patient succeeds with most can vary widely. I believe that the best management strategy is to create as many tools as possible. The more tools we have in our toolbox, the more things we can fix/build/accomplish! Guiding a patient in becoming proficient in all these tools and allowing the patient to pick and choose depending on what works best for them is the ultimate goal.

I start every patient with an in-depth discussion of how our alert systems (pain processing/sensation) work. The goal is to do everything we can to reduce perceived threat and we do not fear what we understand!

 Some examples of tools for the toolbox include: pain education, mindfulness training techniques, graded exercise exposure, neuroplasticity retraining.  I generally start every patient with a discussion of how our bodies react to interpret and process a pain signal. if we can lift the veil of the underlying Physiology then it is often much less fearful for the patient. Again, it is all about threat reduction and we do not fear what we understand!

Woman expressing discomfort due to chronic pain sitting on a couch clutching head and abdomen, highlighting the daily challenges faced by those navigating persistent pain conditions

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