Everyone I work with is in some level of pain in their body. This can be aggravated by certain triggers or for no reason at all. It can also be background and always there, or very sharp and short lived. The consistent thing is everyone wants it reduced to zero, ideally right now.

Pain reduction, long term pain reduction takes a bit of time. Medication has fooled us into thinking it can be a quick fix, and it can be for a short time 4 to 8 hours for prescription medication. Once the medication has worn off the pain returns and more medication is taken to stop it. This cycle is a yo, yo effect like turning a switch on and off and can be cyclic in nature for many injuries and pain sufferers.

All medication does is switch the signal off to the brain that there is any pain. The body needs to know there is pain so it can redirect pain endorphins and anti-inflammatory endorphins to reduce pain and start the repairing of the damaged tissue or the part of the body in pain. This cyclic process reduces the pain and inflammation of the area and allows the body to go to healing or repair mode.

The challenge for treatment and rehabilitation programmes is to balance movement and mobility with pain reduction and tissue repair, which can be a challenge at times and certainly not a fast and predictable process.

I tend to outline 25% reduction in pain a session with the goal of little or no pain after 4 sessions as a guideline. After a couple of sessions and the pain has reduced, people forget what the pain was like pre treatment and instead focus on zero.

This is problematic for two reasons firstly clouding the progress made in this example a pain level of 8 to 4 is a significant reduction in pain, but its not zero. The second is as part of the treatment process I alter movements and activity, I want you to move a do stuff! This can slow pain reduction but not overall rehabilitation, as I work with the initial goal of reducing pain and increasing mobility.

This goal can create a impasse as even with a pain level of 2 and a massive increase in mobility, the pain is not zero.

The main reason for this change is as the tissue is repairing the movement is causing small amounts of damage, so it begs the question why not pain treatment first then rehabilitation.

This process significantly Increases recovery time as the tissue is set in a rested position. As the movement and loading increases it damages the tissue lots as its repaired at a different length under no load. This will result in massive limitations with to mobility and even basic movements will be painful and limited.

I had my first Hip resurfacing 18 years ago at the age of 33. I was young mobile and relatively fit at the time. The rehab process was bed rest in hospital for 7 days, 7days limited walking on crutches. 6 weeks on crutches, 6 weeks on sticks reducing to 1 stick then 3 months learning how to walk again the pain and muscle wastage was significant.

My second hip replacement 6 years ago, walking on day 1 with crutches, 1 to 2 weeks on crutches. 1 week on one crutch and walking short distances with no crutches and a week using no crutches with full movement, and 6 weeks post-surgery could walk longer distances.

This accelerated recovery process is used for all rehabilitation the challenge comes with breaking movement habits and practicing new movements enough, as people I work with tend to have a chronic long term pain issue and are living life at the same time.

Tracking progress is key when rehabilitating from a injury as it shows how much progress you have made to your goal.

Pain reduction is not the only indicator as mobility is also a essential marker.

For more information on goals or tracking progress during rehabilitation check out the podcasts HERE

 If you would like to find out more how I can help you please book a conversation HERE https://calendly.com/interxpainclinic/conversation

About the author

Stephen Grinnell MSc Health and Rehabilitation
Pain and Physical Rehabilitation Specialist
Stephen has had his own Pain and Rehabilitation Clinic for over 11 years where he has treated well over 2500 people with lots of different pain and injury issues. Stephen’s personal physical rehabilitation journey started with a serious injury while on active service with the Royal Marines 25 years ago. This injury resulted in a long journey of complementary rehabilitation and two replacement hips. Stephen has developed his own bespoke treatment protocols using a variety of medical devices to help pain and inflammation resulting in accelerated recovery. Expert areas of focus are Plantar Fasciitis Treatment, Back pain issues particularly Lower Back and Sciatica and hip and knee replacement rehabilitation. Stephen previously had a successful academic career lecturing at a variety of Colleges and Universities in the Sports Science, Rehabilitation and Training areas. Stephen has also worked in The Queen Elizabeth Hospital Physiotherapy department during the Covid 19 Pandemic helping the recovery of COVID patients. In 2022 Stephen has been extensively researching and trialling protocols to treat plantar fasciitis. His Expertise has resulted in the successful treatment of 103 people and counting with a current success rate of 93%

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