How to restore your clients' chronic pain through movement

As part of a Hexfit Webinar, under the theme of recovery from chronic pain by the sport or movement professional, we discuss with Véronique Gagné, kinesiologist specialized in chronic pain and founder of Kinéden. 

Presentation of the speakers

Véronique Gagné - Kinesiologist & Founder of Kinéden

Initially a lifesaving coach for over 10 years, Véronique has always had an interest in sports and movement. She therefore undertook a bachelor's degree in kinesiology and founded Kinéden over 12 years ago. Seeing the many clients living with chronic pain, she knew she could help them through movement. She therefore became certified in rehabilitation in the context of chronic pain.

Chronic pain can last for months or even years and affects all parts of the body. It interferes with daily life and can lead to depression and anxiety. Your clients may be suffering from this condition without even knowing it.

The first step in treatment is to find and treat the cause. In most cases, chronic pain sufferers turn to their doctor. This is usually followed by a prescription for medication. But these have their limits and do not always provide a complete cure.

However, there is a solution that is often unknown to patients: healing through movement under the supervision of a professional.

What is chronic pain?  

Chronic pain is pain that lasts longer than three months. The pain may be felt all the time, or it may come and go. It can affect any part of the body.

Chronic pain can interfere with your clients' daily activities, such as working, socializing and caring for themselves or others. It can lead to depression, anxiety and sleep problems, which can make the pain worse. This response creates a cycle that is difficult to break.

What is the difference between chronic pain and other pain? 

Chronic pain is different from another type of pain called acute pain. Acute pain occurs when there is an injury, such as a simple cut or broken bone. It doesn't last long and goes away once the body has healed.

Chronic pain, on the other hand, persists long after an injury or illness has healed. Sometimes it even happens for no apparent reason.

What causes chronic pain?

Sometimes chronic pain has an obvious cause, such as a long-term illness like arthritis or cancer that can cause ongoing pain.

Injuries and illnesses can also cause changes in your clients that make them more sensitive to pain. These changes can remain in place even after the original injury or illness has healed. Something like a sprain, fracture or brief infection can cause chronic pain.

Some people also experience chronic pain that is not related to a physical injury or illness. Health professionals call this response psychogenic pain or psychosomatic pain. It is caused by psychological factors such as stress, anxiety and depression. Many scientists believe that this connection comes from low levels of endorphins in the blood. Endorphins are natural chemicals that trigger positive feelings.

It is possible for several causes of pain to overlap. For example, in the case of two different illnesses or the combination of migraines and psychogenic pain

Mentalities must change 

According to the fear-avoidance model, people with chronic pain avoid physical activity because they think it will make their pain worse. This behavior leads to decreased levels of physical activity which actually worsens the pain as muscles atrophy, mobility becomes more limited and you become more sensitive to pain. This negative feedback loop of chronic pain and inactivity can be a difficult cycle to break.

 

"From experience, I will fix your problem within three to six months if you follow the program to the letter."

Véronique Gagné, Kinesiologist

Therefore, it is important to understand the factors that impact the perception of pain:

The perception of pain

The experience of pain is known to have two distinct neural pathways. In the first pathway, the pain signal comes from any part of the body and activates the anterior cingulate cortex of the brain, which is associated with pain perception. People react differently to this stimulation because the feeling is determined by activation of the second pathway involving the medial prefrontal cortex and nucleus accumbens, which is associated with motivation and emotion. In addition, there are non-physiological factors that contribute to pain perception, such as personality, sociocultural variables, learning, and emotional reactivity.

Personality

Over the past few decades, several theories have been proposed about personality in the chronic pain population. With the advent of the biopsychosocial approach in the 1980s, the diathesis-stress model dominates the field. The model emphasizes the interaction between an individual's biological predisposition and the impact of the environment to explain different responses to chronic pain.

 

Socio-cultural variables

Early theories of pain psychology evaluated global factors, such as gender, age and culture. In most studies, women generally report experiencing more recurrent, severe, and longer lasting pain than men. Previous research has also shown that thresholds increase with age. It was once thought that we differ culturally in a way that affects how we feel pain. However, we now understand that there are differences within cultural groups that can affect their experience of pain.

Learning

Chronic pain may be a conditioned response, or learned behavior, rather than simply a physical problem. The behavior begins purely in response to the presence of an injury, then is reinforced and becomes a conditioned response. Similarly, inactivity may relieve pain in some patients, but leads to a vicious cycle of deconditioning and worsening chronic pain. Pain can result from these conditioned fear responses, or avoidance behaviors, that persist even after the pain has gone.

 

Emotional reactivity

Compared to other negative emotions, such as fear, sadness, guilt, self-loathing, and shame, anger is the most predominant emotion in patients with chronic pain. Anger refers to an emotional experience that may be a current mood state or a general predisposition to anger. People with significant anger problems may have problems with empathy. However, it is a skill that can be developed and cultivated over time. Research has shown that human beings tend to be more empathetic towards their friends, while stress can discourage people's ability to empathize

Treating chronic pain through movement

When your client is in pain, he or she will tend to take it easy to avoid further damage. This is unlikely to help - quite the opposite, in fact. Not moving enough often leads to a cascade of factors that can amplify the pain. Exercise is actually the best way to retrain an overprotective pain system. 

"From experience, I will fix your problem within three to six months if you follow the program to the letter."

Véronique Gagné, Kinesiologist

Stretching and strengthening exercises can retrain the pain system and readjust the pain buffer, reminding it that movement is normal and "safe." An added benefit is that exercise releases endorphins, which can actually prevent pain signals from reaching the brain.

Starting movement therapy is often the most difficult part because of the way chronic pain can affect your clients' state of mind, behaviors and beliefs. This is where the other 2 pillars of best care practices come in. Educating your clients is important to understand how pain works and to realize that "pain" does not always mean "injury." Behavioral therapy helps to discourage pain behaviors that reinforce disability and pain, such as inactivity.

How does movement-based treatment for chronic pain work?

It all starts with a questionnaire that focuses on the patient's liabilities and expectations. This allows us to collect all the data in order to establish an analysis. After having recalled what exactly chronic pain is, physical tests are performed. They allow us to determine the patient's physical capacities and range of motion. This is followed by the creation of a personalized training program with objectives defined according to the patient. 

"From experience, I will fix your problem within three to six months if you follow the program to the letter."

Véronique Gagné, Kinesiologist

The second thing that keeps people motivated is the logbook. It allows the patient to see their progress and to compare. The goal is to accumulate several pain-free days. And just because there is one day with pain does not mean it is negative. 

As the program progresses, it is adjusted regularly to maintain the patient's motivation, but also to adapt to changes.

Movement has health benefits beyond musculoskeletal pain management.

Healing through movement helps restore strength, flexibility and energy. When we move, our bodies create substances that help our joints, discs and even our lungs stay lubricated so they work smoothly. By working muscles and joints harder than usual, it conditions them to relax and improves mobility and strength.

Exercise improves overall health because the contributors to pain also impact your overall health. Arguably one of the most important benefits of exercise is that it improves mental well-being by improving sleep, increasing stress resistance, improving confidence and reducing fear of movement. Exercise has also been shown to relieve symptoms of depression. The improved blood and oxygen flow resulting from exercise can also have a positive impact on cardiovascular health.

How to get certified in rehabilitation in the context of chronic pain?

As demonstrated in this article, chronic pain is a very complex subject. It is therefore important to rely on reliable sources to ensure proper management of chronic pain.

Fortunately, the Quebec Institute of Kinesiology offers a training program for health and exercise professionals as well as the general public.

Camille Boutin

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