A practical guide to understanding and living with chronic pain 

Presented by

Meghan Van Dongen, PT 

Tuesday, May 22nd 5:30-7 PM
Martin Luther King Jr. Memorial Library

901 G Street Northwest Washington, DC 20001
Room: MLK Room 221

Pain solutions is an educational session that is designed to help individuals with chronic pain conditions understand the causes of pain and how nutrition, exercise, and daily decisions can impact pain levels. During the session different strategies will be presented to successfully live with chronic pain. If you have further questions about this class please contact Meghan at 202-347-1800 or Meghan@set-sports.com.

PLEASE RSVP TODAY, MAY 21!!!!!!

Well yes! Cycling is a wonderful cardio workout. In a class it can be great to be encouraged to increase the resistance, to stand and use the whole body to power through, and the intervals in which you work are great for cardiovascular work. In addition the community and music can make the intensity of the exercise that much more tolerable, even enjoyable.

Just like any exercise there can be things to be careful to do in order to prevent injury.

MOST importantly make sure your bike is set up properly. If you have not done a class before have the instructor take a few minutes to run through the bike set up. This is the number one cause for injury from spinning classes.

Secondly, make sure you are hydrating. This is an intense workout session. You will sweat. You need to hydrate.

Resistance: Adjust your resistance to your ability. With any workout you want to work in a moderate intensity level. It should be a challenge but you should be able to talk in short statements and able to breath. If you are struggling then take a bit of the resistance off or do not ramp the resistance as fast as the rest of the class or remain seated for some intervals.

Shoes: It is possible to wear normal sneakers for these classes. Although the claim is that your workout will be more effective if you clip in. Also this may decrease the injury rate for the exercise. I am not sold 100% on either of these points but thought I would present them in any case.

Spinning as a cardio workout is a good alternative and a good exercise to cross train with other exercises. Just make sure you have a good fitting bike, you hydrate, and you work on a level that is appropriate for you.

http://well.blogs.nytimes.com/2012/02/13/pedal-power-comes-with-a-duty-for-all/

http://www.msnbc.msn.com/id/47211549/ns/health-diet_and_nutrition/

Most people are so frustrated with this diagnosis because of 2 reasons: 1) there often times is not a direct known cause or trigger for the start of their pain, 2) depending on the specialist you see you will get broad variations in treatments. Historically, plantar fasciitis was thought to be a time and medication issue. Treat it with an anti-inflammatory, take some time off from activity and over time it would get better. As time and research has developed we transitioned into stretching the plantar fascia and strengthening the foot. Then the idea went to custom shoe inserts. In truth the answer is some combination of these is probably the best.

In a recently published case study it was established that if a patient is treated for their individual impairments in joint mobility, range of motion, and mechanical motion then there is a significant reduction of symptoms. The case study can be read in the November 2010 published Journal of Orthopedic and Sports Physical Therapy. What seems to be able to be derived from this case study is that plantar fasciitis is a result of several functions. It is important to re-establish proper joint mobility, motion and mechanics around the foot and ankle to adequately treat plantar fasciitis. There is not a one size fits all approach. Each person will have different joints that may be limited therefore it is important to look at each individuals’ limitation to make a proper treatment plan. Physical Therapy is a good place to start in order to evaluate the precipitating factors that may be contributing to a person’s plantar fasciitis.

In the end, there is hope for those experiencing plantar fasciitis symptoms and pain. The sooner you begin with treatment the less compensation patterns will develop and the more straight forward your treatment will be. So it may go away on its own but why wait?

At first glance CrossFit seems like a great exercise routine. The exercises are functional in nature and focus on strengthening people in the ways we use our muscles most. Squats and lunges, pull downs, abs, etc working on abs, gluts, lats, chest, quads. These muscle groups are important in preventing injuries in everyday life and muscle groups that most strengthening programs and classes over look. So in theory I like CrossFits’ actual muscle work.

I do get concerned with the idea of lifting the heaviest possible weights that you can to complete the set or repetitions. In my experience lifting like this leads to people being resistance focused and not form conscious. When a person repeatedly sacrifices form to lift a heavier weight they are at an increased risk for injury. The second concern I have with the CrossFit model is maximum weight repetitions for a set period of time as fast as you can. Just as previously discussed, people sacrifice form and control to use momentum and get more repetitions in. This sacrifice of form can lead to muscle strains and improper mechanics. Again risking injury.

Overall, CrossFit is an interesting, fast paced, challenging program that works on complete body functional strengthening. If form is the focus of the movements and maintaining your form as you follow the faster, heavier model then I think it is a fantastic mental and physical exercise. However, too often form is not the focus and injury does occur. So my advice is to be aware of form and proceed with caution. If there is pain during or after an exercise it is important to stop and make a change in weight or speed so that the exercise remains pain free. Remember that pain is our body’s way to communicate that something is not working right. Good luck!

1) Low Back pain may be preventable.

2)A third of Adults in America have pain that affects them in their daily activities.

3)Americans’ first line of defense is pain medication.

4) More than one day of bed rest can negatively affect recovery.

5) Exercise can be a treatment as well as a preventative measure.

For more information and details about this survey and how physical therapy can help to address low back pain go to:

http://www.apta.org/Media/Releases/Consumer/2012/4/4/

www.dcroadrunners.com

www.runningtheusa.com

www.runwashington.com

1) Surgery and rehab is made much easier if you understand what it entails. It is impossible to explain to my 70lbs boxer why he is only allowed on a leash, can not play, can not jump up on furniture or down off furniture, and why we have to do exercises all the time. I am lucky that my human patients can understand. The more a person pre-surgery or post surgery understands about the healing process the easier it is to be compliant with a rehab program. It is my job to provide insight and expectations so that my clients do understand what is ahead of them.

In a study regarding pain published in Archives of Physical Medicine Rehabilitation in Aug 2010 it was described that patients who were given information about the physiology of pain had a significant decrease in their perception of handicap.  Therefore, the better job I do in describing the injury, the surgery and the rehab to my clients the easier and theoretically the more successful their recovery will be.

2) Boredom is difficult. My dog is used to running free at the Congressional Cemetery. He has been reduced to leash walks and watching the parade of dogs pass our house. There are days where I swear he looks at me and is saying “PLEASE Can I go play?” Ridiculous I know. Again to him (lesson one)it is not possible to make him understand why. People are like this too. They come into their appointment and look at me like is today the day I can shed the crutches or Can I please ride my bike or When can I start running again? Unfortunately, at times all I can offer is a home exercise program and promise better things to come in the future.

3) Patience is required. Every 4 weeks we go back, get another set of x-rays and see that Nash is healing. We get a new list of exercises and new restrictions on activity. In the meantime, we are happy healing is happening but I will admit it does not seem fast enough. After 4 weeks of the same exercises and restriction level I would say patience is at a minimum. Unfortunately, healing can not be rushed and takes time. No matter how much I would like to take my dog to the park it is not time yet. That is a bum deal. So we are left to wait!

4) Time is a premium. Exercise takes time. Nash and I are now up to 3 hour long walks a day, 3 10 minute sessions on hills, walking through a ladder for 5 minutes, plus his other exercises. I know, as a therapist, I shoulder be a exercise and rehab die hard. WHO HAS TIME to spend 6  hours a day doing exercise. So I must confess during the week we get 2 good exercise sessions in and 1-2 walking sessions that include the hills. Nash continues to make strength gains and is healing well, so I think we are doing fine. As a people physical therapist I could make exercise a full time job for my patients as well. However it is my job to be realistic, know time is a valuable resource that needs to be balanced when assigning home exercises. Yet, the end goal remains the same of full recovery in as quick a time frame as healing allows.

5) Treats are a great motivator!!! Self explanatory for a dog right? If logic is not the reason for rehab, treats can be a great motivator. So treat yourself. If you have done the exercises every day that week treat yourself to something you value. You deserve a reward for all the work you are putting in. Make it something you REALLY will work for.

I have been able to get a good reminder of what a mental and physical demand recovery from surgery or an injury can be. As a therapist, I appreciated the perspective that Nash has given me to be just a bit better focused and maybe slightly more sympathetic to my clients. Fingers crossed the 12 week x-rays will have us running again in the park and playing with all our 4 legged friends.

http://well.blogs.nytimes.com/2012/02/15/how-1-minute-intervals-can-improve-our-health/