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Queen Mary's University London | SEM 2016

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Pain in sport -- concepts to consider for overcoming pain successfully.

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Queen Mary's University London | SEM 2016

  1. 1. Pain in sport Richmond M. Stace MCSP MSc (Pain) BSc (Hons) Specialist Pain Physiotherapist
  2. 2. Behind every pain… …is a story …a person Know the person to know the pain It’s as much about the person as the condition – Oliver Sacks When a person is better, the pain is better People with persisting pain often fall in the cracks
  3. 3. Picture this.. 16 year old sporty girl with shin pain 2 years and worsening Continues to play sport most days at school Very tender to touch Sometimes very painful to walk First thoughts?
  4. 4. Then…. 8 year h/o migraines Digestive disturbances Disturbed sleep Widespread tenderness Perfectionist & demanding school This a case for……
  5. 5. A lack of signs? Puzzling? Is there an actual injury? Is there sensitivity? e.g./ hamstring ‘re-injury’ What’s the story?  is there damage or does it just feel like damage?
  6. 6. Acute pain  Is it an injury?  “I sincerely thought it was the last ball I would be touching for a long time because of the pain”. Messi (2012)
  7. 7. Acute injury  Is there actual damage?  Does more damage = more pain?
  8. 8. Pain is… Normal Part of protection Important for survival Unpleasant A motivator compelling action
  9. 9. Pain definition IASP An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
  10. 10. Pain is the No.1 global health burden  Back pain, neck pain, headache, migraine, OA  All in top 12  depression  Persisting pain  What do you think about?  Is persisting pain in sport?
  11. 11. The problem Pain misunderstood Society Healthcare Wrong messages communicated Low expectations Even morphine affected by expectation Poor outcomes
  12. 12. Persisting pain in sport Yes How common? Impact – this is the ‘lived experience’ Person Professional vs amateur Participation Performance Playing with pain
  13. 13. What can we do?  Develop understanding of pain  Answer the question: what is pain really?  This answer leads to a route onwards  Different thinking  Neurobiology  Neuroimmunobiology  neuroimmunoendobiology
  14. 14. What is pain?
  15. 15. What is any experience?  The brain’s best guess!  Making sense of the world now  Generates & constructs explanations for its sensory input  Generates predictions of sensations  Generates hypotheses to try to explain what is happening in the outside world
  16. 16. Mature organism model (Gifford)
  17. 17. Important principles
  18. 18. Change  We change  ‘Neuroplasticity’  Which direction?  There’s more than one direction  If you think there is…  Your choice
  19. 19. Whole person  ‘I’ think  ‘I’ feel (pain, thirst, hunger)  My ______ does not feel pain, I do  What do we treat?  Or who do we treat?
  20. 20. Embodied cognition The body an extension of the mind We are more than a brain Our bodies in the world do much of the work needed to achieve goals (not just the brain) e.g mechanics of walking Gestures reduce load on brain I think with my whole person Where do you feel anxious? Hungry?
  21. 21. Embodied athletes Identify with body & performance Their sense of self encompasses body & performance ‘gestures’ part of their cognition Automatic Predictions not responses – otherwise miss the ball! Injury => loss of sense of self
  22. 22. Pain  Consider…  Pain is a lived experience  Pain is not an accurate indicator of tissue damage  Pain is about perceived threat  Pain is allocated a space  Pain is dynamic
  23. 23. What influences pain?  The meaning – what do you tell yourself?  The context  Where you are  What you are doing  What you are planning to do  What you have just done  Emotional state – anxiety, stress  Tiredness  Prior experience  Beliefs about pain/health  Attention bias  Who we are with
  24. 24. Pain in sport  Expected  Part of training & playing  Accepted risk  ‘no pain, no gain’  What if the pain persists…… or injuries recur?
  25. 25. New injury  What do you want to know?
  26. 26. The injury moment  Context  Mechanism  Meaning  Body responses  Pain intensity  Current health  Early care  Initial management  Messages given  Investigations  Other’s responses  Facial  Verbal
  27. 27. Injury – not in isolation  Why?  Pain vulnerabilities  Pre-existing sensitivity  Functional pain syndromes  Injury patterns  Fatigue  Health  Prior injuries & pain  Circumstances  The person  Priming factors  Pain vulnerability  Genetics  Body sense  e.g. hypermobility
  28. 28. Persisting pain Begins at the moment of injury Vulnerable Uncontrolled pain Wrong treatment Pain beyond a useful time? Or are there health issues? Habits of thought and action
  29. 29. What have you seen? Features?
  30. 30. What do we see?  Loss of sense of self  Change in body sense  Altered movement patterns  Altered thinking  Outlook?  Altered planning  Change in perception of the environment  Sickness responses  Other aches and pains  Poor sleep  Varied emotions
  31. 31. What are we trying to do?  Restore a sense of self as defined by the person  Resume a meaningful life  Matching what is expected with what is happening  What does that look like?  Ask the person?  Their vision
  32. 32. How do we do it?  Working knowledge of pain  Reduce threat  Take healthy action  Develop body sense  Sensorimotor training  Motor imagery  visualisation  Focus on health (not pain)  What we focus on, we get more of…  Deal with distractions from the vision  Programme must be lived  Moment to moment  Build tolerance for activities  Graded exposure  General fitness  Sleep habit  Meet basic needs!  Pain Coach  Strengths based coaching  Become their own coach
  33. 33. Key points Pain is whole person: when the person gets better, the pain gets better Early messages are key! Understanding pain is vital – working knowledge Pain is a lived experience, which the programme must reflect Pain is temporary, each moment unique Change is certain; direction can be a choice
  34. 34. Thanks! @painphysio www.specialistpainphysio.com painphysiolondon@gmail.com 07932 689081 UP | understand pain – www.understandpain.com @upandsing