What Are the Best Options for Managing Chronic Pain?

More than 20 percent of the U.S. adult population, or 50 million people, are trying to manage chronic pain. More than 20 million of them have what is known as “high-impact pain” where the pain is so severe, it can limit everything from activities of daily living to exercise to going to work. These estimates are from the Centers of Disease Control and the National Interview Survey that looked at the health of more than 30,000 adults.

Let’s begin by first taking a look at the differences between acute and chronic pain. According to Medicinenet.com

“Acute pain is of sudden onset and is usually the result of a clearly defined cause such as an injury. Acute pain resolves with the healing of its underlying cause. Chronic pain persists for weeks or months and is usually associated with an underlying condition, such as arthritis. The severity of chronic pain can be mild, moderate, or severe.”

Medicine.net

It seems that everyone you talk with these days is dealing with some form of chronic pain. From those that I’ve spoken to, three areas of the body seem to be most prominent: the low back, knees and shoulder area. It also seems that each individual has their own way of trying to manage their chronic pain.

Case Study: Managing Chronic Pain

Over the past few months I’ve known a few people who were diagnosed with various stress injuries. Each resulting from either exercise or a repetitive movement. No one in this group had ever broken a bone or experienced any type stress fracture in their life…until now. As a result, their gait was thrown off and their body became severely de-conditioned over time. The body is an amazing organism. When we have an injury, the body tries to compensate in order to function. Each individual tried to maintain some type of basic exercise routine as best they could. For example, one friend tried to maintain her fitness level by biking outdoors for about 30-75 minutes 3-4 times a week. They had a stress fracture in one of their toes that they were dealing with.

As a result of an injury, it’s easy to start popping medications in order to alleviate the pain. Chronic pain can take its toll not only physically but mentally as well. It’s also easy to try different alternative therapies because you’re trying to be proactive. Different therapies, like massage therapy, acupuncture, chiropractic and even regular exercise and yoga may help. The issue, however, is they don’t address the root cause of the pain. Why did the injury happen in the first place? What is the mechanism hiding behind the injury? Different specialist will give you varying reasons why this has happened to you. Some will not even offer you that much insight, just try to treat it. They treat the symptom(s), again, not the root cause.

Myofascial Therapy Can Help Manage Chronic Pain

A few friends found that myofascial therapy worked really well. This is typically performed by someone like a physical therapist who has had additional training working with fascia. They are trained to address the issues not with various modalities but manually (i.e. using their hands) helping to release tight fascia (connective tissue) around the injured area.

One person found that the Egoscue Method worked really well. This method was founded by anatomical physiologist, Pete Egoscue, decades ago. He built a great reputation helping famous golfers get out of pain. It involves a full digital assessment followed up with specific bodyweight only exercises to address the issue and realign the spine and body. He has a great book, which I’ve read and recommend often, called Pain Free on Amazon.

This was one of the first therapies that offered me, when I was previously injured, an idea of why my injury occurred in the first place. For me it was all about finding that mechanism that caused the injury in the first place. I was then able to address it, and begin to work on specific exercises to – in my case, realign the spine and hips – eventually getting me back to a healthy (posture) baseline. My job is to now work on those specific, daily, movements (i.e. prehab) in order to prevent this from happening again.

Additional Modalities for Managing Chronic Pain

Massage therapy, acupuncture, meditation, cryotherapy, flotation tank, chiropractic, yoga, foam rolling and even exercise can all help. Each modality is beneficial and has a place at the table in managing chronic pain. I have personally tried each of them and, to some extent, they all work albeit temporarily. When trying to relieve chronic pain, it’s best to have a trained therapist observe your standing posture, and how you move. Remember, if you have movement competency issues – and most of us do – you need to work on addressing those issues first. Otherwise, you may end up spending a great deal of money and investing a lot of your time without ever eliminating the pain and finding the answer to why it ever happened in the first place.

Hopefully the advice in this article is something you can use if or when needed. Don’t get comfortable taking medication or trying different therapies just because that’s what you’ve done in the past or someone recommended you give it a try. Question everything, think out of the box, be your own advocate and first and foremost, determine the root cause of the pain.

Jefit Elite Can Record & Track Your Injury History

Jefit app, named best app for 2020 and 2021 by PC MagazineMen’s HealthThe Manual and the Greatist. The app comes equipped with a customizable workout planner, training log, the ability to track data and share workouts with friends. Take advantage of Jefit’s exercise database for your strength workouts. Visit our members-only Facebook group. Connect with like-minded people, share tips, and advice to help get closer to reaching your fitness goals. Try one of the new interval-based workouts and add it to your weekly training schedule. Stay strong with Jefit.

A Foam Roller is an Affordable & Versatile Product

There are literally hundreds of fitness products you can choose to use. There is one product, however, that won’t break the bank, reduces stiffness, and can be used either at home or in the gym. The product is a foam roller. Not only is it affordable, it’s extremely versatile in the right hands. The foam roller gained popularity back in the 1980’s thanks to a physical therapist who brought it into the mainstream from the world of clinical rehabilitation.

Why use a foam roller? Because it can be used to prepare the body for exercise, it’s a great recovery aid, effective as a massage tool, improves mobility, and keeps connective tissue, like fascia, healthy.

Use a Foam Roller as Part of Your Dynamic Warm-up

Before your next strength workout try incorporating a few dynamic warm-up movements. Then use a foam roller for 5-10 minutes, to “roll-out” some tight areas, and see how you feel afterwards. More importantly, notice the difference in the way you feel during your workout. We have a tendency to sit for prolonged periods of time throughout the day. As a result, muscles and connective tissue become tight and restricted. Overtime, this negatively affects your posture, the way you move, and how you perform in workouts! Regular bouts of foam rolling can help offset these issues and more.

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Incorporate a Foam Roller into Your Recovery Process

Another benefit of using a foam roller is it has the potential to help the body recover faster from a workout. Foam rolling can decrease the “perception of pain” that the body may be experiencing from overtraining. It targets the myofascial network in the body, helping to reduce trigger points and release restrictive connective tissue and muscle.

The body has a tendency to experience delayed-onset muscle soreness (DOMS) from an intense workout. A 2015 study in the Journal of Athletic Training suggested that foam rolling after intense exercise is a great way to reduce soreness and help with recovery. The study looked at college-aged males and showed those who foam rolled post exercise, were able to perform better at 24, 48 and 72 hours after exercise that induces soreness. And a comprehensive review published in the International Journal of Sports Physical Therapy reported foam rolling promotes short-term increases in range of motion.

Finally, a meta-analysis, published in the Frontiers in Physiology (2019) showed foam rolling had a positive effect on performance and recovery. This particular review of 21 research studies and 451 subjects, also showed better results were exhibited during a warm-up phase rather than as a recovery component of an exercise session.

Foam rolling is not the be-all-end-all when it comes to fitness products but you can definitely benefit from regular use, before and/or after a workout. Give it a try and experience the benefits yourself.

Use the Award-Winning Jefit App

Jefit was recently named one of the best fitness apps by eftm.com and PC Magazine for 2021. Jefit is a workout app for gym and home. It helps you plan and stick to your workouts on a regular basis. While there are already over 3800 complete training routines available, it also comes with a customizable gym workout planner. This way you can personalize your own regime that works with your specific fitness goals. Stay strong!

References

Pearcey, G.E.P., Bradbury-Squires, D.J., Kawamoto, J.E., Drinkwater, E.J., Behm, D.G. & Button, D.C. (2015). Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Journal of Athletic Training, 50(1): 5-13.

Cheatham, S.W., Kolber, M.J., Cain, M., & Lee M. (2015). The effects of self‐myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: a systematic review. Int J Sports Phys Ther., 10(6): 827–838.

Wiewelhove, T., et al. (2019). A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery. Front. in Physiol. https://doi.org/10.3389/fphys.2019.00376



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Are You Focusing Enough on Mobility in Workouts?

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You should not experience joint pain when you perform activities of daily living (known as ADL’s). How does your body feel during a typical day? Do you feel pain when you move your hips, shoulders or knees through their full range of motion? Take the shoulder joint as an example. When you perform shoulder flexion, extension, rotation, or for that matter internal or external rotation, are those movements pain free? Do you have joint pain when working out? If pain is present, there may be an issue with the mobility of that joint.

What is Mobility?

In order to better understand mobility you first have to grasp what flexibility is. Flexibility is the ability of a muscle or group of muscles to stretch when needed. Conversely, mobility is the ability of a joint to actively move through its expected range of motion. Both flexibility and mobility change over the course of time. Think of both as nourishment for your body; flexibility keeps the muscles happy and healthy while good mobility leads to happy and healthy joints, like your hips and spine. When moving and doing any type of activity, good flexibility and mobility are associated with pain free movement in the muscles and joints respectively.

Never Enough Time for Mobility

When you go for a run or have a great strength training session, you feel the benefits of each immediately. This may not be the case, at times, for mobility. You need to put the time in each day to work on improving mobility now so it continues to pay back dividends as you age. Take 5-10 minutes before each workout and work on the areas that you feel like your lacking mobility.

Begin with areas on your body where you experience the most pain. This along with limited joint range of motion are key ingredients that will eventually lead to dysfunction and it needs your attention, now!

Check for Mobility Issues with Simple Testing

A previous Jefit blog post looked at the pressure placed on the back when sitting, standing and walking. Read that post to better understand how heavy loads placed on the body can effect the spine. Keep in mind you can kill two birds with one stone here, start using mobility drills to act first as a warm-up while also working on mobility.

Apley’s Scratch Test

  • To test your mobility of your right shoulder, stand up and raise your left arm straight above your head (see picture below).
  • Flex your left elbow placing your left palm on the upper back and neck area, then slide it down between your shoulder blades.
  • Take your right hand and reach behind your body so the top part of your hand rests on the middle of your back.
  • Reach down with your left hand while reaching up with your right. The goal is to try to touch the fingers of both hands together.
  • Have someone measure the distance between your fingertips. If your fingers are touching or overlapping, record that as good.
  • Now switch arms and test your opposite shoulder.
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Right shoulder Apley Scratch Test – testing shoulder mobility

If you’re like me and have a few inches of separation between your fingers (see picture above), you need to work on improving shoulder mobility. Begin by using a foam roller regularly to rollout the upper back and shoulder areas. Hanging from a pull-up bar with both hands, progress to single-arm hangs for 15-30 seconds and repeat for a few sets. Next, stretch the shoulder capsule daily performing a posterior capsule stretch followed by a tricep stretch. You can use a yoga strap to help stretch and close the gap between your fingers. This is a good first step before adding in occasional vibration work, massage and myofascial release.

Kneeling Thoracic Mobility

The mid-back or thoracic spine (T-spine) is an area that is restricted in most people especially those who do a great deal of sitting or driving. The key here is to first release any tight fascia around the mid back area. The best bet is to perform foam rolling or “rolling out” on taped tennis balls or a lacrosse ball. After loosening the area, try the following mobility drill. If you have difficulty or feel “resistance” rotating your body while moving your elbow up towards the ceiling, you need to work on T-spine mobility.

  • Start in a quadruped position (on all fours).
  • Touch your left hand to the left side of your head.
  • Exhale. As you breath in rotate your body and raise that left elbow up towards the ceiling, keeping the hand in contact with the head throughout.
  • As you’re doing this, push the right into the floor. Think about your mid-back during this dynamic movement.
  • Slowly return to the starting position, following your breath. Move to the speed of your inhale/exhale. Repeat for repetitions.

Simple Hip Mobility Test

The area that many people have trouble with is hip mobility. Mobility issues or dysfunction in this area typically leads to other major issues like back-related problems. A good first step is to add in hip mobility drills as part of your dynamic warm-up prior to every strength or cardio workout. Then foam roll 5-10 minutes hitting the upper thigh before lying side ways to roll the gluteus medius. Finally, position yourself on the foam roller to target the inner thigh and roll out that area before lying supine rolling out your gluteus maximus. Then try this quick test to assess hip mobility.

  • Sit tall in a chair with your feet slightly wider than hip-width apart.
  • Without using your hands, see if you can lift and cross your right leg over your left? Then try the same on the opposite side (you should be able to).
  • After attempting that, position the right ankle above your left knee that is bent (like in the picture below).
  • Take a few deep breaths in/out and relax.
  • Now take a look at the angle of the right leg that is crossed.
  • If the leg feels comfortable and drops below a 45-degree angle or is parallel to the floor, you’re in good shape.
  • Most people, however, will have a 45-degree angle or greater and feel tightness in the hip complex. Is so, you guessed it…work on hip mobility.
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A quick and easy hip mobility test

These are just three of the many tests you can do on yourself to assess where you’re at mobility wise. Mobility work must become a component of your weekly exercise routine. There may be days where your body just needs to skip a workout and rollout and work on mobility drills. Your body and performance will love you for it. Stay strong and mobile with Jefit.

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