Physiotherapy treatment of chronic pain

A physiotherapist’s approach to managing chronic pain should incorporate an active rather than passive approach. A passive approach is when treatment is “done” to the client and the client is overly reliant on their treater. This not only includes hands on treatment or electrotherapy but also an excessively supervised exercise program where the client is unable to confidently modify their exercise program. In contrast, an active approach empowers a client to understand their condition, utilises supervised exercise as a “training ground” to teach the client how to independently upgrade (or temporarily downgrade) their exercise program and how to implement strategies independently to cope with any setbacks.

Physiotherapy sessions may include the provision of education to allow for safe movement, a graded increase in exercise and activity, general exercise for global reconditioning and to improve mood levels, goal setting and the development of a range of self management strategies that the client may confidently implement to prevent flare ups in pain or to manage exacerbations in pain. The physiotherapist needs to adopt a coaching role, assisting the client to problem solve, rather than a traditional treatment plan.

Goals of treatment may include a return to suitable work, independence with domestic activities, re-engagement in leisure activities and a reduction and cessation of reliance on ineffective pain medications. It is unlikely to be straightforward or easy and people with chronic pain may experience regular set backs during treatment. Indeed it may take many episodes for the person to be consistently confident that they can effectively self manage. However, as this occurs, the frequency that you consult your physiotherapist should reduce.  Beware that this approach requires treatment from a physiotherapist who has undergone extra training in providing this approach.

One goal may be to vacuum the whole house in a day. Treatment may include developing a plan to gradually increase the amount of vacuuming completed each day to achieve this goal over a set time frame. Treatment may incorporate the progression of an exercise program based at home or a local gym to assist in the achievement of this goal. This may include lunges and cable exercises with increasing resistance to simulate the motion of pulling the vacuum cleaner forward. Treatment may also include the progression of an aerobic exercise program to harness the pain relieving effects of general exercise. Regular reviews may maximise adherence with an exercise program and allow for problem solving any barriers that impact on the achievement of this goal (eg thinking “I felt good so I kept going until I finished the whole house” may have led to overdoing this activity, a flare up in pain and a fear of attempting to achieve this goal again).  Often, the help of a psychologist with experience treating pain can also be helpful within an integrated approach.

So, why wait? If pain is stopping you from living the life you want, today could be the day to make a change.