Pain is defined by the International Society for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. In essence, this means that although pain is a sensation (like hearing or smell) that we all recognise, it is also influenced by our thoughts and emotional state. Just as the sound of the same song may be met with delight, disgust or indifference by different individuals (or even by the same individual at different times), a pain response to the same disorder may vary widely. Actual tissue damage may cause pain (eg touching an open flame), but pain may also be generated as an alarm signal when there is potential for, but not actual tissue damage (eg if you get too close to the flame, but don’t actually get burnt). Pain can also be generated without any physical threat to tissues at all, but it is still a very real sensation and thus is described in terms of such damage, even though no such damage occurs.
Pain is a multidimensional experience and involves complex interactions between:
Physical factors such as faulty postural/movement patterns and/or structural pathology
Lifestyle factors such as chronic stress, types and levels of activity, physical conditioning and poor sleep
Cognitive factors such as beliefs, fear, negative emotions, anxiety and low mood
Nervous system factors such as hypersensitivity reducing thresholds to noxious and non-noxious stimuli such as cold, altered pain processing and heightened stress responses
In a persistent pain state all of these factors need to be considered and addressed to achieve an optimal outcome. The degree of contribution of each factor varies for each person and thus the treatment of a persistent pain state should not just be a “one size fits all” solution, but rather an individualised multi-factorial approach which considers the relative contribution of each of these factors and then addresses them accordingly. It is well recognised from a large body of research that a treatment approach which focuses on the multi-factorial nature of pain is more effective than mono-therapies.
Our approach at Yarraville physiotherapy thus reflects this and so rather than just simply achieve temporary relief of symptoms, our aim is to identify and modify all underlying drivers of a pain state (utilising as appropriate manual and exercise therapy, lifestyle modification and cognitive strategies) and to educate our patients to understand their problem and how to self manage it.
Tendon problems occur at various sites of the body, including the shoulder, elbow, hip, knee and ankle. The term tendinitis has been replaced by tendinopathy, as it is now well recognised that tendon problems are not inflammatory in nature. Generally tendinopathy is a response to faulty loading. This can relate to either excessive or lack of activity, particularly when the amount of tendon load alters rapidly (rather than gradually, which tendon will adapt to much better). Other contributing factors may include faulty biomechanics or sporting/occupational technique, lack of strength/conditioning, reduced flexibility, obesity and high cholesterol.
Management of tendon problems involves identification of then modifying risk factors, optimising tendon loading so that it is neither excessive nor insufficient and critically, appropriate exercise prescription. There are also a number of injection techniques now being widely used for tendinopathy with evidence to support their use, but they should be followed with quality rehabilitation if long term benefit is to be achieved. Surgery is used for complete tendon tears and on carefully screened occasions for tendinopathy that has failed to respond to an adequate amount of good quality conservative treatment. Again, follow up rehabilitation is vital to ensure an optimal result.