Physiotherapy for Pain Management: Part 1 - Strategies for a Healthier, Active Life
Camilla Yang • June 6, 2024
As National Pain Week approaches in July, now is a good time to shed light on the crucial role physiotherapists play in supporting individuals in managing their pain. Pain, whether acute or chronic, can be a debilitating force that impacts every facet of an individual's life. It can restrict mobility, impede on daily activities and independence. In part one of our Physiotherapy for Pain Management blog series, our Clinical Coordinator for Physiotherapy, Jyoti Chatla discusses the role physiotherapy plays in the management of pain and the key strategies and lifestyle changes we can all do to lead a healthier, more active life that is free of pain.
How can physiotherapy manage chronic pain conditions?
Physiotherapy plays as vital role alongside other medical and allied health interventions in the management of chronic pain.
Chronic pain is multi-factorial in nature and extends beyond the normal expected timeline of tissue healing. Chronic pain has a complex biopsychosocial nature to it and physiotherapists are trained to work with clients experiencing it.
Physiotherapists with thorough assessment can identify underlying factors that could be contributing to chronic pain. Some of the factors which can be improved with physiotherapy include core and global muscle weakness, muscle tightness, reduced range of motion in joints due to restrictions in intra-articular movements, and tightness in surrounding structures of the joints. Clients with chronic pain also go through a phenomenon known as fear avoidance behaviour where due to their pain experience, they avoid movements with the anticipation of triggering their pain. Physiotherapists can work with clients to help them by gradually exposing them to the movements that they may be fearful and avoidant of due to anticipation of pain using pacing strategies, graded exposure to exercises and client education.
Also, there is strong evidence in literature that suggest how exercise and physical activity helps with pain perception, mood elevation and has overall mental health benefits which are crucial in management of chronic pain conditions.
What are some common techniques or modalities used in physiotherapy for pain management?
Treatment modalities depend on underlying impairments that the clinician may have identified during their assessment and are tailored to each client.
Some treatment modalities such as manual therapy, dry needling, soft tissue release are used alongside exercises such as progressive strengthening training, balance, range of motion and flexibility, Pilates and core exercises, and hydrotherapy.
How do personalised exercise programs play a role in alleviating pain and improving mobility?
Every individual is different and have different factors that can contribute to their chronic pain. A physiotherapist’s role is to complete a thorough assessment to identify underlying impairments that could be contributing to a client’s difficulties in their daily activities, participation in the community, work, and leisure. Based on the individualised assessment, the physiotherapist then designs a client specific treatment plan with intensity and frequency suitable for the client – taking into consideration their baseline pain, fitness and exercise capacity, and most importantly their goals.
Physiotherapists can monitor the client’s symptoms and modify the exercises to be more suitable. Physiotherapists ensure that the intensity of exercises are progressed incrementally to ensure the client is progressing, without risk of injuries or compromise in the form of exercise.
Are there specific lifestyle changes that are recommended to clients for pain management?
There are many lifestyle changes that physiotherapists recommend to clients to help them manage their pain including:
- Active lifestyle: Maintaining a healthy active lifestyle is crucial for clients with chronic pain. It is a well-known and established fact that the lack of physical activity is one of the major causes of various cardiovascular diseases. Clients with chronic pain are at risk of gradual decline in their level of activities and therefore are at risk of developing various comorbidities. Simple exercise such as brisk walking for 30-45mins per day is very effective. Walking is low impact and low intensity exercise and does not need any additional training or specialised equipment due to which it is easily accessible. There are also various other low impact exercises that can be practiced indoors such as cycling and Tai-chi. Physiotherapists can design a simple home exercise programme which can be easily completed at home. If a client has membership to aquatic centres and enjoy water-based exercises, they can go to the pool and practice under water walking and exercises at safe height. If client enjoys group-based exercise programme, they can enquire in their local gym, councils or local volunteer groups who run such group exercise classes.
- Adequate sleep: Rest is very important for the body to recuperate and recover. It is during sleep that our body undergoes healing, restores energy, repairs cells and tissues amongst many other important functions.
- Optimum nutrition and hydration: Maintaining optimal nutrition is important for the body to have adequate resources to help repair, recover and restore.
- Stress management and relaxation: Stress and low mood has been linked to how an individual with chronic pain experiences or perceives pain. If a client with chronic pain is experiencing stress or has difficulties with their symptoms it is important that they see their GP and talk to them about their symptoms and seek professional help.
What are the key strategies or approaches that promote a healthier, more active life for individuals managing pain through physiotherapy?
Physiotherapy offers a more holistic approach to management of pain. Physiotherapists with thorough assessment aim to identify the root causes / factors that are contributing to a client’s pain and design an intervention in the form of physical exercises, client education and functional rehabilitation to promote a more active lifestyle and gradual return to function.
Physiotherapists may use the below approaches:
- Hands on techniques: Physiotherapists use various hand on techniques such as joint mobilisation, soft tissue manoeuvres, to help manage pain, improve joint mobility, and promote relaxation.
- Individualised exercises: Physiotherapists develop tailor made exercise program for the client to improve their function using exercises targeting muscle strength, endurance, flexibility, joint and tissue mobility, balance, and proprioception.
- Exercise progression, monitoring, and adjustment: Physiotherapists monitor client symptoms and document their progress and accordingly adjust the exercises to suit individual needs and goals. Exercises are progressed gradually with a graded approach so the client’s tolerance to movement improves.
- Client focussed goal: Treatment designed by the Physiotherapist is focussed and based on individual client goals. They will set SMART goals in collaboration with the client. This helps make the client feel more motivated and focussed when they make progress throughout their rehabilitation process and achieve their goals.
- Functional rehabilitation: Physiotherapists includes exercises that follow functional patterns and body movements required to perform activities of daily living such as sit to stand, standing on one leg, reaching, lifting, walking to a certain distance, and climbing stairs. It often involves task specific training in a safe and supportive environment under the guidance and support from the physiotherapist.
- Client education: Physiotherapists promote active lifestyle through client education. The aim of client education is to empower the client with the knowledge of the nature of their pain, understand the tissue healing process and the role of activities and exercise in promoting healing and tolerance to pain with movement. Physiotherapists ensure that the client understands and has self-management strategies so that they can manage their own pain using techniques such as activity pacing, use of proper body mechanics, relaxation, and other modalities such as a heat and cold pack. Education will help clients feel more confident and empowered when they feel they are in control of their pain and have the right tools and strategies when they need to manage their pain.
If you would like to book in one of our physiotherapists to help you manage your pain, fill out our referral form here.
In the aged care sector, allied healthcare professionals play a crucial role in helping facilities and providers meet their 11 quality indicator goals. Among these experts are Dietitians, whose specialised knowledge in food and nutrition can have a positive impact to the health and well-being of care recipients. At Vivir Healthcare, we recognise the importance of nutritional care where our Dietitians are dedicated to supporting aged care facilities and providers around Australia in delivering exceptional care to older adults, helping to improve health outcomes and overall quality of life. In this blog, we will explore the 11 aged care quality indicators and discuss how our Vivir Healthcare Dietitians can support all care recipients while enhancing your facility’s and service's overall performance. Aged care Quality Indicator 1: Pressure Injuries Dietitians are well placed in the prevention and nutritional management of pressure injuries by supporting and maintaining skin integrity. Pressure injuries are common in residential aged care, particularly for residents who are bed or chair bound and non-ambulant. Entirely preventable and combined with regular repositioning, pressure injuries can be prevented with optimum nutrition. Dietitians will focus on ensuring residents receive adequate protein, energy, micro nutrients such as vitamin C, E and minerals zinc and iron. These nutrients are equally important in the management of established pressure injuries. Dietitians can assist residents to increase their protein and energy intake through small dietary changes to support wound healing. Dietitians are also well placed to prescribe wound-specific supplementation. Some residents are more susceptible to pressure injuries and impaired wound healing if they have co-morbidities such as diabetes and/or chronic kidney disease. It’s important that a Dietitian is involved especially when co-morbidities are present as impaired renal function can worsen with high protein intake. A comprehensive nutrition assessment will ensure that appropriate recommendations are made for the individuals unique situation. Aged care Quality Indicator 2: Physical Restraint For residents that live with dementia and experience behavioural challenges because of the disease, at times physical restraint is used to protect themselves and others from potential harm. Residents who have poor nutrition and poor oral intake, may experience an increased rate of progression of cognitive impairment. Dietitians can assist staff and family to ensure residents nutrition requirements are met and work around challenging behaviours with food and mealtimes. Having a Dietitian involved in the care of residents with dementia may help to slow the progression of the illness and may reduce the likelihood of the need for physical restraint. Aged care Quality Indicator 3: Unplanned Weight Loss The main referral received in aged care for dietitians is for unintentional weight loss and malnutrition. Dietitians are at the forefront in prevention and management of weight loss. It is estimated that approximately 60% of residents in residential aged care are either at risk of malnutrition or are malnourished. Unplanned weight loss is a key indicator and risk factor for malnutrition. Unplanned weight loss can occur for multiple reasons in people residing in aged care homes and in the community including; complex medical conditions, hospitalisations and poor appetite to name a few. Dietitians assist to prevent and manage unplanned weight loss and malnutrition by prescribing high energy high protein diets, food-first approaches e.g. food fortification and if necessary, oral nutrition supplements. Dietitians also assist to educate and support care and kitchen staff to optimise residents' diets in the kitchen and/or at the table. Aged care Quality Indicator 4: Falls and Major Injury Most falls and major injuries, while common, are entirely preventable in aged care and in the community. Working alongside allied health professional, for example Physiotherapists , Osteopaths and Occupational Therapists , Dietitians make nutritional recommendations to compliment physical activity to promote optimal muscle mass to support strength and conditioning of skeletal muscle. Adequate nutrition, focusing on adequate protein and energy intake, through dietetic intervention combined with physical exercise can reduce the likelihood of falls and therefore subsequent major injuries such as fractures Aged care Quality Indicator 5: Medication Management Many residents in residential aged care often require nutritional supplementation as the ageing process requires increased nutrition requirements for particular nutrients. Dietitians can support and optimise nutrition intake through food first approaches which may help to reduce the reliance of expensive supplements or medications, decreasing the risk of polypharmacy. Aged care Quality Indicator 6: Activities of Daily Living Dietitians are well placed to support residents and clients with their day-to-day activities. Supporting optimal health to maintain independence for as long as possible. With respect to food and eating, Dietitians can make personalised recommendations to clients and residents around nutritious choices when food shopping, cooking methods and mealtime support. Aged care Quality Indicator 7: Incontinence care A common issue in residential aged care and in home care clients, incontinence can be debilitating and socially isolating. In some cases, Dietitians may be able to relieve the symptoms of incontinence especially if there are dietary triggers, lack of fibre or intolerances. For those that experience incontinence, there are increased fluid losses that require replacement. Dietitians can provide guidance on appropriate fluid intake to ensure adequate hydration. Aged care Quality Indicator 8: Hospitalisation As outlined above with respect to falls and major injury prevention and therefore subsequent hospitalisation, Dietitians also play an integral role in supporting residents and clients upon return home from hospital. In most cases, weight loss is an undesirable consequence of a hospital admission. Residents and/or clients that are hospitalised and are undernourished are at an increased risk of infection, wounds, increased length of stay and increased risk of death. Dietitians can help to correct and stabilise unplanned weight loss and hospital acquired malnutrition and wounds with targeted nutrition support through individualised nutrition assessments. Discharge plans often recommend dietetic input upon return home for those residents and/or clients identified with weight loss and or malnutrition during their hospitalisation. Aged care Quality Indicator 9: Workforce Dietitians make up the important network of allied health professionals that are underutilised in aged care. As outlined above, Dietitians can provide support and value addressing each quality indicator to support positive health outcomes for residents and clients. Dietitians support multiple staff across the aged care setting to enable them to build the capacity of their clients and residents. Vivir Healthcare boasts an experienced, passionate team of Dietitians across Australia, ready and eager to play a role in the care of elderly Australians. Aged care Quality Indicator 10: Consumer Experience Food is an important source of enjoyment for residents and consumers in their day to day lives. Dietitians are uniquely placed to bridge communication between staff, residents and clients to improve the overall dining and mealtime experience. Vivir Healthcare Dietitians regularly complete mealtime assessments and menu reviews in aged care to ensure compliance, enjoyment and nutritional adequacy. Food and eating is an integral part of life and it is up to everyone to enable the consumer experience and choice to be at the centre of their care. Aged care Quality Indicator 11: Quality of Life. As above, it has been addressed how Dietitians can enhance the consumer experience, particularly when it comes to food and mealtimes. Inevitably, there are times when nutrition focuses shift away from corrective and intensive interventions as illustrated under the above quality indicators to individualised, scalable recommendations to preserve and optimise quality of life. Dietitians are often called upon for weight loss the context of progression toward end-of-life care. Some residents and clients may require a palliative approach if they are living with a life limiting illness. Dietitians can ensure that foods and fluids provided align with the residents or client preferences going through this life stage. As with wound care and wound prevention, adequate nutrition is integral to supporting skin integrity to prevent the development of new pressure injuries or sores. Dietitians will make recommendations accordingly and apply dietary strategies to prevent further skin deterioration and improve overall quality of life.
“Have you been doing your exercises?” I wonder if you’ve been asked that question before. Perhaps it was posed to you by a health professional, it may have been posed to you by an inquisitive family member or it may be a question that you’ve posed to yourself? In my role as a physio , I spend a lot of my week doing exercise with clients. Some sessions are focused on strength, some sessions are more targeted towards aerobic fitness, and other times we work on balance, range of motion or any number of other important metrics of physical health. I have clients whose sessions are completed sitting down in a chair and clients who walk for kilometres. I have clients who do hours of exercise every day, and clients who find it hard to get motivated. But in those wonderfully diverse experiences, one consistent theme is the focus and promotion of resistance training. The role of resistance training in maintaining good physical and psychological health has long been testified to. And so, my goal in this article is not to tread over old ground or to walk a well-worn path - though we all need to walk it from time to time. I want this article to present the same message but from a different angle. I want to get practical. I want to give you three thoughts that I try to prioritise when implementing resistance training with clients: The human body has potential. Focus on strength and power. The positive feedback loop. Let’s dive in! The Human Body Has Potential. The human body has so much potential. Whether you’re 50 or 90. Whether you meet the step goals on your apple watch everyday or have never done a day of exercise in your life. You have potential. Research shows demonstrable improvements in quality of life, depression and muscle strength through the performance of resistance exercises. It shows improvement in functional activities like climbing stairs, getting out of a chair, getting dressed and catching the bus. It shows improvements in physical and psychological well-being. It shows improvements in pain. Loss of muscle mass is a gradual process that, on average, begins after age 30 and accelerates after age 60 (Chang et al., 2019). We call this sarcopenia. This diagram shows the negative pathways that can result from sarcopenia and a loss of muscle mass (Hunter et al., 2004).
In Australia’s ageing population, falls prevention for elderly people cannot be overlooked. According to the most current 2023 Australian Government statistics, falls contribute to 43% of injuries leading to hospitalisation, making falls the top cause of injury related hospitalisations in Australia, with people aged 65 years and over being the most affected. As the impact of a fall can lead to loss of independence, confidence and impact overall well-being, understanding the role that Physiotherapists and Occupational Therapists play in supporting people implement fall prevention strategies to prevent future fall incidents, and engaging in their expertise, can help improve the quality of life for you or your elderly loved one.
