The medical community has a lot of scary sounding words for what usually turn out to be relatively straightforward concepts. One that is beginning to surface, particularly for patients with chronic pain syndromes is called Central Sensitization. Like most diagnoses, this sounds big and terrifying! But the great news is that being sensitized isn’t just easy to understand, it is sensical to treat as well.
The concept is remarkably intuitive: our brain has a very simple job, and that is to keep you alive. It might be looking for wounds, signs of danger, the next meal, or where you physically are in space, but everything it does is often directed toward that one goal: stay safe. As our brain subconsciously notices these different signs, it will send your consciousness a message. For food, hunger. For looming threats we have fear. For suspected wounds, we have pain. The more scientists study pain, the more they have learned that pain is not necessarily the result of true damage to tissue, but the brain’s perception that tissue needs to be addressed and should not be used until it is sure it is safe to do so. When you think about it, this is a remarkable reflex. If there is real damage to my ankle and I put too much weight on it too fast, I could put myself in more danger!
But something strange sometimes happens, and sometimes our body will continue to perceive a threat even when tissue damage is no longer present. We see these patients all the time in therapy, patients who have been told there is nothing physically wrong with them. They are sometimes accused of faking their pain, or called malingerers. Sometimes there is evidence of the body’s high sensitization to threat, like with excessive swelling in things like Complex Regional Pain Syndrome, but we can not explain why.
There is a new, exciting theory out, however, and I think it is going to turn the medical community on its head, because the treatments really do seem to work. The theory is that our bodies simply are not as good as detecting “real” versus “perceived” threats as we thought, and a body that perceives constant threat will continue to try and protect us from these threats. It can result in many of the symptoms we see after any kind of injury: tight muscles, intense pain, range of motion restrictions, but without the physical damage because these symptoms are being put in place by nerves that think they are protecting us!
So what are the treatments? Well, we have to convince the body that these limitations are unnecessary. If the body feels that lifting too much weight could damage a muscle, we begin with light weights that do not create threat, or lighter loading like isometrics, to activate these tissues without increasing threat. Then, over time, as the body acclimatizes to these stimuli, we gently increase load, or movement, or range, until the brain understands that it is no longer under threat. We can also take advantage of activating certain nerves and processes with techniques borrowed from psychology when treating patients with stress disorders by lowering their brain’s perception of threat. By taking this new combined approach of loading a body in a non-invasive way over time, or by lightly touching and stimulating tissue (progressive loading and manual desensitization) and calming the brain, a lot of chronic pain now has a new, alternative, and non-invasive approach!
Sound cool? It is! And here at Hohman, we are just as excited about using this new science to help!