Is Chronic Pain Real? Myths of Chronic Pain

By Amanda Traylor, physical therapist at CHOC Children’s

amanda-traylor-physical-therapist-choc
Amanda Traylor, physical therapist at CHOC Children’s

Every year in October, the American Physical Therapy Association celebrates National Physical Therapy Month and this year, we’re highlighting the role physical therapy plays in treatment and management of chronic pain. Pediatric chronic pain is more common than you may think. In a 2014 international survey of pain in adolescents, approximately one third of adolescents reported musculoskeletal pain on a monthly or more frequent basis. It can start after an injury, illness, or without a trigger at all. Chronic pain can have a range of effects, from the mental stress of pushing through pain to participate in physical activity to avoidance and removal from activities including school and sports. At CHOC, the rehabilitation team frequently treats children and adolescents with diagnoses of chronic pain, complex regional pain syndrome, amplified pain, fibromyalgia, and pain associated with hypermobility. Here are some common myths associated with chronic pain, debunked.

Myth 1: Your pain is all in your head.

While it may be true that there is no damage to or illness in your body, the pain is real. Children and adolescents frequently express their frustration with the disbelief and doubt projected onto them about their pain. But the tricky thing is, the head is in charge of your pain. Whether there is tissue damage or not, your brain is the one that perceives the pain signals and interprets them. While the brain is the command center of your pain, the nerves are the messengers. Without the brain and nerves, there would be no perception of pain.

Myth 2: Rest will make things better.

During an acute pain episode when there is damage to the body in some way, pain is a protective response. It lets us know when to rest and allow healing and teaches us to avoid dangerous situations. With chronic pain, this learned response becomes harmful. The more the body rests, the more feedback is sent that the body is injured. Movement can help counteract that feedback and return you to the activities you enjoy. Your physical therapist can teach you how to move in the correct ways to protect your joints, prevent injury and restore your ability to move around in your own environment.

Myth 3: Pain medication will help my pain.

Prolonged use of pain medication has been a topic of interest in the past few years due to the opioid epidemic. As the body builds up tolerance to commonly used pain medications, higher and higher doses are needed for relief. With a chronic pain, this could yield harmful side effects and does not address the cause of the pain. In some cases, other medication options may better address the origin of chronic pain. These options, including non-pharmacological management, should be discussed with your physician.

Myth 4: Physical therapy alone will help.

Physical therapy is an excellent tool to address movement dysfunction that occurs as a result of prolonged pain. It can help return patients and families back to the activities they enjoy through a variety of strategies tailored to each individual’s needs. Physical therapy could include strengthening, balance training, stretching, endurance training, relaxation strategies, neuromuscular re-education using electrical stimulation, and more. But physical therapy alone is not the gold standard. A pain psychologist and physician are vital to the team. A pain psychologist can help address the effects that chronic pain can have on your life as well as decrease the amount of pain signals sent to your nerves via cognitive behavioral therapy.

Myth 5: The pain only affects the patient.

Chronic pain has major impacts on not only the individual experiencing it, but also their family and friends. Parents see the effects of the pain and want to help, but frequently feel that they are at a loss. Siblings want their sister or brother to go back to the role they played before the pain started. Friends at school can see the individual pulling away, limiting themselves from the activities they previously enjoyed together. When a child is affected by pain, their loved ones are affected as well. The parent, family, and friend support through the treatment and management of this diagnosis is essential. Frequently, the medical team incorporates the entire family in our approach and their participation can make the biggest impact on the individual’s success.

Learn more about rehabilitation services at CHOC

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Rehabilitation Therapists’ Role in a Pediatric Environment

By Leesha Augustine, physical therapist; Hema Desai, speech language pathologist; Erin Keller, speech language pathologist; Adriana Rusch, occupational therapist; and Vicky Vu, occupational therapist at CHOC Children’s

The field of rehabilitation services includes a wide variety of opportunities including hospitals (where therapists can treat patients in any department), schools, and outpatient facilities including specialty facilities in the fields of mental health, sports medicine, wellness programs and rehabilitation/skilled nursing. Rehabilitation treatment can be provided for a variety of reasons throughout someone’s life from infancy through adulthood. The Rehabilitation Services team at CHOC Children’s includes physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs). Each therapy discipline also has licensed therapy assistants.

What training is required to work in pediatric rehabilitation services?

The therapist track for each discipline requires graduate school in order to be licensed by their respective national boards. The Doctor of Physical Therapy (DPT) Program is a three-year post baccalaureate program. The traditional OT program is a two-year master’s degree, with the option to further specialized training with a two-year clinical doctorate (OTD). SLP programs are also a two-year master’s degree, along with completion of a nine-month clinical fellowship following graduation. The assistant track for each discipline require a two-year associate degree including a hands-on practicum and licensing exam.

What does a physical therapist do?

They have the opportunity to work with patients and their families to help them restore function to allow them to return to school, sports, playing with friends, work and family events.

rehabilitation
After surgery, physical therapy played a big role in Sydney’s life. Her PT, Robin, is a two-time Olympic medalist and helped Sydney, a fellow athlete, connect with her treatment.

What does an occupational therapist do?

Occupational therapists help others participate in daily activities as independently and safely as possible. They also help children with sensory difficulties, fine motor skill delays, oral motor and feeding skill delays, and dressing difficulties.

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Occupational therapists help others participate in daily activities as independently and safely as possible.

What does a speech language pathologist do?

The role of a SLP is to prevent, assess, diagnose and treat speech, language, social communication, cognitive-communication and feeding/swallowing disorders so that individuals can interact with others to the best of their ability.

rehabilitation
Nicole, a speech therapist at CHOC, works with patients with feeding and swallowing disorders, speech delays, brain injuries, and vocal cord dysfunction.

Where would you find rehabilitation services in a hospital setting?

The depth and scope of Rehabilitation Services at CHOC Children’s Hospital is vast, with members of the department working within most service areas of the hospital, including: four specialized intensive care units, the hematology/oncology unit, the medical/surgical unit, and the Neuroscience Institute.

Members of the rehabilitation team provide developmental support for many infants in the neonatal intensive care unit (NICU). You may find a SLP or an OT coaching a parent on how to feed their baby for the first time, an OT making custom hand splints to help facilitate improved hand function, or a PT may provide specialized wound care  or assist a patient out of bed for the first time. The rehabilitation team will work with children and families in the pediatric intensive care unit (PICU) so that a parent can feel safe holding their child after a long-term intubation, a patient with a brain injury can say, “I love you” to his family, and play with his favorite toys.

Children with prolonged hospitalizations due to cancer treatment may receive rehabilitation therapy to encourage developmental skills as well as to recover from the effects of their illness and treatment. While they are admitted to the hospital, we work closely with them to help them regain function in a variety of areas: gross motor skills, fine motor skills, daily activities such as dressing themselves and taking steps, feeding and swallowing, eating and drinking safely, and being able to communicate with their friends and family.

As much as rehabilitation professionals love working with children and their families while they’re in the hospital, the primary goal of this team is to facilitate a safe discharge home and to enable our patients and families to participate in the activities that are most important to them.

Our Orange campus also has a multidisciplinary outpatient rehabilitation department including PT, OT, ST, hand specialist, feeding and wound care therapists. Here, our PTs, OTs and SLPs keep working with our patients after they are discharged from the hospital, as well as patients that are referred for pediatric specialty care from their pediatrician. You will also find PTs, OTs and SLPs working in our ambulatory care clinics, and serving as clinical instructors in their graduate and assistant programs.

No matter the setting for rehabilitation services, treatment goals always have the same common theme― helping kids enjoy doing the things they like best like riding a bike, drawing, or even being able to eat a cupcake!

Learn more about rehabilitation services at CHOC

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At-Home Wound Care Tips for Parents

By Ruchi Bagrodia, physical therapist at CHOC Children’s

Did you know that the physical therapy team provides wound care for the kids at CHOC Children’s?

Part of their scope of practice, both physical therapists and physical therapist assistants complete coursework in wound management during their higher level education. Several PTs and PTAs at CHOC have received specialized training in wound care and many have gone on to receive board certifications in wound care. With this training, a therapist is able to evaluate wounds, decide on the best treatment, and create a comprehensive wound care plan in collaboration with the patient, family, and medical team.

Physical therapists are able to use their expert knowledge of anatomy, tissue healing, movement and positioning to develop an individualized plan of care that also aims to improve movement and function. Successful wound healing may allow a child to more quickly return to school, participate in gym class and enjoy a summer trip to the beach with their family.  The ultimate goal of physical therapy is to restore function and allow people to get back to the things they love doing!

How do PTs provide wound care at CHOC?

At CHOC, PTs and PTAs provide wound care services for kids on both an inpatient and outpatient basis. During an evaluation, a PT will decide how to best clean, dress, and protect the child’s wound, and also provide recommendations to the parent to encourage wound healing and to prevent complications.

Here are some tips to remember when caring for your own minor wounds or skin injuries at home:

  • Keep dried scabs moist using a healing ointment or petroleum jelly for faster healing time. While it may be challenging, try your best not to pick at scabs!
  • If a wound is open (appearing wet, bleeding or draining liquid), cover it with some type of bandage. Leaving it open to air will increase the risk of infection.
  • Common signs of infection include redness, swelling, pain and warmth. Call your doctor if you notice an increase in signs of infection that are not already being treated.
  • When using over-the-counter antibiotic ointments for minor cuts and scrapes make sure to follow the dosage instructions. It is not recommended to use many of these ointments for more than seven days unless stated by your doctor. Many people have allergic reactions to triple antibiotic ointments. If you notice a wound is getting worse with an ointment, stop using it and talk to a health care professional.
  • Hydrogen peroxide and rubbing alcohol are commonly used to clean wounds, although both are damaging to your healthy skin cells. Instead, simply use mild soap and water to clean a cut or scrape.
  • Different types of sandals, shoes, plus foot and ankle braces can all cause areas of redness caused by too much pressure to the skin. If the redness does not go away after 15 minutes upon removing the pressure, the fit needs to be modified to avoid further injury to the skin.
  • Nutrition makes a difference in wound healing! Incorporate foods that are high in protein, Vitamins A and C, and Zinc into your diet to help with healing. Learn more by visiting ChooseMyPlate.gov for tips on how to create a balanced diet.

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Importance of Stretching for the Young Athlete

By Victor Araiza, physical therapy assistant at CHOC Children’s

Stretching can often take a back seat to your general exercise routine and sport-related activities, but these are an essential part of any conditioning or physical therapy program. Stretching decreases the risk of injury or re-injury and promotes wellness.

Why is stretching so important?

Stretching the right way will help improve flexibility and make it easier for you to move. Stretching properly can increase and improve motion in your joints, increase blood flow, and decrease feelings of stiffness. Other potential benefits of stretching can include reducing delayed onset muscle soreness, increasing athletic performance and reducing the risk of tendon or muscle tears.

It is important to stretch correctly and know which muscle groups you want to stretch. Often, the muscles that tend to be tight are the hamstrings, hip flexors, quadriceps, calves and chest muscles. If proper technique is used when stretching, it will help improve flexibility and increase range of motion. This will increase blood flow and decrease stiffness, in turn decreasing the risk of injury or reinjury.

When to stretch

It is recommended that you perform static stretches after exercising, engaging in strenuous physical activity or participating in an athletic event. Static stretches target specific muscles based on the position you are in with the intent to elongate just past the point of a moderate pulling sensation. The static stretch should be held in the same position for 30-60 seconds and repeated two to three times. For an athlete, it is common to perform a dynamic warm-up prior to sport related activities and static stretches after activities. The American College of Sports Medicine guidelines recommends stretching activities be done at least two days per week. It is also important to know and understand which stretches would benefit you based on your limitations and desired activity participation.

Stretching is encouraged:

  •  When range of motion is limited.
  • Prior to or after vigorous exercises.
  • As a component of your sport-specific conditioning program, team warm-up/cool down and before/after a participation in a sporting event.

When is stretching not encouraged?

  • When someone has excessive movement in their joint(s)
  • An athlete who has experienced a recent fracture
  • After sudden onset of inflammation or swelling
  • When you feel a sharp pain when attempting to stretch

 Tips on how to stretch

It is important to remember that just because you perform stretches doesn’t mean that you will never get injured. Stretching won’t prevent an overuse injury that is predominant in sports that involve the repetition of similar movement patterns. There are other important factors such as strength and endurance training, essential to reducing the risk of injury. Please consult your pediatrician for a referral to physical therapy if you and your child need assistance with an exercise and stretching program.

Learn more about rehabilitation services at CHOC.

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CHOC Physical Therapy Improves Quality of Life

The American Physical Therapy Association declares the vision of the physical therapy profession as “transforming society by optimizing movement to improve the human experience.” The movement system is complex and includes various conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and integumentary systems and their complex interaction that allows kids and teens to experience their environment and actively participate in the activities they enjoy.

How do physical therapists play into this at CHOC? You may see them addressing a wound care plan, educating a family on developmental play activities after an open- heart surgery, teaching a patient how to use crutches after surgery, helping a child balance and coordinate a multi-step task after brain surgery, or progressing the endurance and strength of a child on chemotherapy. Most of all, you will see them educating CHOC families on self-empowerment and independence.

From working with neonates who are learning to self-regulate, to high school athletes hoping to return to their sports after injuries, CHOC’s physical therapists are involved in improving quality of life for our patients and families.

Meet Amanda Traylor, a pediatric physical therapist at CHOC.

Q: What aspect of pediatric physical therapy are you most passionate about?

A: I love working with kids, and we get to work with a diverse age range. I also enjoy the multi-disciplinary collaboration of the rehabilitation department, which includes not only physical therapy, but also occupational therapy, speech and language therapy, and developmental therapy.

Q: What inspires you most about the care being delivered at CHOC?

A: I am inspired by the constant striving of the care team to provide the best evidenced-based practice for our patients and families. Our staff is so involved in our community with different events, education opportunities, and training of future professionals; we really make an impact on Orange County.

Q: What have you learned from your patients?

A: My patients have taught me to focus on what is important and meaningful. Being a part of the medical field, we often establish a plan of care and goals based off the impairments we see, but ultimately it always comes down to what is meaningful for the patient and their family.

Q: What, if anything, surprised you when you became a pediatric physical therapist?

A: We don’t just treat the child; we treat the whole family. The families are truly our backbones for patient care.

Learn more about pediatric physical therapy being delivered at CHOC.

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