Do you know where your pain originates from?

Did you know that 100 million American adults live in chronic pain.(*) Do you know the difference between Acute and Chronic pain?

“While we used to believe that pain originated with the tissues of our body, we now understand that pain does not exist until the brain determines it does,” states Joe Brence, PT, DPT, FAAOMPT, COMT. “The brain uses a virtual ‘road map’ to direct an output of pain to tissues that it suspects may be in danger, acting as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.”

So, here are 9 things YOU Should know about Pain:

  1. Pain is output from the brain. While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses a virtual “road map” to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.
  2. The degree of injury does not always equal the degree of pain. Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).
  3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding may not be the cause of your pain. A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.
  4. Psychological factors, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient’s experience of long-term pain following the operation.
  5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.
  6. Understanding pain through education may reduce your need for care. A large study conducted with military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for low back pain less than their counterparts.
  7. Our brains can be tricked into developing pain in prosthetic limbs. Studies have shown that our brains can be tricked into developing a “referred” sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or from the “phantom” limb. The sensation is generated by the association of the brain’s perception of what the body is from birth (whole and complete) and what it currently is (post-amputation).
  8. The ability to determine left from right may be altered when you experience pain. Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain, and have noticed your sense of direction is a bit off, it may be because a “roadmap” within the brain that details a path to each part of the body may be a bit “smudged.” (This is a term we use to describe a part of the brain’s virtual roadmap that isn’t clear. Imagine spilling ink onto part of a roadmap and then trying to use that map to get to your destination.)
  9. There is no way of knowing whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way. While some people claim to have a “high tolerance” for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain “feels like.”


*   Institute of Medicine’s 2011 report Relieving Pain in America

9 things You should know About Pain, Joe Brence, PT, DPT, FAAOMPT, COMT.


First time for Physical Therapy? What would your Ideal (clinic) Scene be?

So, you were just handed a prescription for physical therapy by your doctor – who has just asked you if you have ever tried PT before, and, while asking, the first thing that crosses your mind is pain and torture.  And, since you can’t get that idea out of your head, you confess to your doc, “I’m not sure about this whole physical therapy thing.” But, your doc says to you, “What if you were to create an ideal scene of where you would like to go to therapy in your mind, what would it be like?” “Ok,” you say, “I’ll try it!”

So you start telling your people that you have been prescribed physical therapy. So, you ask them if they ever had physical therapy?  Did they like it? And, Where did they go? As you’re listening to their answers, you keep an open mind… Why? Because you have already created your ideal scene of what physical therapy should be like in your head, and you just want confirmation of what you do and don’t want.

So, here is your thought. First, it’s that whole pain and torture thing, you tried to get past it but you just couldn’t, so you found a really cool blog online that debunked that whole physical therapy = pain and torture myth. Shew, now you feel better! Ok, moving forward, you want an outpatient clinic (because your people said outpatient is better than a hospital setting). You want it to be well managed, organized, clean, as well as a friendly and productive clinic (because we all know that no one wants to waste quality time out of their day).  Even better, you want high-quality, pleasant and effective treatment. Wow! You are on to something…so let’s keep going. Just like your physician that you have been going to 4-EVER, you want your therapist to Listen, Ask (questions), Acknowledge (what means the most to you), Review (your doctor’s findings and how it relates to your problem), and lastly you want Change (as needed) just in case you get stuck in a rut!

Sweet! You have just created the most idyllic clinic in your mind. Oh, wait! You remembered…making that dreadful first call to the clinic!  No, no, no, not.want.a teleprompt menu with that (indefinite-hold) elevator music! Yes, you want your call handled quickly, efficiently, and thoroughly with respect. Even better, you want to be able to go online, request an appointment and have the Clinic call you!

Hey, that’s you are ready!

Now where do you go? Hmmmmm, I think you just answered your question!

Snap-Crackle-Pop Goes the Knees

Creatively coined crepitus, one still might picture those 3-little guys sitting on the edge of the cereal bowl just waiting for the milk to smother the ingredients down at the bottom creating a symphony of, what we know to be snap-crackle-and popping. However, that symphony may not be music to your ears when your knees do it, as it can mean a malfunction of the mechanics between the muscles around your knee and the position your kneecap is sitting in.

Could it be hip related? Sure. Could it be foot related? Absolutely. Could it be hip/thigh/knee/foot related? You know it!

And that cracking or grinding around or under the knee cap when you are walking up or down stairs, or while squatting to pick something up off the floor, can occur at any age!

H2O: Water Therapy from the Inside Out

Ahhh-swimming; that oh-so wonderful feeling of being able to cool off on a hot day! Gliding through the water, that is 800 times denser compared to air, de-weighting us to the point where we can, somewhat, believe it brings out the child in us. And why shouldn’t it!? For most of us, we couldn’t wait to run and jump in, splash, and free-stroke. Yes! Free-stroke equaled Free-dom!

Confidently we become buoyant, meeting a greater resistance by moving our arms and legs through the water (vs. air); hence we feel the restorative powers- like a superhero! And, when we are finished with our swim, whether it was for an hour, or several, we get exercise; pain-Free at that…might even have a little appetite too from so much exertion! Not-to-mention looking a little more toned and sculpted.

With our busy lifestyles, and as we age, we are gonna have aches and pains-and maybe a little joint cracking here and there.  You may even be experiencing a little (or a lot) of arthritis now. What to do? Ah-yes, go swimming! Because to be pain-free means you have to move consistently, and frequent movement is a hard-sell to those of you in pain! Whether you have musculoskeletal disorders, chronic back pain, need lumbar stabilization (pregnancy), have foot, ankle or knee pain, shoulder pain, or any kind of arthritis–results from swimming and aquatic therapy are immediate!

Rekindle your memory of youth and rebuild your confidence of daily living; pain-Free. Go get in a pool and MOVE; swimming (aquatic therapy)-it’s a high-intensity exercise…….Free yourself today!

It’s Physical Therapy, not Pain and Torture; we promise!

Whoever coined the title Pain & Torture in lieu of Physical Therapy must have been one not-so-happy-in-a lot-of-pain patient!  We don’t know the patient’s demographics, or injury area, to determine why those words came through their lips-but, guess what, it stuck! Now, when I’m out-and-about, I will occasionally hear, “I’m commin’ in to see you all at Carousel for my next dose of Pain & Torture!”

So now it’s up to me to debunk that whole Pain & Torture myth. Here it goes, ready? We do not cause pain and we certainly don’t torture! Hard to believe? Trust me I know, I have been doin’ this whole thing one calls “pain and torture” for a long time now. But, if the tables are turned, it pains me to feel we are torturing you-TRUST me!  This is why at Carousel your physical therapy is NOT all about exercises! That’s not how we do this physical therapy thing at Carousel, and we never will!

How is that? One word, ready? Collaboration! It’s you and your assigned therapist during treatment (or your therapist’s assistant). Either way, its one-on-one care! We are all about YOU and dealing with your pain, your goals, and addressing your needs-together; our relationship is not a passive one-it’s a lasting one!

So, you see, we want to empower (not torture) you to become (pain) free. It’s crucial to your quality of daily life, your ability to earn a living, your ability to pursue your favorite leisure activities….and SO much more!

Running: Look at the Big picture!

OK, the weather is warmer, the sun is shining, well maybe not this last week of April, but you get the idea, right?  Point is, you are ready to R.U.N.! Whether your a recreational runner, or getting ready for all these 5K’s (that pop up everywhere like those beautiful spring flowers), you can, and may end-up, injuring yourself.

Maybe you got new running shoes, maybe you just decided to get up out of your chair and start running like Forrest Gump, or you have activated (or not activated for that matter) muscles that are crucial to your running form, and you, now, are in PAIN! OUCH!

It is important to listen to how you run! Even with your earbuds in, you can still “notice how you strike the ground,” as physical therapist Robert Gillanders, PT, DPT, OCS says. Or, as recrational runner Katie McDonald Netiz stated, “I could not squeeze my glutes, which sounds ridiculous that a runner wouldn’t be able to do that, but I couldn’t.”

So, take a minute to refresh the do’s and dont’s before you put your body on that running regimen. Here is a link to a wonderful guide to healthy running: the E-book: The Physical Therapist’s Guide to Healthy Running.

As therapists, we are the experts in restoring and improving motion in people’s lives. Kara George, PT, DPT, CSCS is our running expert and go-to professional who can create specialized treatment and injury prevention plans for runners of all levels.

So whether you are returning to running, or just beginning we can get can help you get to the starting line of your running regimen!




Non-traumatic rotator cuff tears: Surgical Intervention vs. Conservative Treatment

Well, it’s no secret that Physical Therapist’s are partial to conservative treatment for any non-traumatic injuries before enduring the hardships of surgical intervention. Yes, we can be your first line of treatment because it’s cheaper, and has no side effects – in most cases, of course! No doubt, some patients are hesitant to try conservative treatment first because they wanted a quick fix. But, guess what? Some, well most, of them ended up back at physical therapy anyways, because what they didn’t realize was that quick fix wasn’t so quick after all!

When you factor in pre and post-operative care, the recuperation time will be greater compared to going the conservative route. If you factor in the time your shoulder will be completely immobile in a sling, and, that there is a rehabilitation protocol, including, guess what? yep! aftercare physical therapy, you might think twice about the alternative.

So, do we have your interest now? Well, don’t fret, if you have recently been diagnosed with a rotator cuff tear and are on the fence about which treatment plan works for you, read this abstract recently published by The Bone & Joint Journal Formerly known as The Journal of Bone & Joint Surgery (British Volume) Jan. 2014-International research with real clinical relevance.  The abstract Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. compared three different methods of treating symptomatic non-traumatic tears of the supraspinatus tendon in patients above 55 years of age.

Ultimately your plan of care is your choice. But, we think you will have a change of heart on your choice after reading this!