…How it really works.

Warning: this gets sciency

Chronic pain is a complex condition. Recent research has shown that the brain plays a significant role in the development and maintenance of chronic pain.

One of the key ways that the brain contributes to chronic pain is through the process of neuroplasticity. Neuroplasticity refers to the brain's ability to change and adapt in response to experiences, like movement and pain.

When joints move we lengthen and shorten various muscles that span those joints. Muscles send sensory data about their length into the brain and the brain constructs an internal map of the body by piecing together the length of all of our muscles. Neuroplasticity tells us that this internal model or (cortical map) is constantly being updated. In other words, when you change the way you move your body, your brain changes.

These body maps expand and contract. They increase or decrease. Quite literally, The area of the brain that is dedicated to receiving this muscle movement (sensory information) will expand or contract based on the amount and frequency of information being sent.

How quickly? Finger webbing experiments show that changes to cortical maps of Fingers can occur within 30 minutes . 1

This study is so interesting and such a great example of neuroplasticity.

A group of people had their four fingers on one hand webbed together (like a mitten). This modified their sensory feedback. Instead of having four fingers to move independently and provide lots of sensory information. The four fingers moved as one. They were then asked to do some manual tasks while their brain maps were monitored. The area of their brain that receives sensory data from the hand began to shrink within 30 minutes. Their brain map was remodeled based on the quantity/quality of input. Since all four fingers were not moving independently or as freely, the brain map that receives the movement (sensory) information didn't need to dedicate as much area to receiving the movement input so, it shrank.

In the same way that the brain map can shrink, it can also expand and dedicate more space to receiving data. For example, if you start a new exercise routine or learn how to play an instrument, your brain will need to create a new internal model of your body. This will involve learning the new movements and positions of your muscles. As you continue to exercise or practice, your brain will continue to update this internal model. This will make it easier for you to perform the exercises and will also help to improve your coordination.

Let’s consider chronic pain. How does pain become chronic? Could our brain map expand to receive frequent sensory (pain) Input? The answer is yes, even long after the injury or perceived injury has resolved. Additionally, The inactivity that goes along with pain can shrink the same area leaving more space to dedicate to the pain input.

Let's consider what led up to the injury in the first place. We now live in a less physically demanding world. What happens when we don’t move our bodies as much? Our body maps which are formed by muscles and joints firing synapses (a junction between two nerve cells, consisting of a minute gap across which impulses pass). These synapses need exercise just like muscles do. With less use our body maps contract, they disorganize and become blurry and smudged. 2 Our brain ʻshrinks down to our daily lifeʼ. These blurry brain maps mean a loss of fine motor control, tissues become deconditioned and this activates our protection system. 3 Pain is our protection system, right? Like when you touch a hot stove and feel pain, you pull your hand away. So the newer view is that these blurry brain maps predispose us to injury and really drive chronic pain along with the expanding and contracting of the map.

Interestingly we are now viewing pain as a behavioral decision made by the brain - based upon the perceived need to protect parts of the body. 4

Think about it, our blurry brain maps lead to a stiffened motor control pattern. 5 We have greater compressive loads on joints, discs, tendons and ligaments when there is constant stiffness. We experience tissue fatigue and pain in muscles that are being over-activated. We sit all day and the lack of movement causes the same tissues to be loaded constantly.

Additionally, our synapses are not being exercised because we are not moving, Our brain's understanding of our body may be blurred and fuzzy and has triggered a protection mode based on a perceived threat that we could injure ourselves. So now we are stiff and our body is tired of protecting itself and our muscles can only do so much for so long and our brain is remodeling to receive more pain and less movement information.

We are stiff and achy and can't do the things we want to anymore. So what can we do?

We need to move! We need to move every joint and every muscle as often as we can. It seems impossible to do this when we can barely move. Let me help.

How can I help?

The most important part of our treatment is to apply a gentle but rapid passive movement to the joint system to induce a change in the brain. The aim is to amplify sensory awareness and progressively remap the patient’s joint system back to their brain. We’re using sensory discrimination retraining during the treatment process.

Remember, When we move less, or avoid using part of our body after an injury, brain maps shrink and contract. Instead of the brain being able to sense all of our small joint movements in high definition, it becomes low resolution and blurry or smudged. When the brain can no longer control small joint movements, the protective response is to tighten the outer muscles and stiffen our joint system. We know that blurry and contracted brain maps result in persistent pain being felt in the body parts because of protective behavior.

Your pain is not in the hardware - your joints and tissues. It’s a problem with your software - your brain and nervous system, that has become learned over time.

During our treatment, When we make very quick but gentle movements of your spine, we're amplifying the sensory signals from your joints and expanding your brain’s understanding of how they should be moving again. The treatment is designed to retraining your brain.

Why are some movements fast?

Because there are special receptors in our joints and muscles that will only activate with a very quick movement. This is why physical therapy with its slower movements of stretching and exercising is not as effective.

Why do I need to come often at first?

We use a course of treatments because the effects of each visit builds upon the previous. As we retrain your brain to move your body in a healthier way again, deconditioned tissues get stronger. Think of this treatment as a workout and you are trying to get fit. It takes time and consistency to reach your goal.

Will I still feel sore after the treatment?

It is normal to still get sore at times during the process. It is just your brain’s way of telling you that tissues need to be stronger and they are still being protected by sensitive receptors. It is like getting fit again - there’s discomfort, but you get stronger with time.

But my doctor diagnosed me with …blank… They said I would be like this forever.

Arthritis and degenerative changes in discs and joints are seen in people with no pain. Injured tissues and disc bulges, herniations even fractures are seen in people with no pain. The same way that some people with pain can have clean imaging. Think of it this way, If you take an X-ray when you have pain and then take it again when the pain stops, the images will look exactly the same – so what was really causing the pain?

1 Maria L. Stavrinou and others, Temporal Dynamics of Plastic Changes in Human Primary Somatosensory Cortex after Finger Webbing, Cerebral Cortex, Volume 17, Issue 9, September 2007, Pages 2134–2142, https://doi.org/10.1093/cercor/bhl120

2 Schabrun, S. M., Elgueta Cancino, E. L., & Hodges, P. W. (2017). Smudging of the Motor Cortex Is 2 Related to the Severity of Low Back Pain. Spine, 42(15), 1172–1178. http://doi.org/10.1097/ BRS.0000000000000938

3 Moseley, G. L. (2011). Disrupted working body schema of the trunk in people with back pain. British 3 Journal of Sports Medicine, 45(3), 168–173. http://doi.org/10.1136/bjsm.2009.061978

4 Moseley, G. L., & Butler, D. S. (2015). Fifteen Years of Explaining Pain: The Past, Present, and Future. 4 The Journal of Pain, 16(9), 807–813. http://doi.org/10.1016/j.jpain.2015.05.005

5 Meisingset, I., Woodhouse, A., Stensdotter, A. K., Stavdahl, Ø., Lorås, H., Gismervik, S., et al. (2015). 5 Evidence for a general stiffening motor control pattern in neck pain: a cross sectional study. BMC Musculoskelet Disord, 16(1), S39–26. http://doi.org/10.1186/s12891-015-0517-2