THE PAIN RELIEF JOURNEY:
UNDERSTANDING HEADACHES:
Often, we reach for painkillers without investigating the real reasons behind headaches. It could be due to muscle tension, dehydration, deficiency of nutrients (magnesium deficiency is a common cause of migraines and headaches1 ), or blood glucose spikes (eating too much sugar is one of the most common causes of migraines in quite a few of my patients). By ignoring these factors, we risk recurring pain in the future.
THE IMPORTANCE OF SELF CARE:
While immediate treatment is important, we emphasise teaching patients how to manage their pain independently. This includes rehabilitation exercises, pain science education (studies have shown that learning about pain can help to reduce pain in the long term2-4 ), lifestyle recommendations, and stress management techniques (a variety of stress reductions techniques have shown good effects to helping with pain and chronic pain conditions 5-7 ). Our first step in this journey is called RECLAIM, which empowers patients to take control of their pain and regain a pain-free life. Within this first step, our patients also learn to recognise and respect the many causes for Why We Feel Pain and the different factors which can make our pain worse.
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3 Steps to Pain Free
WHAT IS COUNTERSTIMULATION?
Before we dive into our “Go-To” exercise, let’s discuss counterstimulation. Counterstimulation is the underlying mechanism for how our “Go-To” exercise helps to relieve pain. It’s also the underlying mechanism behind how a variety of other treatment practices reduce pain levels. Treatments such as massage, cold packs, heat packs and acupuncture. Counterstimulation is the process by which a form of sensory distraction is used on the body to over-ride other more noxious signals (a scientific term for potentially harmful or unpleasant) taking priority within the nervous system. The more noxious signals that we are able to prevent reaching the brain, the less likely the brain will be in sounding the “alarm system” of pain. It can be viewed as a temporary “distraction” from pain, and for many of my patients this temporary interruption can be a huge source of relief!
HOW COUNTERSTIMULATION WORKS:
The practice of Counterstimulation is based upon the theory of “Gate Control.” (references see above: 1) The Gate Control Theory was first proposed by Dr Ronald Melzack and Dr Patrick Wall8-9 in 1965.
In the human body it is easier to think of our nervous system in two distinctive parts; the brain and the spinal cord. Nerves from the body transmit information about the current state of the body into the spinal cord. The spinal cord then decides whether to allow information from the body to continue to travel up towards the brain and influence decision making processes within the brain.
Only once a large enough amount of noxious information has travelled into, or is already present within the brain, will the brain then make a decision to turn the on the alarm system which creates the sensation of pain (for more understanding of this process, read our blog on Why We Feel Pain?).
When your body sends noxious signals into the spinal cord, counterstimulation can help by temporarily blocking these signals from traveling up the spinal cord and on towards the brain. It may be useful for you to think of the spinal cord acting as passageway which facilitates information to travel between the body and the brain. Hence, counterstimulation can act as a key which closes a gate within in the passageway of the spinal cord, thereby preventing danger signals transmitted from the body being able to reach up to the brain.
THE SHORT TERM RELIEF OF COUNTERSTIMULATION:
It is important to be aware that counterstimulation can only provide temporary relief from pain. For some, the effects can last a few days, while others may only feel relief for a little as only 15 to 20 minutes. Despite its temporary nature, it’s a valuable tool in managing pain and can support the journey toward longterm healing.
(Although, there has even been speculation from the researchers of Gate Control Theory to suggest that repetitively performing counterstimulation, may have long term and lasting effects for reducing chronic pain 9 ).
QUALITY OVER QUANTITY:
During the “Go-To” exercise, the harmless sensation used to “Close” the gate in the spinal cord is mechanical pressure. A common mistake people make when practicing our “Go-To” exercise is thinking that more pressure equals better relief. However, applying too much pressure can turn a gentle counterstimulatory sensation into a noxious one, thereby counteracting the intended effect.
THE GOLDILOCKS EFFECT:
Finding the right amount of pressure is crucial. Just like Goldilocks, who sought things that were “just right,” you need to find the level of pressure that works for you. This requires some experimentation and patience. For each and everyone of us, these levels are totally individualised, and there is an art to finding your own personalised “Goldilocks” effect for counterstimulation. The true art of this practice will come about with a willingness for you to calmly explore, experiment and discover what level of mechanical pressure works best for you.
PERFORMING THE ‘GO-TO” EXERCISE:
Our primary technique is known as Trigger Point Release Therapy. This technique can be applied with the use of different tools (such as massage balls and foam rollers). The tool that we recommend for most of our patients is a massage ball. The reason why we like to use a massage ball is that it is small, portable and easy to be able to perform wherever you go!
Whilst the science for how trigger points arise is poorly understood, there is a general accepatance that they do exist10-12 and can be a significant cause of repetitive muscular and joint pain within the body. The key to success with Trigger Point Therapy is that it requires an approach and mindset which is less prescriptive, and something more exploratory. Whilst the practical principles outlined below will be a useful starting point to get you going. The effectiveness of the technique will come with personalised minor adjustments, tweaks and alterations which will to help make it more efficacious for you in the long term. These will only be uncovered with a williness for you to spend a bit of time comparing and contrasting the responses of your body between slight changes in body position, pressure application into the massage ball, breathing techniques and the ability to relax your mind.
STEPS FOR TRIGGER POINT THERAPY:
- Find a comfortable area on the floor with enough room for you to be able to lie with your legs straight, your arms outstretched above your head and out wide to either side of you (many of my patients lie on a yoga mat but a carpeted floor can also work just as well).
- Lie down so the area you want to treat is on the floor.
- Place the massage ball under the muscle you want to target. Aim to place the ball in a part of the target muscle where you feel there may be a trigger point.
- If you feel familiar pain, you’ve likely found a trigger point. If the trigger point is particularly sensitive, you may even feel the pain referring from the trigger point to a different part of your body.
- If you don’t feel anything, move the ball and try again. Although, one of the skills of Trigger Point Therapy is your ability to sense and assess whereabouts trigger points may be located, based upon the sensations you feel when you first lie onto the massage ball.
- Adjust the pressure until it feels right—between 40-60% discomfort. Although, please remember the Goldilocks Effect mentioned above.
- Melt into the position, whilst breathing calmly until the discomfort reduces to 0-20%.
- Repeat as needed for other trigger points.
- Stretch gently the trigger pointed muscles afterwards to enhance the effects. You can do this routine 3-5 times a day.
CAN VIBRATION ENHANCE THERAPY?
Vibrating massage tools are gaining popularity. While research on their effectiveness is limited, some find them helpful for muscle recovery and pain relief. There is some good evidence that it can help with temporarily improving flexibility/joint range of motion13-15, and also with temporary relief for chronic pain conditions16.
Additionally, some may argue that regular vibration into parts of our body can serve as extra sensory input for helping the brain to become more accurate with sensory mapping and predicting touch. Some research studies have shown this to be strongly related with improving symptoms of chronic pain17-18 .
Plus, correctly using vibration tools on our muscles generally feels nice, which in turn helps us to be able to relax our minds and emotional state……..and this is something that continues to show a strong association for reducing pain and threat within the body19-20 .
My general response with regards to most questions about Counterstimulation, is that whether another counterstimulatory input would work for you, is very much an individual response. You might want to try vibration tools to see how your body responds.
WHAT COMES NEXT?
Remember, counterstimulation and trigger point therapy only provide temporary relief. To truly heal, it’s important to address the root causes of your pain. For most people, the journey to addressing these root causes requires a process of investigation, learning and exploration of the necessary steps that would need to be undertaken in order to achieve true healing.
At EvoRehab, the process in which we help our patients treat and identify the root causes for their pain comes in the form of three-steps: RECLAIM, RETRIEVE, and RESTORE. Each step is designed to help you manage your pain and work towards long-term healing.
CONCLUSION:
With the right tools and knowledge, you can take charge of your pain. Explore our three-step process and see how it has helped others regain control of their lives. You deserve a pain-free journey!
References
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2. Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002;48(4):297-302. doi: 10.1016/s0004- 9514(14)60169-0. PMID: 12443524.
3. Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain. 2004 Feb;8(1):39-45. doi: 10.1016/S1090-3801(03)00063-6. PMID: 14690673.
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6. Flynn DM. Chronic Musculoskeletal Pain: Nonpharmacologic, Noninvasive Treatments. Am Fam Physician. 2020 Oct 15;102(8):465-477. PMID: 33064421.
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8. Katz J, Rosenbloom BN. The golden anniversary of Melzack and Wall’s gate control theory of pain: Celebrating 50 years of pain research and management. Pain Res Manag. 2015;20(6):285–6. PubMed 26642069 ❐ PainSci Bibliography 52145 ❐
9. Melzack R. Myofascial trigger points: relation to acupuncture and mechanisms of pain. Arch Phys Med Rehabil. 1981 Mar;62(3):114–7. PubMed 6972204
10.13. Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004 Dec;8(6):468–75. PubMed 15509461
11.14. Calandre EP, Hidalgo J, Garcia-Leiva JM, Rico-Villademoros F, DelgadoRodriguez A. Myofascial trigger points in cluster headache patients: a case series. Head & Face Medicine. 2008 Dec 30;4(32):32. PubMed 19116034 ❐ PainSci Bibliography 55349
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