By: Caitlin Larkins, PT, DPT, CBIS, Cert. DN, Outpatient Physical Therapy Advisor
While low back pain is extremely common, it can be difficult to treat, especially if it’s lasted for a long time. In these cases, research recommends that physical therapy interventions should include aerobic exercise, manual therapy as appropriate, and a specific type of patient education called pain neuroscience education, or PNE.
PNE is meant to help patients understand the underlying science behind pain to create strategies and tools to help people treat their pain on their own. For example, did you know that pain is a protective mechanism? Our brains are constantly analyzing information sent from the body to the brain in addition to incorporating environmental cues to determine if you are in danger. Pain is an output from the brain meant to help keep us safe. This is an effective system if there is the potential for tissue damage (i.e., stepping on a Lego in bare feet), but why do we sometimes still have pain if the danger is gone?
This is where your therapy team can help! By retraining your brain to better analyze any potential threats, we can help decrease the intensity of pain signals that your brain sends.
Here are four techniques that your therapist may use:
1. Stories, Metaphors, and diagrams – These help facilitate education on pain science topics relevant to your individual pain experience
2. Graded Activity – Exercise can help decrease pain and improve function; however, sometimes we have to gradually add exercise to improve your tolerance to movement
3. Parasympathetic Activation Tools – Strategies like breathing, meditation, and cold therapy can help increase your body’s “rest and digest” response and help decrease its pain response
4. Mindful Language – Instead of saying “I have a bad back” or “My bad leg,” consider saying, “My back is sometimes sensitive” or “My right leg” to reframe how you identify your body and help improve your expectations for recovery
