A study: Rewiring the Brain

In the past 3 issues of fixnews, we have been chatting about pain and how it is a response of the brain. We’ve started to explore the amazing way in which pain is our body’s way of protecting itself and that the brain is capable of constantly weighing up all information in each and every moment of time to produce a pain experience, or not. We can start to visualise all of that grey matter with its trillions of nerve connections, pulsing, surging and deciding. The brain is very busy indeed.

Through education and a better understanding of these processes (and I have only really just begun!), we can actually change the brain’s nerve connections and wiring to bypass pain experiences that may be entrenched within its grey matter. We’ve started to explore the plasticity (or ability to change and adapt) of the human nervous system and we can increasingly see with real time scanning, this adaptation before our eyes.

This is all very promising news and should give new hope to sufferers of persistent or chronic pain. Same can be said for suffered of chronic fatigue, mental illness and other afflictions.

Today I’m going to share with you the findings of a study by Dr Lorimer Mosely, a physiotherapist and Doctor of Pain Management. He has researched pain extensively and has published many papers. He is interested in the interface between physiotherapy, psychology and physiology in those that suffer from chronic pain.

This simple study published in 2005 demonstrates amazing well the role of education and the immediate effect it has on the brain wiring. As physiotherapists, we see every day that pain beliefs, attitudes and physiology can alter movement performance. Pain can change what muscles we activate, movement control, good movement patterns or habits and postural support. The best example here is the ‘switching off’ of the deep abdominal muscles that support the spine when amidst a painful lower back episode.

In this single subject study, the 36 year old woman had a 5 year history of lower back pain (LBP) after a fall at work. She had not returned to work because of the injury and was reliant on pain medication for relief. She underwent real time ‘functional MRI’ (fMRI) scans at 3 occasions to see brain activity for her particular ‘pain movie’ or wiring in the brain for pain.

The woman was taught to contract her deep abdominal muscle and scanned while performing these contractions. She was sent away to practice her abdominal exercise for a week and rescanned again performing the contraction one week later. She then underwent a 2.5 hour highly detailed education session with a physiotherapist talking about the physiology of the nervous system, the brain and pain physiology. Diagrams were drawn, metaphors used and pictures looked at to help with the information delivery. She was scanned for a final time once again performing the same abdominal exercise to compare activation patterns in the brain to her earlier scans.

The scans showed that brain areas that were activated when performing the abdominal exercise reflected this woman’s ‘pain movie’ and involved multiple areas of her brain, including some that are known areas involved in human pain. The first 2 scans reflected a very similar activation pattern or ‘movie’. However the third scan immediately following the education session showed significantly reduced brain activity when performing the same abdominal contraction.

It seems likely that the reduced brain activity in this woman at this final scan reflected a change in her beliefs or attitudes to her pain after hearing about how pain works in the body. Perhaps the new information had allowed for her to feel less threatened or anxious about her pain and the abdominal exercises that she had been asked to perform? Perhaps in some way she had begun to overcome the fear of her own pain, the barrier which she possessed that was preventing her from getting better? Could this education session be a catalyst to ‘unravel’ her ‘pain movie’, reduce her pain levels to allow for exercise, to gain strength and better support for her spine?

Perhaps she has turned the corner in her pain levels and function? New hope.

6 ways to care for your pelvic floor muscles and spine when you are pregnant.

From your experiences at your Fix Program classes, I hope you all have a new awareness of your pelvic floors, pelvis and spine. But with your changing body shapes and levels of that relaxin hormone rising as the weeks of pregnancy tick by, these areas of your body really are under strain. Here’s my top 6 ways to incorporate your ‘core’ into your everyday, both now and for after baby arrives.

1. Think tall and long. By gently lengthening through your waists, you will be using your ‘core’ and supporting your spines well. Pelvic floor muscles work at that low level we require for everyday when you are tall. Try this sitting, standing and walking.

2. Make time to attend to your pelvic floor muscle exercises. Remember to pop our red dots about the house to remind you – behind the kitchen doors, on the dishwasher, on your computer monitor. Or associate drinking water with the time to lift our pelvic floor a few times.

3. Use your legs. When bending, lifting, or needing to generally get down low, remember your folding hips. Try to keep your trunk long and fold your trunk over the hips. This will keep your spine supported (see tip 1) and safely aligned.

4. Become familiar with ‘the knack’. This is a strong lift of your pelvic floor whenever you feel a sneeze or cough coming on, or just prior to a bend or lift of the groceries or baby capsule. This supports the pelvic organs, strengthens your pelvic floor muscles and prevents any embarrassing leakage when the bladder is under pressure with baby in utero. (All very normal in pregnancy and early months post-natally.)

5. Keep your legs together (like a lady!). Pelvic girdle pain is very common in later stages of pregnancy. It can involve the joints of the pelvis in your buttock region (sacro-iliac joints), or the pubic joint at the front of the pelvis. Try to keep your legs together, avoiding separation at the pubic region when you get in and out of the car, or as you roll out of bed.

6. Keep up a high fibre diet. With your pelvic floor muscles already under immense pressure from baby, the last thing you want to do is to strain on the toilet. A diet high in vegies and fruit will stop this and any other associated rectal problems such as haemorrhoids and anal fissures, other common joys of pregnancy that no one tells you about!

What are ‘urgency triggers’?

It is well known that the terms women’s health and pelvic floor go hand in hand together. A huge emphasis is place on this group of muscles in reducing the symptoms of incontinence among both women and men with either large improvements or complete cessation of symptoms. There have been countless studies conducted on the association between the two which is why we- your physiotherapists- sound like a broken record sometimes when we say “lift your pelvic floor”.

But what about the times when you feel a sudden urge to urinate and you feel that your pelvic floor muscle control alone just won’t be enough?

Urgency refers to the sudden desire to void or pass urine with the inability to defer or wait for longer than 5 minutes.

Urge ‘triggers’ refer to certain activities, places, or times that may bring on an urgency episode. For example, driving home from work every day you have absolutely no desire to pass urine and then as soon as you put your keys in the front door, you feel you have to run to the toilet. Or when you turn the tap on when brushing your teeth, or when you are in the cold section in the supermarket. These are just a few of the many triggers that may bring about an urgency episode. Urgency can happen without leaking.

The great news is that urgency can be cured, and if not, greatly improved. We already know how to contract the pelvic floor muscles so I am not going to talk about that in detail but that does play a large part in fixing these triggers.

There are a few other things that you need to do to manage an urgency episode.

The most effective technique is perineum pressure. This is placing your hands over your front passage and applying pressure. You will often see children doing this when they need to wee. I understand that this might not be seen as the most appropriate thing to do while searching for cheese in the supermarket! With that in mind, the corner of a table or the edge of chair can be great at applying the pressure while it looks to others that you are just resting your legs or have a little rest.

Technique two is raising your heels off the floor and coming up on to your toes. Again you will often see children doing this. The reason this movement may help is linked to the neural pathways from your pelvis to the brain. Keeping it simple, by lifting your heels, the message to your brain shifts from your bladder to the muscles contracting in your calf and lower leg.

The next technique is distraction. I will often suggest to my female patients to count backwards from 100 by 7’s. This shifts your brain to thinking about something other than your bladder and while you’re busy subtracting 7 from 72 your urgency has passed or reduced.

Breathing and walking slowly is the last important technique. Breathing and walking slowly will keep your muscles relaxed (remember your bladder is a muscle, after all). If you think about when you get a cramp in your leg, you would normally find staying still and breathing is more effective in stopping the cramp. Racing to the bathroom will contract the muscles more, including the bladder muscle, making it harder for you to control. Holding your breath will make it harder for you pelvic floor muscles to contract to help stop leaking and to help you pass the urge.

Contracting the pelvic floor is the final step in reducing and controlling an urgency episode.

When you feel a sudden urge to pass urine, try any or all of the above steps. I am absolutely certain that your urgency will improve with the above techniques. It might work better on some occasions compared to others and that is very normal. You just need to give it a go. Good Luck.