Welcome to Advance Physical Therapy, Inc. Newsletter

We hope you had a wonderful Thanksgiving weekend! We are thankful to be able to practice physical therapy and use our service to help people live healthier and more pain free.

It's great to be in good health and we should continually strive to make this a priority in our lives so that we can enjoy being more productive with our family and friends. But more often than not, our health (physical, mental and spiritual) gets trumped by other matters such as work, deadlines and stress. Pain is often ignored to a degree and we let our bodies tolerate higher and higher levels of stress and strain...until inevitably it reaches a breaking point.

This month's article highlights the nature of pain and how manual therapy can be an effective source of healing. The key is to be proactive and take action sooner than later.

To Your Health,

Advance Physical Therapy, Inc.

The Nature of Pain and Restorative Effects of Touch
A Manual Physical Therapist’s Perspective
Ask anyone whether they or someone close to them has ever utilized the skills of a physical therapist, and the answer is almost always “yes.” The American Physical Therapy Association defines physical therapists as “highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility-in many cases without expensive surgery and often reducing the need for long-term use of prescription medications and their side effects.”  PT’s treat a wide array of disorders and conditions, from back pain to difficulty walking after a stroke.  A common feature to many conditions we see is pain. Pain tends to inhibit muscles from activating properly, and our bodies are expert at compensating for painful movements, which can go on to cause new movement and pain problems.
There are roughly three types of pain that people suffer from, and most of the time, there is more than one present at a time: nociceptive, peripheral neuropathic, and central sensitization.
Nociceptive pain is most familiar. The pain is localized to the area of injury. If you fall down and scrape your knee, it hurts on the scrape, and when you bend your knee, stretching the skin on top, it hurts. There is a clear mechanical nature to the occurrence of pain. Once the scrape has healed, bending the knee no longer causes soreness.
Peripheral neuropathic pain is the pain that occurs when there has been an injury or strain to a nerve, such as the leg pain that occurs when a lumbar disc is protruding (herniated) on a nerve root, causing sciatica. Here, the relationship between mechanical compromise and pain occurrence becomes a little fuzzy. Peripheral neuropathic pains can, and often do, get aggravated without any movement or stretch.  Even psychological stress can trigger severe peripheral neuropathic pain.
Central sensitization is the result of pain that has gone on for months after the original injury to the tissue has healed. The pain does not have a clear mechanical nature, and is the most unpredictable and disabling of the three types.
 Here is an example of central sensitization:  Like many Saturdays, you finish an afternoon of yard work, and your back is a little sore. You go to bed, get up the next morning and for the first time, can’t straighten up. There is a searing pain in your back and buttock, instead of just the usual stiffness. You miss three days of work because you’re flat on your back in bed, taking as much Tylenol as possible. Fast forward many months later, and many appointments with physicians, chiropractors and physical therapists, who all concur that the MRI you had to beg for shows nothing more than the degenerative disc changes that would be expected for someone your age. Although you’re able to work and carry on with family life, you’ve been “babying” your body, because your back and buttock hurts a lot. It can still “go out” if you’re not careful, and hurts worst in the morning, then eases up a bit, only to worsen again after an afternoon on the computer and commute home. You’ve given up yard work and your regular recreational softball league.  You find yourself yelling at the kids more and even your love life has suffered.
This type of pain persists beyond the typical few weeks to 2-3 months healing time.  You’re frustrated because your MRI results do not reflect the lingering and disabling pain you feel.  Surely, there must be more damage that is not showing up on the MRI?  Research is showing that some types of pain, like central sensitization, persist not because there is ongoing damage to the tissues, but because of cellular adaptations in the pain circuitry of the spinal cord and brain. The nerves are more sensitive to the pain input from the tissues, and the signal is actually amplified before signaling the brain. The brain itself is also “sensitized” and interprets even non-pain input from the tissues as painful stimuli. As well, thoughts and beliefs can alter the brain’s interpretation of input from the tissues.  At this point, pain sufferers are taking opiate analgesics, NSAIDs, topical medications, and anti-depressants with varying results.
Aside from the use of medication, many PT’s use their manual therapy skills and knowledge of movement to ease all three types of pain, even chronic pain driven by central sensitization.
Manual therapy is specific hands-on techniques that may be used to manipulate or mobilize the skin, bones and soft tissue. All physical therapists have some manual therapy coursework in physical therapy school. Some PT’s pursue additional training after licensure. Manual therapy certification can come from a number of sanctioned physical therapy continuing education companies and organizations, and will often appear as “COMT” (certified orthopedic manual therapist) or “CMT” (certified manual therapist), “CFMT” (certified functional manual therapist) after the professional degree:  DPT, MPT, MSPT or PT.
The use of touch to assess and treat is not used exclusively by manual physical therapists, but more expertly. Unlike massage therapists and other hands-on healers, we perform a very thorough interview of the patient as part of the initial evaluation. The remainder of the evaluation is spent observing movement, checking reflexes, and checking active and passive movements of the joints and soft tissues, like muscles, tendons, ligaments and fascia. The exam is a process of ruling in and ruling out possible causes for the pain and movement problem. For the manual physical therapist, the passive exam, with the patient lying comfortably on the treatment table, is particularly informative. The resilience of the joints and tissues, along with other information gained from the exam, informs the manual physical therapist of the physical therapy diagnosis, the prognosis,  and the mutually agreed upon goals of physical therapy treatment.
The sense of touch has recently been getting much attention in the scientific and popular press.  We are learning more about the way touch, or tactile stimuli, are processed in the central nervous system.
Many of us were taught that touch is sensed at the skin and joints by specialized cells in the skin and joints, called mechanoreceptors and proprioceptors. The message about the  type of sensation is rather predictably relayed to the brain by nerve fibers and the message is unaltered. Now, we are finding out more about, not just the way sensation is processed in the periphery, but how touch sensation is perceived and interpreted to have beneficial effects on our health.
In his book, Touch: the Science of Hand, Heart and Mind, neurophysiologist David Linden describes how therapeutic touch can lower heart rate and blood pressure and stimulate “feel good” hormones and neuropeptides to boost our mood.  Additionally, he explains how the sensation of touch is altered by the emotional context of the person.  
Individual studies have also described the calming effect of touch in infants and its role in cognitive development, and the role of therapeutic touch on decreasing stress-related cortisol levels in widows.

While touch-mediated therapeutic effects do not require the skill and training of a manual physical therapist, we are happy to help our patients with any pain or movement problem. Give us a call today to see how we can help.
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."
Soreness vs Pain - What's the Difference?

There are many benefits to exercise, including the potential for improved physical and mental well being. However, there may also be some physical discomfort associated with these activities due to the stresses placed on the body.

When experiencing discomfort, it is important to understand the difference between exercise-related muscular soreness and pain. Muscular soreness is a healthy and expected result of exercise. Pain is an unhealthy and abnormal response. Experiencing pain may be indicative of injury.

Individual Activity Threshold

In order to make physical improvements, your body needs to be pushed to an appropriate level where gains can occur.

Each person's body has a different activity threshold dependent upon many factors, including age, baseline strength, and participation level. Remaining on the safe side of your threshold will result in muscular soreness. Exceeding your threshold will result in pain.

One of the expected outcomes of exercise, when done appropriately, is that this threshold will progressively increase. For example, when an individual begins running, their safe threshold may be 5 minutes of running. After several weeks of progressive increases in duration, this runner's threshold may increase to 20-30 minutes.

To maximize your exercise gains and minimize injury risk, it is important to be realistic about your activity threshold and to be able to differentiate between moderate muscle soreness and pain.

Soreness vs. Pain: How To Tell the Difference

The chart below highlights key differences between muscle soreness and pain.

  Muscle Soreness Pain

Type of discomfort:

Tender muscles, tired or burning feeling with exercise, dull, tight and achy at rest

Ache, sharp pain at rest or when exercising


During exercise or 24-72 hours after activity

During exercise or within 24 hours of activity


2-3 days

May linger if not attended



Muscles or joints

Improves with:

Stretching, following movement

Ice, rest

Worsens with:

Sitting still

Continued activity

Appropriate action:

Resume offending activity once soreness subsides

Consult with medical professional if pain is extreme or lasts >1-2 weeks


If we can answer any questions or field any topics of interest regarding  physical therapy, health and wellness or about our programs, please contact us. We'd love to hear from you.
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2944 Broadway Street                         1208 E. Arques Avenue Suite #105
Redwood City, CA 94062                    Sunnyvale, CA 94085

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