The Center For Pain Resolution

HealthReach’s CENTER FOR PAIN RESOLUTION provides effective and compassionate treatment for people of all ages affected by unresolved pain.  This specialized approach can be applied to a wide range of problems, from headaches or TMJ pain, to knee pain or chronic back pain.  Our dedicated, hands-on experts focus on improving patients' function by treating the sources of their pain and providing effective strategies so they can reach the goal of independent self-management.

OUR PHILOSOPHY:

At the Center for Pain Resolution, we believe that each patient is a unique individual.  Each person must therefore be extensively evaluated to determine three things

• What structure or tissue is the source of their pain?
• What is causing the irritation of the painful structure or tissue?
• What changes can be made to reduce or eliminate the abnormal irritation?

Until these questions are adequately answered, treatment may not be directed at the source of the problem.

One common strategy to reduce abnormal irritation on painful structures and tissues is patient education focused on correcting postural and movement problems.  However, problems known as "restrictions" or "dysfunctions" can make the abnormal movement pattern difficult to correct.  Our therapists specialize in identifying and treating the various types of restrictions and dysfunctions that commonly (and uncommonly!) occur.  Once these restrictions and dysfunctions are corrected, normal movement becomes easier, less painful and more natural.

These restrictions and dysfunctions can be broken down into four categories:

• Connective tissue restrictions
• Muscle dysfunctions
• Joint restrictions
• Muscle imbalances

Connective Tissue Restrictions occur primarily in the fascia, which is a thick but strong connective tissue that is continuous throughout the body.  Through injury, the fascia can become restricted and cause pain or limited mobility in one or more directions of movement.  One visible example is a scar from an injury or surgery.  Other restrictions can occur in deeper layers of the fascia and may go undetected.

Treatments May Include:

1. Myofascial Release - the therapist assesses the mobility of the fascia in all directions, then uses prolonged, low-force stretches to free the restricted directions.  These stretches are low in force so the patient is comfortable and the muscles will not "fight back" or resist the stretch.
2. Craniosacral Therapy - This method has similarities to Myofascial Release.  The basic mechanism of mobilizing the connective tissue with prolonged low force stretches is essentially the same.  The difference lies primarily in the assessment method.  Craniosacral Therapy assesses the deepest connective tissues using their attachments at the skull (cranio) and tailbone (sacral).  From this assessment, the therapist determines which region of the body is most restricted and verifies the results of the mobilization on the fascia as a whole after the treatment.

Who Can Benefit?

Anyone experiencing pain or limitation in movement may have one or more restrictions in the fascia.  Since the fascia is interconnected from head to toe, it is possible that restrictions in one region of the body can affect not only that area, but others as well.  This can be understood by pulling down on the front of your shirt (simulating the restriction) and feeling the pull in the back of your neck (simulating the effect of the restriction).

Muscle Dysfunctions are muscle control problems that cause skeletal muscles to contract abnormally and resist movements that will stretch them.  These dysfunctions can go undiagnosed since there is nothing structurally wrong with the muscle; only the function is impaired.  Despite this lack of true tissue damage, these dysfunctions can be the source of very significant pain and limitation causing stress on joints and other structures.

Treatments May Include:

1. Strain and Counterstrain - the therapist identifies the muscle in dysfunction, then treats it through a very specific positioning that "shuts down" the dysfunction and returns the muscle to a normal state.  After a gentle 90 second hold, the muscle is slowly returned to neutral and rechecked for its ability to lengthen normally.
2. Contract-Relax Stretching - the therapist has the patient gently contract the dysfunctional muscle at the end of its non-painful range of motion, then uses the relaxation effect after the contraction to gently stretch the muscle further.  This process is repeated several times to "ease" the muscle further into its restricted range of motion.  This treatment promotes independence since it can often be performed at home.

Total Motion Release -the therapist determines where the greatest muscle dysfunctions are through specific movement testing. Exercises targeted to reduce these dysfunctions are performed and immediate changes in movement and pain are noted.  The patient is then taught to self-assess and self-treat their dysfunctions in the same way.  This treatment can be thought of as performing active Strain and Counterstrain, and is therefore an excellent treatment to encourage patient independence.

Who Can Benefit?

Anyone experiencing pain or limitation in movement could have a muscle dysfunction.  An important point about this particular problem is that patients often report additional pain in the muscles on the opposite side of the dysfunction.  This occurs because the opposing muscles fatigue in an attempt to fight the muscle dysfunction during normal activities.  Due to this mechanism, this problem can be the source of unresolved pain or pain spreading to other areas of the body. 

Joint Restrictions are limitations in the normal ability of a joint to travel through its full range of motion without pain.  Through injury or postural problems, joints can become painfully limited in one or more directions of movement.

 Treatments May Include:

1. Mobilization with Movement (Mulligan Concept) - the therapist identifies the painful movement and which joint is restricting motion.  The therapist then holds and maintains a joint mobilization that eliminates the pain while the patient performs the same movement.  This procedure is repeated multiple times until the patient can perform the movement without help from the therapist.  This treatment promotes patient independence since many of the mobilizations can be done by the patient at home using towels or straps.  Other mobilizations can be maintained by the use of tape applied by the therapist between sessions.
2. Mechanical Link - the therapist identifies and assesses the restricted joints, then uses a very specific low force mobilization (a "recoil") to mobilize the joints.  This treatment provides a gentle way to achieve an effect similar to higher force mobilizations.
3. Muscle Energy Technique - the therapist identifies and assesses the restricted joints, then positions the patient so that a series of gentle muscle contractions performed by the patient mobilizes the joints.  In some cases, the patient can be taught to safely perform these mobilizations at home.

Who Can Benefit?

Anyone experiencing pain or limitation in movement could have a joint restriction.  One or more restricted joints could also be the mechanism for pain spreading to other areas of the body.  To understand why, it is useful to think of joints as links in a chain.  If there is restriction at one level, there must be additional movement at other levels.  Since the other levels are forced to do additional work, they can also become painful.

Muscle Imbalances are muscle tension, length or control problems that create abnormal patterns of movement, resulting in abnormal stresses on joints and other structures.  Muscle imbalances can be created by poor posture, faulty body mechanics, or by some type of trauma.  Some imbalances can be obvious, such as a limp that does not go away after the pain from an injury or surgery is gone.  Other imbalances are very difficult to see, and may only become apparent during specific testing.

Treatments May Include:

1. Neuromuscular Re-Education Exercises - the therapist assesses and identifies any muscle control deficits using multiple stability tests.  The therapist then uses very specific, low intensity exercises to encourage normal muscle control.  Once the muscle control normalizes, the patient is progressed to strengthening exercises.
2. Strengthening Exercises - the therapists assesses the strength of the muscles through testing.  The patient is then instructed in exercises for any muscles that are either abnormally weak, or need to be stronger to provide stability to support a weakened joint, disc, or other structure.
3. Stretching Exercises - the therapist assesses the flexibility of the muscles through testing.  The patient is then instructed in exercises to lengthen the short, tight, or contracted muscles that are limiting normal motions or joint mobility.

Who Can Benefit?

Anyone experiencing pain or limitation in movement could have a muscle imbalance.  Research suggests that some patients who have a back injury lose the ability to properly control certain muscles, even after their back has healed.  This problem impairs their ability to stabilize their joints, making reinjury more likely.  This may help explain why 80% of patients who have a back injury serious enough to seek treatment will have at least one or more serious incidents in their lifetime.  This may also explain why one study found that almost 40% of patients reported virtually no difference in back pain one year after having surgery.