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Why Your Pain Isn't Completely Resolved After Physical Therapy

Commonly Missed Factors That Stall Healing


If you have a long-standing injury or chronic pain that is not resolving, this list is for you. Put on your detective hat because it may be time to evaluate other factors that are limiting your ability to heal. The following are some of the lifestyle and health categories which may contribute to tissue healing and symptoms:


1. Poor Stress Management

This may be the number 1 factor of poor healing and getting stuck in a pain-tension cycle. Stress has been shown to:


  • Slow Tissue Healing: Stress changes hormones and increases inflammation.

  • Increase poor-health choices: Stressful events are fatiguing and our brains often seek out comforting activities like watching your favorite show or eating ice cream.

 



QUICK TIPS ON STRESS MANAGEMENT:


Create a calendar of to-do items and stick to it. Tick the difficult tasks off first so they don’t stick in the back of your mind and cause increased stress throughout the day.

 

2. Poor Sleep Hygiene

It is well-known that sleep deprivation is detrimental for our health. That's because while you sleep, your body is in optimal rate of tissue repair. Lack of sleep or disruptive sleep equals less efficient healing processes.


Many research studies have been conducted looking at the relationship between sleep and pain. Sleep deprivation leads to:


  • Higher prevalence of musculoskeletal conditions

  • Higher rates of pain

  • Increased negative mental states

 




QUICK TIPS ON IMPROVING SLEEP:


Ditch the screens 1-2 hours before bed and avoid bright lights. Blue light blocking glasses can help get your body red for sleep during this time. Try to be in bed getting ready for sleep by 11pm.


 

3. Nutrient Deficiencies

Nutrients provide the body with building blocks to build and repair. Nutrient deficiencies can cause muscle and bone pain, nerve pain, muscle spasms, inflammation, and slow tissue healing. Some of the nutrients that have been linked to poor healing and/or chronic pain include:

 

  • Vitamin D

  • Vitamin B12

  • Vitamin C

  • Magnesium

  • Amino Acids

 



QUICK TIPS FOR GETTING YOUR NUTRIENTS:


Whole foods are great, but smoothies can be a great way to consume additional nutrients. Functional grade protein powder and multi-vitamins can be helpful as well. Talk to a nutritionist or dietary specialist to learn about your individualized nutrient needs are.


4. Inflammatory Diet

Taking a multivitamin will not undo the negative effects of eating at McDonalds. A calorie is not just a calorie, and it’s not all about the macros. Processed and Highly processed foods are usually high in sugar and unhealthy fats, while being low in nutrients and fiber. They can alter the bacteria in the gut and cause systemic inflammation which has been linked to pain.

 

The good news is that eating an ANTI-inflammatory diet that is rich in whole foods and healthy gut-supporting nutrients has been linked to decreasing symptoms of chronic conditions, stress, and pain. It can also boost the feel-good chemicals, your physical health, and improve your ability to move and get stronger.






QUICK TIPS FOR EATING AN ANTI-INFLAMMATORY DIET:


Skip eating out and make your meals at home. Try to use as many products that have a short expiration date as possible. Usually, a longer shelf life means the product is more processed.


5. Negative Mindset

Pain catastrophizing can increase the perceived pain intensity AND psychological distress in people with chronic pain. There is also a link between negative mindset and chronicity of symptoms.


Swaying response patterns to pain: Fearing the worst will happen can actually change how you move and act. Muscles can feel tighter and movements may become more rigid. This creates a feedback loop to your brain that you are not safe which in turn can intensify sensations like pain, tingling, or dizziness.

 



QUICK TIPS FOR IMPROVING MINDSET:


Sometimes we are not even aware of the negative loop that runs through our minds. Next time you are feeling pain, stop and reflect on what thoughts are popping up? Are they neutral, negative, or positive? If they are negative, can you counter them with “true” positive or neutral thoughts?


6. Gut Dysbiosis and Stealth Infections

Gut dysbiosis is an imbalance in the the microbiome of the digestive tract. This can include bacteria and fungus that are supposed to be there but are in the wrong place or quantity. This can also be linked to "leaky gut" which relates to the condition of increased intestinal permeability that allows for bacteria and toxins to "leak out" of the digestive tract and into the blood stream. Stealth infections are caused by organisms that stay in your body and can cause illness or symptoms over time.


Gut issues and infections can lead to:

  • Increased bloating

  • Inflammation

  • Poor nutrient absorption

  • Muscle tightness

  • Headaches

  • Muscle aches

  • Joint pain

  • Nerve Pain

  • Mental health issues

 



QUICK TIPS FOR OPTIMIZING GUT HEALTH:


There are many practitioners that tackle infections. When it comes to full-body healing, integrative and functional medicine practitioners generally have the tools assess and treat people. Do your research and find someone who feels competent working with your set of issues.


7. Lack of Social Support

People who feel socially isolated have a higher risk of experiencing chronic pain and increased perceived intensity of pain. They also may have a decreased pain tolerance and use negative coping mechanisms for pain such as alcohol and comfort food instead of engaging in positive conversation or exercise which have been shown to have pain-relieving effects.


Chronic symptoms such as pain and dizziness can come and go and fluctuate widely. It is important to have good social support in place for improving mindset, reminding each other of tools for successful, and for holding each other accountable to goals and actions. (See the benefits of having an accountability partners here.)

 



QUICK TIPS FOR IMPROVING SYMPTOMS THROUGH SOCIAL SUPPORT:


Call up a friend to catch up and talk about light topics - Try not to ruminate on negative symptoms if possible. Bonus if you have a particularly funny friend who can make you laugh.


8. Toxic Relationships

Similar to social isolation, people who are in negative relationships at work or at home have a higher occurrence of chronic pain and other symptoms. Generally, people who state they are frequently affected by a toxic relationship, have higher stress levels which contributes to slower healing and more pain.

 

Being in relationships that feel unsafe tend to bring our nervous systems into the state of fight, flight, or freeze. This sends messages of danger to your brain, keeping it on high alert. Think about it as turning up the volume dial on all stimulus in your body. People who live in this state are more likely to heal slower and to perceive normal sensations and movement patterns as painful.

 



QUICK TIPS FOR IMPROVING SYMPTOMS WITH TOXIC RELATIONSHIPS:

If you cannot exit a toxic relationship, learning to rewire your thinking and holding patterns is key. Begin by noticing your thoughts when you feel triggered by this person. Next, start to notice how and where you hold tension in your muscles when you are interacting with this person. Noticing and starting to change these mental and physical tension patterns can be very helpful in pain management. It can also help other pain-reducing habits work more effectively.


9. Poor Lifestyle Habits

This broad category speaks to anything you may do on a regular basis that is symptom-provoking or slows healing. Some are included above. Other examples of this include:


  • Smoking

  • Drinking alcohol

  • Dissociative activities (scrolling, mindless tv, always mentally living in the future)

  • High risk/high impact sports (fighting, skateboarding)

  • Undereating/binge eating/negative thoughts surrounding eating

  • Frequent anger and victim mentality




QUICK TIPS FOR CREATING BETTER LIFESTYLE HABITS:


Surround yourself with people who have already adopted good lifestyle habits. It is easier to assimilate to the positive actions of people around you than to resist the negative ones. If you are working on undoing a negative habit or implementing a positive one, figure out what's most successful for you first. Are you an all or nothing person or do you need to make small incremental changes? Regardless of style, consistency is the key for forming new, lasting habit.


10. Unresolved Trauma

Trauma is a hot topic today. From a physical therapist perspective, we tend to see more muscle tension and certain types of holding patterns in people who have experienced higher amounts of perceived trauma or stress versus people who would consider themselves to have little stress or trauma in their lives. This increased muscle tension can lead to the feeling of chronic tightness and pain.


Although some believe you can process through old trauma patterns using only the brain (ie. talk therapy), and some believe you can process it just through just body movement (ie. pilates, shaking, tai chi), I have found the most success in combining mind-body techniques that suit the individual.


  1. Understand your thoughts during stress

  2. Understand how you hold yourself and react during stress

  3. Learn to rewire your thinking

  4. Learn movements that unlock tense muscle groups in your body

  5. Learn to move and strengthen in these new movement patterns available after unlocking tension

 



QUICK TIPS FOR TACKLING TRAUMA:


If you are new to working with your own trauma tension patterns, work with a somatic experiencing practitioner to help guide you.


Please keep in mind that the information presented are for education only. If you are struggling with dizziness or balance issues, please book a free consultation to see if working with an expert is right for you.




Dr. Stephanie House has over 15 years of experience in the health and wellness field and currently owns her own practice as a mind-body physical therapist in Charlottesville, VA.


She holds post doctoral certifications in vestibular therapy, dry needling, yoga therapy, and pregnancy and postpartum. With extensive continued study on topics such as mind-body medicine, integrative health, breathwork, and somatic therapy, Dr. House's extensive knowledge and comprehensive approach gets to the root of movement dysfunction and pain.

 

If you are ready to change the way you move and feel, work directly with Dr. House or join the House of Balance Newsletter.


"I don't heal or fix people. What I do is get your body and mind to an optimal place so you can start to heal yourself. We all have a greater capacity to heal than we are led to believe. With the appropriate input and support, our bodies can do amazing things." Stephanie House, PT, Founder

 

For specific questions or inquiries, reach out to Dr. House directly: info@houseofbalancept.com or visit her website: www.houseofbalancept.com


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