Playing (and Living) with Pain

Sometimes it’s hard to tell you’ve had too much of a good thing—until it’s too late. I remember the day I learned that lesson. I was 41 years old, at the end of a seven-mile run. The sky was clear, the air sweet, and my heart and mind filled with an endorphin-induced high. It was August 2001, and all was right in my runner’s world. 

Then, I felt the first faint twitching, like something in my upper hip was being plucked. I finished my run and hoped the snapping would subside. It didn’t. The next day it grew—and kept getting worse. 

I sought help from what seemed like an endless lineup of physicians, specialists, and physical therapists—then chiropractors, acupuncturists, and massage therapists. Still no diagnosis. I didn’t know it then, but my treatment launched a journey that hasn’t ended, and likely won’t. 

I’m not alone. Earlier this decade, the Centers for Disease Control reported that 150 million adults in the United States participated in some type of non-work-related physical activity. Sports participation by people 45 and older in the U.S. has grown steadily since the 1990s. Those 55 and older make up our health clubs’ fastest growing membership—increasing by a whopping 380 percent since 1987—according to another study.

More active later in life, we’re still only human. Pain management and chronic pain (lasting longer than three months) are topics many of us must learn. Understanding how the body works—and finding the right resources when it doesn’t—is one way to manage pain and get back on your game. Knowing your body’s limits and adapting to them is another. Fortunately, there are plenty of experts to help with both.Biomechanics 101
One surefire way to manage pain is to avoid it. “As a population, we tend to overdo things,” says Erik Ekstrom, MD, of the Institute of Low Back and Neck Care, whose clinics include locations throughout the metro. He sees plenty of patients suffering from degenerative issues, such as arthritis and disc maladies in their backs. He also treats many who’ve over- or misused their bodies.

“As children we do more activities—we skip, run, jump, and bike,” says Ekstrom, who specializes in physical medicine and rehabilitation, sports medicine, and spine care. “Cross training like that is important, but we get away from it as adults.” This forces the body’s neurological and muscular-skeletal systems out of balance.

“If you’re going to run, play hockey, or ride a bike, your success is based on patterns of movement [that] draw on those muscles time and time again,” says Doug Merz, owner of Merz Physical Therapy at The Marsh Center for Balance and Fitness, in Minnetonka. Improper training, poor technique, bad footwear—all can prompt muscles to overcompensate, which leads to overuse and injuries.

“Physical conditioning is one way of preventing injury—especially core conditioning,” says Paul C. Biewen, MD, physical medicine and rehabilitation specialist at Twin Cities Orthopedics, in Edina. The core stabilizes the spine, pelvis, and shoulders, and movement in related extremities. “Core strength keeps the spine in a better position, so if something unusual happens, the muscles can compensate and relieve the pressure,” Biewen says.

Merz suggests every athlete enlist a qualified trainer to demonstrate good form from the start. “Get your biomechanics evaluated by a good trainer or physical therapist [for] the activity you’re interested in,” he says. Snap, Crackle . . . Stop 
Sometimes, injury can’t be avoided. When and how it’s treated, however, can make the difference between a short-term injury and one that persists. Michelle Gorman McNerney, MD, a sports medicine physician at TRIA Orthopaedic Center, in Bloomington, says getting the injury checked out immediately is the best first step.

“You need to get the subtle things addressed,” she says. “Small injuries can be the result of a muscle imbalance, and physical therapy early on can help. Doing more upfront can prevent a lot of things from turning into a serious problem.”

Start with your family physician to rule out other possibilities, then consider visiting a physician with sports medicine training who can review your medical history, biomechanics, and injury—and then develop a course of treatment. Merz recommends seeing a physical therapist, along with your physician. “Many [physical therapists] have relationships with the fitness centers and trainers you need for rehabilitation,” he says.

Team Approach
Some pain management clinics offer an integrated or complementary care approach, which includes a staff of specialists who provide physical and massage therapy, plus alternative forms of treatment including acupuncture, reflexology, nutrition, and psychological counseling for the emotional effects of long-term pain.

The advantages of a pain management clinic include a team approach between doctors, therapists, athletic trainers, and other specialists. It also may be more convenient—especially if you need X-rays and other diagnostic procedures.

Assembling your own team of professionals has its merits, too. Merz recommends finding the right specialist for your sport and injury, via word of mouth. “Find people who are involved in the activity you’re interested in and ask around,” he says. “They’ll know who’s good.” One session with the right specialist, he says, may be worth several with someone with less knowledge about your sport.

Ultimately, you have to take control. “I tell my patients, it won’t hurt my feelings if they try something else,” Merz says. “It’s their body, and they’re the ones in pain.” Letting Go and Finding Balance
Regardless of treatment, patients must learn the difference between healing and fixing, says Alfred Clavel, Jr., MD, co-owner of the Minnesota Head and Neck Pain Clinic, which has multiple metro locations, including St. Paul. “Muscles assume a fight-or-flight response against pain and naturally tighten up to brace against it,” Clavel says. “Often, stabilizer muscles are not used and grow weaker. Treatment includes strengthening and conditioning of [those] muscles.”

Practitioners often relax muscles by releasing tightness or spasm through myofascial release or soft tissue work. Acupuncture, acupressure, massage, physical therapy, and chiropractic work can all be effective. Back, neck, tendon, and joint injuries may require more significant treatment, including injecting medicine—such as steroids—into the injured area.

A healthy, balanced body is like a “pie” game piece in Trivial Pursuit, says Richard Printon, a chiropractor at the Hennepin Faculty Associates Alternative Medicine Clinic. “You have to look at it holistically,” he says. “We need each of the slices filled in.”

Slices include taking the time to heal, proper conditioning to avoid injury, and good nutrition. Eating the wrong foods can increase the inflammation that’s causing your pain, Printon says. “Stay away from fast foods, processed foods, excessive alcohol and caffeine, creams, and potato chips,” he says. “A Mediterranean diet is a good model to follow.”

Stress and emotional management are critical slices of the pie that often go untreated. “Long-term, unending stress releases a cascade of physical reactions,” Merz says. Movement therapy such as yoga, Pilates, and Tai Chi can help restore balance and settle the nervous system.

Patients may need psychological assistance and active therapies including relaxation techniques, coping mechanisms, and self-monitoring skills to go on with life—even with pain—says Nancy Carlson, director of pain services at the Courage Center, in Golden Valley. “Often times patients put up roadblocks to their own recovery,” she says. “Because they’re afraid of change.”

Staying in the Game
Change. That’s what I did. In late 2008, I changed my physical therapy to focus on releasing the complex set of muscles surrounding my hips, and I started a workout regimen with a rowing machine, weights, and an elliptical trainer. I’m getting in shape and sleeping better. Whether I run again doesn’t really matter—I’m happy being active and feeling fit. In the end, that’s the name of the game.

Mike Knight is a writer whose workouts include elliptical and rowing machines, weights, biking, hiking—and when no one’s looking, the occasional run.