General pain considerations
It is important to gain an understanding of how pain works in general as this has been shown to improve people’s ability to manage their condition more effectively.
How is this relevant to you?
The most important thing you should know is that pain does not always mean harm. It is possible to feel no pain with damage to our body. It’s also possible to experience a lot of pain even when no damage to our bodies has been shown.
We know now that pain is far more complex than only what is going on in our bodies and can be influenced by other areas of your life. These include:
- Mood and emotions
- Beliefs about pain
- Avoiding meaningful activities/social contact.
- Lifestyle choices
This is often referred to as the biopsychosocial model of pain. This means all areas of your life can influence pain. It is important to look at your life as a whole when dealing with spinal pain to see if there are any other contributing factors.
Goal setting
Before starting rehabilitation for your knee, it is important to consider setting some goals. Setting meaningful activity goals can help with motivation during rehabilitation as often the process of recovery can be slow.
By setting activity goals (alongside your exercise targets) and tracking progress, this allows individuals to see improvements with rehabilitation. If you are struggling to achieve these goals then you can make the necessary changes to your rehabilitation programme as required.
There are a few things worth considering when setting goals.
They key is to set goals that are:
- Realistic
- Enjoyable
- Specific
- Timed
An example of a goal for knee pain is shown below:
“By the end of September, I would like to be able to walk around the local park with my family”
At set intervals you can review the activity to see if this is getting easier for you to perform. If it is not, maybe consider if it is at too high a challenge for you at the moment? Remember back to it being a realistic target.
If you continue to see no progress, it might be time to discuss with a health care professional to see if they can help problem solve to allow you to get back on track with your goals.
Managing daily activity
The longer we have pain the harder it can be to keep active. Our activity levels often change based on our pain and this often leads to a change in how we approach day to day activities.
You may find that on your good days, when pain is not too bad, you overdo it. This is common in patients with knee pain on tasks that involve bending the knee, stepping up and down and crouching/squatting. This can lead to increased pain, which means you then need to rest for either the rest of the day or for days later. This is often called over and under activity cycling or boom/bust cycling.
Over the long term this pattern of activity can result in you resting more for longer periods of time, which then reduces your motivation to be active, which leads to avoidance of overall activity. Unfortunately, in most cases this will lead to reduced strength, stamina and flexibility of the tissues in your shoulder. This can often lead to more pain from your tissues having to then work harder when trying to be active.
Successful management of activity
Remaining active with pain can be achieved by following some key themes from the example shown below of a patient with knee pain who wants to do some home improvements.
Plan
- Plan the activity in advance and consider what your capabilities are at this time.
- Look at what options are available, such as equipment that could make it easier.
Prioritise
- Consider if there are options available to get help from a family member or friend.
- Consider what else you have to do in that day or week in order to reduce the overall load within your knee. Prioritise what’s most important at this time.
Pace
- Try to spread the activity out over the course of the day or week even. Take small breaks on a regular basis and plan for these breaks before the point of pain.
Adjust and adapt
- Manage your expectations of yourself from what you can do now over what you did in the past and make adjustments around this.
Flare-up management
It is normal for you pain levels to go up and down, even as you are getting better. These are called “flare ups”. It can be helpful to have a flare up plan in place to help you stay in control of your pain, and get you through these times.
By having a flare up plan in place, you are giving yourself the best chance of controlling your symptoms.
You may have noticed that certain situations or activities which may result in a flare up of your pain, an example may be being over active, or it may be social activities or emotions such as stress or low mood. Sometimes these things cannot be avoided, however if we recognise the things that aggravate our symptoms, we can plan strategies to help manage this.
Flare up plan
By recognising the factors which aggravate your pain, you can plan in advance the tools and strategies to help you manage these. You may find it helpful to write these down.
Examples of strategies to help may include:
- Medication
- Managing activity (remember the fence example on the previous page)
- Short periods of rest
- Mediation/relaxation
- Ask for help (family, friends, work)