As a physiotherapist my job is to help people get back to optimal function – usually this means identifying the cause(s) of pain and working with my patients to develop a plan to reduce it. Sometimes the causes of pain can be linked to obvious tissue damage, physical injury or illness, over-training etc. However, many pain presentations are extremely complex and may also have no clear physiological cause.
Emerging literature suggests that when pain becomes chronic, it literally changes the way that the brain and nervous system work. A normal functioning central nervous system works will signal pain to protect the body from a potential threat. In individuals with chronic pain, the central nervous system may become “sensitized” and begin to signal pain inappropriately. The nervous system gets stuck in a state of high alert, becoming “over-protective”, and can signal pain during activities that should not pose a threat to the individual.
Graded-Motor Imagery
Neuroplasticity is the brains’ ability to modify, change and adapt because of experience. Just as the brain can change the way it signals pain through this theory; it can also be used to break the cycle of pain. Graded-Motor Imagery targets the areas of the brain that are responsible for signalling pain and “re-teaches” them to function appropriately.
Graded Motor Imagery (GMI) is an evidence-based rehabilitation program that was specifically designed to treat complex pain. The program is broken down into 3 stages of graded exposure, which target central sensitization with the goal of teaching the brain that movement is not threatening.
Stage 1: Left/Right Discrimination
The literature suggests that individuals experiencing chronic pain lose the ability to differentiate between left and right when looking at images of their painful body part. This can lead to a distorted mental map of our own body.
By practicing the ability to differentiate between left and right, we are able to activate areas of our brain that contribute to motor tasks unconsciously. This has been shown to desensitize the brain to movement of that body part and prepare for conscious movement.
Before moving on to successfully visualizing part of the body moving without exacerbation of pain – the research suggests that patients should be proficient and L/R Discrimination.
Stage 2: Explicit Motor Imagery
In this stage, patients begin to imagine themselves completing specific movements with the painful body part.
When imaging movement, or even watching someone else complete a movement – our brain activates a sequence of brain cells that are responsible for actually performing the movement. This allows the patient to activate the motor sequence without actually completing active movement and can be a stepping stone for gradually exposing the nervous system to what it is currently perceiving as threatening.
Patients begin with very simple movements that cause minimal pain, and gradually increase movement as the nervous system becomes less sensitive.
Stage 3: Mirror Therapy
Now that the patient is able to visualize functional movements with minimal pain, the patient is ready for mirror therapy. In this stage, we can use a mirror to hide the painful body part and trick the brain into reducing pain sensitivity by having the patient perform movements with both sides but watch the asymptomatic reflection in the mirror.
If you or someone you know is experiencing Chronic pain, or you’d like to learn more about whether Graded Motor Imagery could help you – book an appointment with one of our Physiotherapist’s!
– Kristen
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Moseley, G. L., Butler, D. S., Beames, T. B., & Giles, T. J. (2012). The graded motor imagery handbook. Adelaide, Australia: Noigroup Publications.