If you suffer from headaches, spine or extremity pain that has been resistant to heal, the pain may be due to abnormal reflexes maintaining the pain.The concept is simple even though pain is very complex.After sustaining a sprain, strain or any form of injury the body’s natural response is to protect or guard itself from further injury.This reflex muscle guarding is in the form of muscle tightening to “splint” the area.We have all felt this as a “muscle spasm” and after hours or a few days it calms down and we are able move the injured area again.What if this muscle guarding does not fully resolve and is maintained over time?This will set up a situation of compensation that can be far reaching to other areas of your body.This compensation (avoidance of the painful movement or position) can produce secondary biomechanical problems that can maintain the pain independent of the original injury.The key to resolving the pain is identifying the involved structure/tissue and all the secondary compensations that have developed.It is conceivable that the pain you are experiencing is no longer from the original problem or injury but from your bodies compensation patterns that have developed.
Body Symmetry
Body symmetry can be described best by the following analogy.When a tree is planted ropes are used to secure it and promote a straight growth pattern.If one of the ropes is more taut then the others the trunk and branches will lean toward that side and eventually the tree will compensate and take on that shape.
Similar effects can occur in the presence of an injury.When you sustain an injury the muscles (ropes) will become taut on that side and the spine will be influenced toward that side.For every reaction there must be an opposite reaction and unlike the tree our spine does not lean over but it compensates by subtle movements in combinations like rotation, flexion, extension or side bending.To accomplish this opposing muscles (called an antagonists) reflexively contract to “right the body.”The antagonistic muscles in turn influence other muscle groups that initiate a compensatory chain of events throughout your body.
Reflex Inhibition
Reflex inhibition is the neurological phenomenon that is, in part, the reason the body cannot break out of this compensatory pattern of persistent pain.Reflex inhibition is a very basic neurological occurrence that allows free and coordinated movement.For example, if you bend your elbow your bicep muscle must contract and your tricep muscle must relax to allow that movement to occur.The contraction of the bicep causes a reflex inhibition (a form of relaxation) of the tricep otherwise the bicep and tricep would fight each other and the elbow would not move.To take this concept one step further, assume the bicep has sustained an injury with resultant guarding muscle tone.This guarding muscle tone of the bicep reflexively inhibits the strength of the tricep muscle.This asymmetrical muscle tone will affect the function of the elbow.Because the bicep and tricep muscles attach to the shoulder joint, it may develop secondary dysfunction or pain as well.Imagine if an injury occurred to the spine.There are many more muscles and joints that can be affected creating a chain of events that perpetuates to other areas.
Examination
A comprehensive examination by a skilled Physical Therapist (PT) is needed to identify the dysfunctional areas.The manual examination involves an assessment of restricted joint movement, light palpation for muscle guarding and painful areas.Many times there will be a more painful or restricted side and may or may not correspond to the subjective side of pain.The findings are recorded and act as a guide upon which treatment is based. The goal is resolution of all of the positive findings.A positive finding is easily identified because the palpated area will make the patient “jump” in an avoidance type movement.Interestingly, the amount of the palpation force is light yet the response may be quite pronounced.A positive treatment outcome is also easily identified because the avoidance movement to palpation is completely abolished.
Treatment
Treatment is based on the findings of the physical examination with the goal of treatment to restore body symmetry.The PT will use the concept of reciprocal inhibition but this time to “relax” the muscles in guarding and “wake up” the previously inhibited muscles.Restoring muscular and neurological equality and balance between left to right, front to back, and top to bottom is critical to treatment success and carry-over of the results.The process is painless and involves the patient actively contracting muscles when cued by the PT.At the same time the PT will perform facilitation maneuvers to the antagonistic muscles.This procedure will last between 12-30 seconds and is released and rechecked for a reduction in the pain or muscle guarding in that area.The dysfunctional chain of events previously mentioned can be reversed and the patient may also notice a pain reduction in areas that are distant from the area that is being treated.The PT will then provide education to the patient on how to self assess and treat the painful areas.Prescription of an exercise program will be given to maintain body symmetry.Self- management and self-responsibility are important aspects to the healing process.
Summary
Reflexes are essential for the ability of our body to protect itself and vital to all aspects of our bodily processes. When injury or disease interferes with their normal function there can be very detrimental effects.It is important to identify these abnormal reflexes and restore the body symmetry to facilitate normal pain free function. If your pain is being maintained by abnormal reflex guarding you will notice a significant difference in just a few visits.
