PHYSIOTHERAPY

TO HEAL THE PAIN

OF TRAUMA

STUCK IN THE

BODYVeena O'Sullivan

Physiotherapist, STARTTS

BAppSc (Phty), MAppSc(Phty), Grad Dip (Counselling)

fasstt

1st Australia and New Zealand Refugee

Trauma Recovery in Resettlement

Conference ( 29-31 March 2017)

CHRONIC PAIN & TRAUMA The prevalence of chronic pain is well

documented in survivors of torture and trauma, even decades after the traumatic experience.

Tortured clients often have significant musculoskeletal issues.

PTSD and chronic pain co-occur.

Stress alone contributes to many physical effects.

This presentation will use a clinical case to highlight these complex mind-body connections.

BASIC TENETS

Chronic pain is neither necessarily proportional to anatomical injury, nor is it always a signal of serious disease (however, this always needs to be ruled out).

Pain may persist as “neural memory” because the pain matrix involves many aspects of the CNS.

BASIC TENETSSuffering is deeply imprinted in the body because reactions

involving the brain (sympathetic nervous system and

hypothalamus-pituitary-adrenal axis) spread throughout the body.

The body’s stress mechanisms are activated when traumatic

experiences threaten one’s sense of safety, satisfaction and

connection. A loss of balance between the sympathetic and

parasympathetic nervous system over time leads to illness.

Cumulative negative experiences and resultant negative

emotions (fear, anger, sadness, etc.) create this loss of balance.

The immune system is weakened and a wide range of health

problems ensue.” (O’Sullivan, 2015)

Pain cycle

When emotional pain is too much we

dissociate ourselves from it

Emotional pain: energy in motion

Muscle tension to armour the access to painful experiences

Emotionsare stuck in body and manifest as physical pain

Case study 53 year old Hazara (Afghanistan, minority group)

woman, lives with husband and one son.

Refugee, in Australia for 5 years.

5 children (aged 36 to 22)- three in Australia, and two in America.

Torture trauma experiences: Rape (gang); abduction of husband; survivors of multiple bombing;

Resettlement issues: language, finance/employment, limited support networks.

Relevant physical symptoms

Right sided lumbar

pain radiating into

leg (L4/5 nerve root

distribution)

Headaches and

neck pain

Osteoporosis (early

menopause)

Gastric reflux

Mild urinary

incontinence

Lumbar pain

Impact on function

VAS & DRI assessment

Muscle weakness-

unsupported, loss of control

Incontinence

Tension headaches

Unprocessed emotions held in

body

Interrelationships

Physical

Back and leg pain

Headaches

Incontinence

Social

Relationship issues

Anxiety about disclosure: isolation

Changing roles for herself

Emotional

Anger

Sadness

Hurt

Feeling unsupported

Integrative physiotherapy Acknowledges that sickness comes from the

disconnection of body and mind. Hence, body

and mind need to be brought together for

effective healing (yoga= to yoke).

Aims to provide a sense of safety, relaxation and

calming of the agitated nervous system as pre-

requisites for the deeper work of healing.

Facilitating connections

through the body

The body is a useful place to start the process of

healing, especially when it is too painful to talk

about traumatic experiences.

Emotional and mental layers which contribute to

illness can often be accessed through the body.

Collaboration with counsellor is vital.

Tools

Education and

Guided awareness

Hands on

Exercise

Breath work

Self- care

Working through layers

Pain

Weakness

•Frustration

•Lack of support

•Anger

Release via muscle

relaxation

•Sadness

•Fear

Difficulty processing

deep emotions

•Rejection, loss

•Shame, worthlessness

Outcomes (Pain and disability)

0

2

4

6

8

10

Session

1

Session

3

Session

5

Session

7

Session

9

Session

12

VAS

DRI

What she said

“ I am better now; still I get pain but not too bad-maybe 70 percent better;

I am still scared and very upset by what happened to me……long time…..but I am more strong

……no pads!!!!!

I go to window and breathe when I am upset;

I am stronger: walking now for 1 hour, no pain when I sit…”

Also“My husband is now helping me in the house and I

can go for my English classes or shopping with my friends;

Maybe I can get work when my English is better- I

want to do something with my hands.”

Bibliography and

acknowledgements Images: https://www.google.com.au

Indira Hal-Radovic: my supervisor at STARTTS

Amris, K &Prip, K (2000),Physiotherapy for torture victims, Torture, 10(4):112-117

Buhmann, CB (2014). Traumatized refugees: Morbidity, treatment and predictors of outcome. Dan Med J , 61(8):1-29

Burch, Vidyamala (2008), Living Well With Pain And Illness. Piatkus, London.

deRuiter, M & Gueron, L (2015), Physical Therapy for Survivors of Torture. CVT, Oct 20, 2015 presentation.

Hanson, Rick (2013), Hardwiring Happiness: The New Brain Science of Contentment, Calm and Confidence. Harmony Books, New York.

O’Sullivan, V (2015), Releasing the pain, Refugee Transitions, June, issue 30, 32-37

Shapiro, Deb (2006), Your Body Speaks Your Mind. Sounds True (Inc.), Colorado.

Van Der Kolk, Bessel (2006). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society. The Guilford Press.