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Marie-Josée Ryan – Chronic Pain

I was 23 years old and practicing physiotherapy for over 60 hours a week when I felt my energy and compassion levels running dry. I felt it was time for me to acquire new skills and life experiences. I pursued further studies, including the MA Program in Peace Studies at the University of Innsbruck.

I was curious to learn skills that would enable me to practice physiotherapy in a way that would fuel my energy and compassion levels. After completing my studies in Innsbruck in 2014, I felt ready to resume work as a physiotherapist and I felt both vulnerable and excited about it. Vulnerable because I had been away from the profession and excited because I once again felt passion and love towards it. I returned to Canada and resumed work as a health care professional (physiotherapist) at OrionHealth near Vancouver, British Columbia. I work in a multidisciplinary team attending people struggling with chronic barriers preventing them from returning to their pre-injury work.

The healthcare team I work with includes a physiotherapist, an occupational therapist, an exercise therapist, a psychologist and a physician. I as the physiotherapist focus on collecting subjective and objective information during my mobility and strength assessments. Moreover, I provide treatment sessions which include specific exercise prescription and progression, manual therapy, soft tissue techniques, exploration of active pain management strategies and education regarding the injury and its healing course. An important part of my role as a physiotherapist is to deliver relevant information regarding the biomechanics behind the mechanism of injury and the factors that fuel a timely and sustainable recovery. Together with the healthcare team, we provide comprehensive active rehabilitation to injured workers through contracts from WorkSafeBC. This provincial government agency is a no-fault insurance plan protecting employers and workers. WorkSafeBC’s services include education, prevention, compensation, rehabilitation and support for injured workers.

Everyday, I witness the suffering associated with chronic pain and I struggle at times to stay grounded.

“Will I be able to go back to my job?” is a question I have been addressing on a daily basis for the past three years. This question has an impact on crucial aspects of a person’s present and future life. Whether a person can return to their pre-injury occupation without any limitations is a prognosis that the team makes upon assessment and monitors throughout their participation in the rehabilitation program. To help make this prognosis, our team identifies barriers preventing a person from returning to their pre-injury work. Among the barriers outlined above, pain is the prevailing factor limiting a person’s ability to perform components of their job. Thus, how a person is able to manage their pain influences their ability to return to work.

Supporting workers in transcending return to work barriers and maximizing function is challenging. Everyday, I witness the suffering associated with chronic pain and I struggle at times to stay grounded. Fortunately, working within a supportive team environment encourages me to acknowledge the limitations of the work I do. It also helps me appreciate the extent of which many workers reportedly benefit from the supportive structure we provide as a team. These workers courageously defy the unpredictability of pain by exploring and applying sustainable strategies that promote healing. Seeing a person shift from a pain-focused situation to a productive and functional lifestyle nourishes my vitality levels because I strive to empower clients to take responsibility for their health and thus work collaboratively with them.

Our team provides services to injured workers who typically have been off work for a few months and have undergone medical investigations prior to being referred to our occupational rehabilitation program. This means their injury is no longer acute and they have been cleared to begin a more rigorous exercise program. They typically spend the equivalent of 4 to 6 hours per day, everyday, for a few weeks in the clinic followed by a few weeks of gradual return to work. Most of their clinic time is spent doing active exercises that simulate the specific work tasks so they get stronger and regain their mobility. Moreover, clinicians share a great deal of medical knowledge with injured workers and this tends to accelerate healing through empowerment and understanding.

The second question I hear often is “how long before the pain goes away and when can I return to work”? A sustainable way to approach this question is by naturally producing endorphins via active exercises. However, in many cases, the pain is present at rest and/or exercises tend to increase the intensity and frequency of the pain. In these cases where movement is beneficial but increases pain, medical knowledge is crucial in order to make optimal decisions about the client’s activity levels.

Understanding the human anatomy and physiology, particularly that of the nervous system and its dynamic components is important when transcending return to work barriers. Pain ultimately depends on what the nervous system is experiencing as a real or potential threat and thus the context in which pain is experienced is highly relevant.

I am grateful to work in a challenging environment because it encourages me to cultivate kindness towards our ability to heal and grow as human beings.

The more information we have in assessing whether the threat is real or potential, the more accurate we can teach the nervous system to decide what movements are harmful or beneficial. When pain has been significant and consistent throughout a longer period of time (a few months), neuroscience research reveals changes to the nervous system. Pain that persists makes the nervous system more and more alert to potential danger and the hypervigilance may lead to a genuine fear of moving. In other words, we observe that pain is no longer a reliable guide on whether a movement is harmful when every movement may be perceived as harmful. This reveals that the nervous system needs a helping hand in distinguishing between perceived threats and real threats to our human body.

From the perspective of the nervous system’s chemistry, it is a dynamic system in which the opportunity to produce endorphins can be enhanced or reduced. In order to support this process, we need to convince the nervous system to become an ally in performing movements that are feared. The extent to which an injured worker is able to demonstrate the strength and mobility required to be able to return to their work is what determines the treatment team’s recommendations. At times, the treatment team identifies limitations that prevent the injured worker from returning to their pre-injury work. The worker is referred back to WorkSafeBC, the provincial government agency protecting employers and workers where further assistance may be provided.

Although the nature of the work can be quite serious at times, the group environment defies the isolation that is commonly experienced with pain. This combined with active rehabilitation fosters social interactions which are a hub for laughter, interconnectedness and the release of endorphins. This is the healing environment that I both contribute to and benefit from during my time spent at work. I find it fun that I continue to learn everyday from the interactions I have with my clients. I am grateful to work in a challenging environment because it encourages me to cultivate kindness towards our ability to heal and grow as human beings, inspiring me in my own journey.