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Using Mirror Box Therapy

                                                     

I was just looking through an old book I have on Repetitive Strain Injury (RSI). They go over the usual tips of relaxation, posture, and strengthening.  In 2006, I thought it to be a pretty comprehensive book to treat the RSI that I was dealing with at the time. But nothing in there approaches the science behind the pain and therefore, how we can make lasting changes.

The emerging science out there shows that with chronic and even acute pain the nervous system makes changes all along the pathway (I will call it persistent pain from now on, as it has a lesser negative connotation to it).

Pain was meant to be a danger signal. However, sometimes the danger signals are not accurate. In a spilt second, our nervous system will send a signal beyond our control.

Pain, itself is merely a sensation. That sensation could be tapping, pinching, stroking, etc. This could be contacting a sensory receptor or a nociceptor (pain sensor). That sensation will travel to your spinal cord and then to your brain. Your brain will make an inference about that sensation in combination with your past experiences and the context of your environment.

Your brain makes a determination…”this is dangerous” or “this is nothing that I need to worry about.” If your brain determines this to be dangerous, it will send the signal back to the spinal cord and then to the region you perceive the pain. You then react by jumping back, pulling your hand back or saying, “ouch,” etc.

This pain pathway can become altered and inaccurate.

You may have pain that stays around long after the initial insult or injury. You may even be able to think about doing something that you know causes you pain, and you feel pain.  What is happening here?

The nervous system is adapting.

Dr Lorimer Moseley explains them as “neurotags.” Neurotags are a network of brain cells and neurons that correspond to a certain sensation or feeling that you experience.

Neurotags are complex. They can include emotions, memories, and environment, etc.

An example would be that my arms hurt when I am typing at work but not at home. Or that I can lift heavy weights at the gym but then when I go to lift boxes at work, my back hurts. The neurotag is filled with all networks of brain cells that must be “lit up” for you to feel the pain.

Take one thing/thought/emotion/memory out of that neurotag and wa-la, you don’t feel pain. So imagine those times when you may say, “I don’t have pain when I am distracted.”  Well, you still had those sensations, but because you changed your neurotag by performing/saying/doing/not doing something else, you did not perceive those sensations as pain.

It wasn’t that you “distracted” the pain…you simply weren’t feeling pain at that time.

I invite you to watch this 24 minute video for the short version of a talk by Dr Moseley explaining the above with some great examples. And he’s Australian…who doesn’t like to listen to that accent?  Plus he is an amazing speaker and you won’t be bored, I promise.

 

So what, you ask, do we do about this altered pain pathway?

Emerging science from Dr Lorimer Moseley and Dr David Butler out of Australia has given us some hope. They have found that cortical (brain) changes begin to occur with persistent pain states. That area of the brain that represents your painful area is now “smudged.” They have developed training called Graded Motor Imagery (GMI), that involves left/right discrimination, explicit motor imagery and mirror therapy.

  • Left/Right Recognition: Research shows people in pain often lose the ability to identify left or right images of their painful body part(s) (i.e. when viewing pictures of body parts they are slower and/or less accurate than somebody without pain at determining whether the image is a Left or Right). This ability appears to be important for normal recovery from pain. Lucky for us, the nervous system is plastic, meaning that with practice, we can change it. They developed programs and cards and the Recognise App to go through Left/Right recognition of the body part that is affecting you.
  • Explicit Motor Imagery: This is movement without actually moving, but just imagining movement. This is most likely because 25 percent of the neurons in your brain start firing when you even think of moving or watch someone else move.  Playing basketball in high school and college, I would imagine how I was going to play. I was in essence exercising the part of the brain that would be providing movement later. By utilizing graded imagery, we can retrain the brain without even having to move the painful part.
  • Mirror Therapy: By putting your left hand behind the mirror and the right hand in front of the mirror, you can trick your brain into thinking that the hand you see in the mirror is your left hand. You can exercise the part of the brain that uses your left hand without even moving your left hand. This can be done for shoulders and the lower body, as well.

I use all three of these methods in my practice of painful syndromes, but I have also tried it with stiff knees and shoulders post-surgically and found that it does have a positive effect.

I suspect that there is some cortical “re-mapping” occurring with limbs that have been dysfunctional and painful for some time. You don’t have to have full blown Complex Regional Pain Syndrome (CRPS) to benefit from this type of therapy.

But use caution, sometimes imagined movements may spike your pain levels. Or it may drop them.  The key while you are performing them is to repeat to yourself that “this is not dangerous and what I am doing right now is not going to make my nervous system worse.”

And be patient.  It took your nervous system a long time to get like this, it’s going to take time to make changes. And yes even if you have more of an acute stage of pain/injury, your new understanding about the pain pathways may likely make a more speedy process to return to feeling better.

Even if you have experienced it for 5, 10, 15, 20 years,  you too could learn to change your nervous system.

And no, this won’t “cure” your pain that stems from torn labrum’s (shoulder/hip), torn ligaments/tendons in the knee/shoulder or systemic pathologies such as tumors. These are things that would cause nociceptor pain fibers to fire and are not considered neuropathic.

Please see Dr Butler’s videos on GMI if you want a more in depth discussion. It’s a 4-part discussion…if you watch through YouTube, you will find all 4.

If you have questions, please contact me. Perhaps you are suffering from a painful condition and are looking for help to feel better. Also check out these links:

Wishing you success in changing your brain! And changing your pain. 

I welcome your feedback and if you find this information helpful, please share with your colleagues and your friends. Contact Tianna to see how she can help you with your changing the way your brain processes pain.