PHYSIOTHERAPY TO HEAL THE PAIN OF TRAUMA STUCK IN THE BODY

Size: px

Start display at page:

Download "PHYSIOTHERAPY TO HEAL THE PAIN OF TRAUMA STUCK IN THE BODY"

Magdalene Watkins
5 years ago
Views:

1 PHYSIOTHERAPY TO HEAL THE PAIN OF TRAUMA STUCK IN THE BODY fasstt 1st Australia and New Zealand Refugee Trauma Recovery in Resettlement Conference ( March 2017) Veena O'Sullivan Physiotherapist, STARTTS BAppSc (Phty), MAppSc (Phty), Grad Dip (Counselling)

2 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.

3 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.

4 BASIC TENETS Suffering 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)

5 Pain cycle

6 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 Emotions are stuck in body and manifest as physical pain

7 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.

8 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

9 Lumbar pain

10 Impact on function VAS & DRI assessment

11 Muscle weaknessunsupported, loss of control

12 Incontinence

13 Tension headaches

14 Unprocessed emotions held in body

15 Interrelationships Physical Back and leg pain Headaches Incontinence Emotional Anger Sadness Hurt Feeling unsupported Social Relationship issues Anxiety about disclosure: isolation Changing roles for herself

16 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 prerequisites for the deeper work of healing.

17 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.

18 Tools Hands on Self- care Education and Guided awareness Exercise Breath work

19 Working through layers Pain Weakness Frustration Lack of support Anger Release via muscle relaxation Sadness Fear Difficulty processing deep emotions Rejection, loss Shame, worthlessness

20 Outcomes (Pain and disability) VAS DRI 0 Session 1 Session 3 Session 5 Session 7 Session 9 Session 12

21 What she said I am better now; still I get pain but not too badmaybe 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

22 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.

23 Bibliography and acknowledgements Images: Indira Hal-Radovic: my supervisor at STARTTS Amris, K &Prip, K (2000),Physiotherapy for torture victims, Torture, 10(4): 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, 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.

The use of neurofeedback as a clinical intervention for refugee children and adolescents FASSTT conference 2017

The use of neurofeedback as a clinical intervention for refugee children and adolescents FASSTT conference 2017 FASSTT 2017 Paper presentation Trix Harvey, NFB/Biofeedback clinic team leader at STARTTSS