Chronic Pain

Stride Strong PT’s Formula

• Improve posture through a series of gradual stabilization exercises so patient moves away from offending habits and positions that exacerbate pain.

• Gradual progression of exercises and manual therapy to desensitize area of pain.

• Monitor for fatigue levels, while maintaining the challenge and accountability needed for return to health.

If ever there was one thing that we can ALL say we have experienced, it’s pain.

Throughout history and across race, gender, and partisan lines, there’s one statement we’ve always been able to agree on: stuff hurts sometimes. Everyone has experienced pain at some point in their life, so you might assume that it’s one of those things about the body that scientists have pretty much figured out by now. Wrong. We’ve hit that “the more you know, the more you realize how little you actually know” point in our understanding of pain, and there is a great deal of new and exciting evidence that is helping us to better understand how to help people dealing with complex, painful conditions.

What is pain?

Pain is an unpleasant sensory and emotional experience associated with actual or potential damage, or described in terms of such damage. (International Association for the Study of Pain, 1979)

Rene Decartes was one of the first to describe a “pain pathway” in his 1664 Treatise of Man using examples of a hammer or fire as stimuli creating pain in the hand, which then travels along a series of tubes or threads and rings a bell in the brain. The general population’s understanding has evolved to include things like nerves, the spinal cord, etc, and this crude model still makes sense intuitively. The problem is that this in not just an outdated and oversimplified way of thinking about pain; it’s a way of thinking about your symptoms that can lead to more harm than good.

Waht we pecviree is not aywlas atrccuae.

If our ability to read was like our sense of touch, that sentence would be impossible to interpret. Our eyes transmit the image of the jumbled letters on the screen to a networks in the brain that combine an understanding of the English language with previous exposure to these general combinations of letters and, without much (if any) conscious problem solving, another part of the brain provides the output. In this case, the output is the what we assume to be the intended meaning of the sentence- What we perceive is not always accurate.

There are still many unanswered questions about the complex system of networks responsible what we eventually perceive as pain, but developments in research over the last decade or so are clear: pain is like vision, not like touch. Our brains receive input from a body part regarding sensations of light touch, deep pressure, hot, cold, etc. This information is combined with things such as previous experiences involving this sensation, awareness of the current environment, the person’s mental/emotional state, etc. The person experiences pain when their brain determines, based on the available information, that there is some sort of threat to their body that they should be consciously aware of in order to react accordingly. Lorimer Mosely, a leading researcher in this area (and entertaining speaker with a funny accent), has several videos where he gives fantastic examples describing this process in more detail. He also describes several experiments that are more like magic tricks than a boring lab study. I highly recommend this TED talk: https://www.youtube.com/watch?v=gwd-wLdIHjs

So What?

Because pain is an output that an individual experiences based on their history of exposure to this stimulus, beliefs about an injury, how this pain may or may not negatively affect their life in the short or long-term, etc… it’s vastly different for everyone. The kicker is that these variables have SUCH a large on impact on what we feel as pain that, especially in many cases of chronic conditions where the tissues have had sufficient time to fully heal after injury, the pain a person is experiencing is no longer an accurate reflection of what’s actually going on at the site of injury. At this point, pain is no longer that beneficial protective mechanism alerting us of potential harm.

Where to start with acute pain?

There is really no easy answer for whether or not experiencing pain from a recent injury warrants medical attention. For serious traumatic injuries, such as those sustained in a motor vehicle accident or at work, it is always best to err on the side of caution and contact an MD or get to the ER. For injuries that don’t require emergency attention such as…

  • a knee or ankle that got “rolled,” “twisted,” “jammed”
  • falls where you’re still able get up and walk (though painful)
  • “throwing out” your back after going to pick up your son/daughter

or annoying pain you’ve had for a while and keeps coming back such as…

  • aching in your wrists or elbow from repetitive motions
  • “tightness,” “stiffness,” or a “kink” in your back, neck, or shoulders after a long day of work that is starting to limit your ability do things without pain throughout the day

… seeing your Doctor of Physical Therapy is a safe and cost-effective first step. As experts of the musculoskeletal system trained to thoroughly screen for potential red flags that would benefit from or require further medical attention such as imaging, we promptly refer to the appropriate provider, such as your family physician or specialists in areas such as neurosurgery, orthopedics, or internal medicine.

In the examples mentioned above and after a full physical assessment, one would expect to see significant improvements within the first few sessions using a combination of:

  • educating you about what’s going on
  • hands-on techniques
  • teaching you strategies to manage your symptoms at home and a few specific exercises to continue progressing between sessions

The Role of Physical Therapy in Treating Chronic Pain

If you are dealing with chronic (loosely defined as >3 months) pain that has shown minimal improvement since the initial onset or is getting worse, there are many options to consider. One of the more troubling things I’ve witnessed in my professional career is when someone who has been dealing with pain, has had a bunch of fancy medical names thrown at them to explain why they hurt, and may or may not have undergone surgeries, injections, PT, meds, etc, makes it clear that they believe they’ll be in pain for the rest of their life. I’ll admit that there’s not always a happy ending and that there’s no magic pill, but pain is such a multifaceted physiological process that I’m not convinced the most magic of all magic pills would do it, if such a pill existed.

Treatment for chronic pain in the past has centered around what seemed to be the easiest and straightforward solution- interrupt the pathway somewhere to dull or mask the sensation with a drug, injection, or nerve block. Modern medicine provides us with many great tools like these to provide short-term relief and help people tolerate painful situations as the tissues heal, but there are risks involved with long-term pharmaceutical interventions that can eventually outweigh the benefit. The underlying causes or components of the pain experience must also addressed, and I have yet to hear of a surgical technique that immediately corrects every factor relating to the pain, allowing you to hop off the table as a new person.

In complex cases of chronic pain, the best outcomes often come from using an integrative approach where multiple providers collaborate to help you address the problem from all angles. This care may include medical pain management, physical therapy, cognitive-behavioral therapy or counseling, massage therapy, yoga, or others.

We now know that especially in cases where the tissues have had time to heal after injury, and symptoms persist at levels much higher than would normally be expected, it is necessary to “retrain” the ultimate source of every painful experience, the brain. Physical therapy plays an important part in this process, and several proven strategies are outlined below.

Education: Restructuring Pain Beliefs

Many people suffer from chronic pain that stems from anxiety and fear of further damage- that something might cause them relive that initial painful injury. Sometimes referred to as ‘catastrophising’ or ‘hypervigilence,’ the basic idea is that our bodies become (consciously or otherwise) constantly on guard and expecting the worst. Often restructuring pain beliefs can be as simple as having a conversation about your injury and getting the reassurance that… A) What you’re experiencing is real, and there’s a valid explanation for it. and B) the tissues are healing or have healed, and bending over, for example, will not physically cause damage to the tissues at this point. I don’t mean the kind of “You’re fine, it’s all in your head” speech some may have received in the past. I’m talking about helping you to understand the anatomy and neurophysiology of pain. With this knowledge, a harsh accusation that you’re somehow to blame for this becomes the validating acceptance that pain is, quite literally, always in your head, regardless of the injury.


This can consist of treatments as simple as rubbing both the affected and unaffected limb simultaneously. Because intensity of pain correlates with how serious of a threat the brain considers the signals to be, the goal of these types of interventions is to tell the brain “Look! Something applying pressure to your left foot the same way isn’t causing any problems. Chill out on the conclusions you’re coming to when the same pressure is applied on the right side.”

Graded Exercise and Graded Exposure

These progressive therapeutic strategies work by gradually introducing more exercises and meeting the safe quota at each session or increasing exposure to a movement or situation that a person may have been avoiding for fear of reinjury. Your Physical Therapist will be able to analyze your movement faults and develop an alternate postural strategy to guide you away from the habits that may have caused your chronic pain to start in the first place. A series of graded exercises and drills prescribed to you will then help you strengthen your ability to move away from the offending posture.

By Dr. Nicholas Chamley, Doctor of Physical Therapy


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Alice Holland, DPT

Doctor of Physical Therapy, Director at Stride Strong Physical Therapy
Alice earned her Doctorate of Physical Therapy from USC in 2007, and have practiced Physical Therapy for 12+ years in the Outpatient Orthopedic Setting. Certified in ASTYM, she also has been a featured expert on Physical Therapy on numerous publications including health.com, healthline.com and yahoo.com.
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Latest posts by Alice Holland, DPT

Ana Lucia Pinheiro
Ana Lucia Pinheiro
02:18 20 Oct 17
This place is amazing. I am so happy I found Stride Strong PT. Alice pays attention to all of the details, she watches every single move I make, my posture, and the way I move through every exercise. She is very knowledgeable, she was able to pin-point the problems in my back and she has a plan to help me become stronger where I need. The place is brand new, huge, and has nice exercise machines. I tried a few physical therapists in the area, and Alice is TOP, second to none, and I feel super lucky to have found her. Highly recommended!!
Prashant Gupta
Prashant Gupta
01:00 02 Oct 17
Dr. Alice at Stride Strong is one of the best PTs I have come across. Her attention to detail and assessment of the root cause of injury is very good. She is excellent in evaluating pain patterns and giving a training schedule for a rehab & injury prevention, she is extremely knowledgeable. I would strongly recommend Stride Strong to anyone looking for PT. It is easily the best PT clinics in Hillsboro area.
steven zollin
steven zollin
20:57 14 Sep 17
Highly recommend Stride Strong Physical Therapy , Alice showed me proper form to assist in recovery with my shoulder and is very knowledgeable.
Lindsay Nied
Lindsay Nied
23:33 18 Dec 17
I recently had a massage from Joel at the Hillsboro location. He was able to work on an ongoing issue I have been experiencing with my back after a sports injury, and I left feeling so much better. The whole facility looked incredible, and everyone I met was friendly and welcoming. I would highly recommend Stride Strong for massage and physical therapy.
JoAnn Hatch
JoAnn Hatch
08:20 08 Nov 17
Dr. Sydney is by far the absolute best physical therapist I've worked with ever! Her expertise in designing highly effective and efficient exercise plans is beyond compare. I feel so much better as my strength and function increases. She comes up with the most brilliant and fun ideas to motivate. To my delight she even offered to come to my home in Vancouver and work with me on my own equipment including a Stott Pilates Reformer. Talk about going above and beyond! Couldn't be more grateful I found her!!!
Clare Perry
Clare Perry
21:58 23 Oct 17
A full hour of a dedicated PT professional's time without aides or techs? That's just one of the things that sets this clinic apart from others. Competent, professional, and amiable, Dr. Alice Holland and her team are the best in the area. While I generally see them at the Cedar Mill Clinic on Cornell, situational constraints took me to their new Hillsboro clinic today near Intel Jones Farm. Beautifully furnished, spacious with easy parking and access. May you continue to grow and thrive, Stride Strong!
Joyce Heideman
Joyce Heideman
08:28 11 May 18
After foot surgery I went to Stride Strong for therapy with Alice Holland. She helped me reach my full mobility again by continuously introducing new and challenging exercises. The entire staff is friendly and professional. They are always on time and do not rush. I look forward to doing 1/2 marathons again and riding my recumbent trike. Thank you Stride Strong for your care and high level of expertise.
Suad Daher
Suad Daher
20:48 28 Feb 18
The best physical therapy ever. Both JP and Sydney were a great PT, they helped me understand how I can help treat my injury and how it may have caused. And also they informed about so many techniques that I can use to help my injuries or any other injuries I get in the near future. They are both friendly and nice to talk too, and verbunformative. And there is also Krystal, she is the best front desk receptionist ever, she is nice and friendly and can easily manage your schedule based on the patients comfort if they want to schedule or not. She can help and she replies fast to any patients email. And she is easy to talk to. Thank you Stride Strong Physical Therapy.
Amanda O'Rourke
Amanda O'Rourke
21:38 15 Jun 18
In just a month I've seen great progress! I've been incorporating the exercises taught to me into my daily workout routine. Im very happy with my continued results.
Albert Szal
Albert Szal
23:43 10 Jun 18
Mary Szal here: I've had three sessions with Brittany at the Hillsboro location. I can say that she has been the most effective and instructive physical therapist I've ever experienced. Her personality, energy, knowledge and results are top notch.
Osa Phiangdae
Osa Phiangdae
00:05 22 Mar 18
Awesome place for PT. Hillsboro location has plenty of parking and very spacious. I had the pleasure to work mostly with Dr. Alice Holland and JP. I came in with a shoulder injury and thank goodness they understood what I was going through. They are the best of what they do, I would recommend Stride Strong to anyone who needs PT.
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