May is Mental Health Awareness Month, and, as physical therapists, we cannot overlook the role depression, anxiety, addiction and personality disorders can play in the rehabilitation process. In my experience working in the healthcare profession and listening to patients describe their experience in the “system,” a mental health diagnosis comes with a lot of stigma. These diagnoses are determined by exclusion rather than inclusion and based on patient report because there is no blood test or x-ray for depression. However, there is a chemical response within the body that happens in times of stress or anxiety. Pain can also trigger a body’s chemical response. So it is not a surprise that patients with chronic pain syndromes such as fibromyalgia have a mental health comorbidity. If pain and mental health have a strong correlation, than treating one will positively impact the other.
Did you ever see the movie Legally Blonde? One of my favorite lines to quote is Elle’s defense of “exercise gives you endorphins, endorphins make you happy and happy people don’t shoot their husbands.”
Endorphins are produced in our body to create a feeling of euphoria and to stop pain signals from reaching the brain after an injury. Endorphins can also be produced from exercise. Once again proving the relationship between pain, physical activity and mental health. The challenge to the physical therapist treating patients with a mental health diagnosis is to help them understand this intricate connection between pain and movement. Sometimes patients have increased pain with specific movements and they end up avoiding activity altogether, and not just physical activities. Pain can limit a person’s ability to hangout with their friends, play with their children, go to dinner with their spouse or participate in a family event. Imagine how isolating and hopeless one might feel not being able to enjoy their life.
Physical therapists and patients have the capability to retrain the brain to not associate movement with pain through the correct exercises and stretches. Being more active means producing more endorphins and more endorphins lead to improved self-esteem, self image which allows a greater sense of well being. Exercise can also improve sleep quality, endurance, mood, mental alertness and cognitive function as well as reduce stress and anxiety. All of which are essential for mental health and pain management.
Physical therapists are experts in the musculoskeletal system, and although most of us are type A personalities and have that drive to excel at everything, there are limitations to our abilities. It is important that we recognize this and, when appropriate, counsel patients on seeking professional help from our psychologist friends to enable a holistic approach to treatment.
Understanding Pain in less than 5 minutes, and what to do about it
National Fibromyalgia Association
The Philadelphia Department of Behavioral Health and Intellectual disAbility Services
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