Q&A with Wanda Swenson – Author of The How of Ow

How did you treat your own chronic injuries?

My way of addressing chronic spinal pain was dramatically affected by recovery from my own chronic back pain that wasn’t relieved with standard Physical Therapy (PT) practices. This is when I stumbled on the simple idea—that I later named Postural Isometric Lengthening (PIL)— during a meditation session when my chronic back pain went into spasm. It’s an easy way to work with chronic pains as well as something to use for immediate pain relief of any spinal, shoulder, or hip pain during daily activities. 

Did your own injuries help you develop better ways to treat chronic pain? 

Many people I’ve seen over the years with chronic pain began with injuries and strains from simple injuries similar to ones that I’d had, and recovered well from. They just didn’t know what to do immediately, and progressively, for their own recovery.

By writing this book I’m offering a way for people to do their own self-care as I had—immediately after injury or strain. Education and effective self-care is critical to avoiding, and to recover from, chronic pain. 

Does having similar types of pain as your patients make you a better therapist?

It made me a more confident one. Letting a person know about the timeline of healing, that some degree of pain is normal, and that it will improve with movement, strengthening, and a predictable amount of time passing, is key to being an effective PT.

Could any other physical therapist have written this book?

No other PT could have written this book. It’s filled with personal and professional narratives and my own approach to self-care. 

Who can be most helped by your suggestions?

Anyone who doesn’t know how to begin their own recovery from strains, sprains, and injuries, or anyone who is having trouble resuming their previous level of activity, and who keeps reinjuring themselves when they do try to return to sports or other activities. Also, it’s very helpful for people with degenerative conditions of the spine who have become less active. 

What are some of your top tips on how best to deal with pain? 

1. Learn to do PIL easily and automatically during daily activities, especially with sitting and driving, and in bed before sleep and before getting up.
2. Make sure that knees bend over toes when standing up, sitting down, bending and lifting, and using stairs. (Avoid being knock-kneed.)
3. Take breaks as you work, taking short walks and stretching out hands and fingers. 
4. Don’t ignore the feelings of pain and strains. Address them immediately.

Share some of your most dramatic personal stories of patients you’ve helped. 

An emergency room patient was brought to the PT department in a wheelchair, writhing uncomfortably, apparently in a great deal of pain. I did a maximum assist transfer (meaning she didn’t help me at all) over to my treatment table and I got her lying on her side, put pillows between her knees and a rolled towel under her waist to support her back. Once she was in a comfortable position, I started getting her to do some deep breathing. Then I did some very gentle passive pelvic rocking (manual treatment where the patient doesn’t do anything) and then got her to do it slowly on her own. Then she was able to roll to her other side and do the same thing. After that, she was able to lie on her back with her knees bent, doing more of the same. From there, she was able to roll to her side, push herself up into sitting, and stand up straight. She walked out on her own!  

Once I talked a carpenter through these moves, who was working at my house, after he had severely strained his back while working and was lying on the deck unable to get up. I was on crutches recovering from knee surgery at the time so I certainly wasn’t thinking about getting on the ground with him. We made quite the pair! After doing pelvic movements lying on his side, he was able to stand up straight. He took the rest of the day off, but returned the next day, working and taking breaks to exercise as needed.

I’ve also had dramatic results seeing an older man who was a carpenter. His right shoulder had the most horrible sounding crepitus and clunking (joint sounds) when he tried to raise his arm overhead. I gave him an elastic exercise band and showed him basic rotator cuff strengthening with it. The next week he came in, able to raise his arm overhead without any joint sounds at all. 

Do our emotions affect the level of pain from an injury? 

The very definition of pain lets us know that emotions play a dominant role in our perception of pain. Reassurance and education have to be the first steps a PT takes before treating a patient who’s highly emotional and fearful about their pain. 

Can those who suffer from chronic pain always improve with your methods?

Only if they have an open mind and are interested in being active in their self-care.

What is your success rate and how do you define success with chronic pain?

I define success by how much a person accepts the idea of personal responsibility for their self-care and then follows through with it.

How close is your physical therapy philosophy come to “mind over matter?”

It’s closer to a philosophy of the mind which needs to understand what’s the matter, and to know what to do about it, in the present moment, and as needed during the day.

What is people’s biggest misconception about pain?

That feeling pain means something is being harmed, leading people to not want to move or be active. Usually the first, slow movements done after injury or strain are painful, but slow movement is not harmful. Chronic pain is associated with healed soft tissue and bone, but many believe that they are still injured and movement will make them worse. 

What is the biggest obstacle people face in dealing with their chronic pain?

Rigid beliefs about pain and healing can be the biggest obstacle. Easily discounting self-care and looking for something outside themselves—more surgeries, a better drug, a better health care practitioner—to be the magical fix. 

How difficult is it to change our society’s desire for a “quick fix” to their pain?

The idea of a magic pill or treatment for pain is pretty appealing. For mild pain conditions just doing effective self-care can be a “quick fix.” But for chronic pain, taking personal responsibility for self-care can begin the change.  Easily accessible information about pain and the psychology of pain is key, as well as easy access to good early self-care and strengthening. 

What is mindful, body awareness and why is it necessary?

The emotional reaction we have to pain takes us out of the moment, driving the “stress response.” By observing thoughts, calming the breath, and doing appropriate postures and movements to relieve pain and begin strengthening, this becomes mindful body awareness or practical mindfulness. It can help to avoid chronic pain conditions and begin immediately to relieve pain and to strengthen strained areas. It can also begin to improve chronic pain conditions by increasing awareness of subtle changes in pain with activities and postures, and then responding to them in the moment.  

Have you had success in getting chronic pain patients to stop looking for a “magic pill” and doing the work that it takes to ease their discomfort?

Yes, often after they’ve tried everything else. I enjoy seeing people who have gone to every type of body worker and had extensive treatments with only temporary relief. That makes my job easier. The problem is always some type of instability, deep muscles that aren’t working efficiently and often a lack of flexibility in another area. The answer for these people is strengthening these deep muscles and usually changing a few habits.

What is Postural Isometric Lengthening (PIL) and why is it a revolutionary? 

PIL is very similar to Banda Yoga, which emphasizes an “internal locking technique” which is basically isometric muscle contraction of deep muscles. The only “revolutionary” idea about PIL is using it with daily activities. It can be done in sitting or standing, while walking or lying down. By lengthening the spine and strengthening deep spinal, shoulder, and hip muscles it can give immediate pain relief. Doing it more intensely and for longer periods of time (1-2 minutes) it can affect chronic pain symptoms. I named it PIL, so we can “do” PIL, instead of taking a pill, for pain relief.  

Does western medicine work with chronic pain patients? 

The western medical model for years has looked for a “magic bullet” to go to a problem area and treat it. Pain is a complicated sensation, and there is no “pain center” in the brain. Analgesic drugs only act on our perception of pain, essentially making us not care about it so much.  But of course, physical therapy is part of western medicine too, though it does borrow heavily from eastern traditions. It can be very effective for chronic pain through progressive strengthening and functional exercise.

Why aren’t opioids a good way to control chronic pain?

Opioids can be very helpful for acute pain after severe accidents or surgeries for brief periods of time. They also can be a blessing to people suffering from pain during end of life care. However, opioids used for chronic neuro-orthopedic pain have many side effects: Poor sleep (often a contributing factor to chronic pain), poor mood, fatigue, constipation, slowed cognition as well as worsening pain. 

What is it that we should know about pain that can be helpful in dealing with it?

That it’s normal, and that it will improve with tissue healing, movement, strengthening, and using good mechanics with everyday activities.

What is different about your book than others that deal with chronic pain?

Written in a conversational tone, it’s easy to read and understand. Filled with personal and professional stories, it emphasizes the importance of understanding the science of pain, and dispels the idea that having degenerative conditions of the spine is hopeless. Advice and clear illustrations about simple exercises for the whole body are given (spine, TMJ, shoulders, elbows, wrist, and hands/hips, knees, ankles, and feet), including neuro-orthopedic pains (referred pain from the spine or along the nerve path). It also gives instruction about regaining balance and normal gait after injury or prolonged bed rest. Advice is given about acute care and how to add support to chairs and beds for comfort and initial healing. It covers a lot of information that can easily be applied to daily life. 

If there were only one key message you could get out, what would it be?

The body can heal and be strengthened, no matter what our age. Hindering or helping our recovery is a choice we all have.