True Healing: How Physical Therapy and EMDR Therapy Work Together for Chronic Pain
Introduction
Individuals experiencing persistent pain often face significant challenges in daily life. Simple tasks such as cooking, showering, or doing laundry can become overwhelming, making the idea of engaging in physical activity beyond necessity seem impossible. Additionally, chronic pain can contribute to depressive symptoms and reduced social engagement.
The good news is that the body’s alarm system can be reset, and pain levels can be reduced. Research shows that learning about pain mechanisms, gradually returning to activity, and addressing sources of stress and anxiety can help alleviate pain and restore function. Both physical therapy (PT) and eye movement desensitization and reprocessing (EMDR) therapy can aid in resetting the nervous system to its natural resting state.
Understanding Pain
Pain is a universal human experience, often resulting from injury or surgery that typically heals within three months. Once tissues recover, pain usually subsides. However, some individuals continue to experience pain for months or even years. The common assumption is that ongoing pain must indicate unresolved tissue damage. While structural issues can contribute to persistent pain, the nervous system often plays a larger role in its continuation.
Pain neuroscience education (PNE) likens the nervous system to a car alarm. A properly functioning alarm activates when someone attempts to break into a car. However, in individuals with chronic pain, the alarm becomes overly sensitive, reacting to minor or non-threatening stimuli—akin to an alarm blaring when a leaf falls on the car. This hypersensitivity can manifest as pain from routine activities, such as walking, which should not typically trigger discomfort.
Furthermore, pain is an output of the brain, not merely an input from injured tissues. The brain determines when to perceive pain, explaining why injuries sometimes go unnoticed until they are visually recognized. Understanding this concept is crucial for managing chronic pain. The brain does not always differentiate between actual threats, like a predator chase, and perceived threats, such as a simple walk. Reassuring oneself that certain activities are not harmful can help mitigate pain caused by an overly sensitive nervous system.
Physical Therapy for Chronic Pain
Physical therapy is an effective approach to treating persistent pain. A therapist well-versed in PNE can guide patients with chronic conditions such as low back pain, fibromyalgia, chronic fatigue syndrome, and spinal pain through a gradual return to movement.¹ Manual techniques, including soft tissue mobilization and trigger point dry needling, help desensitize the nervous system. Additionally, relaxation techniques such as breathing exercises and meditation further regulate nervous system activity.
Aerobic exercise plays a crucial role in pain management by releasing endorphins that alleviate pain and support neuroplasticity. Moreover, physical therapists can assist patients in reframing negative pain-related thoughts through cognitive behavioral techniques, fostering a healthier perspective on movement and discomfort.
EMDR for Chronic Pain
Traumatic experiences and ongoing stress can contribute to persistent pain. Originally developed for post-traumatic stress disorder (PTSD), EMDR helps individuals process distressing memories through exposure, dual attention, and bilateral stimulation. Since many individuals with psychological trauma also suffer from chronic pain, EMDR provides a comprehensive approach that addresses both emotional and physical symptoms.²
By reducing the fear response, EMDR makes physical activities less intimidating. Additionally, by alleviating stress and anxiety, EMDR can further decrease pain sensitivity, creating a positive feedback loop that supports recovery.
Combining Physical Therapy and EMDR
Integrating physical therapy and EMDR offers a multifaceted approach to chronic pain management. Physical therapy teaches patients that movement is safe, while EMDR desensitizes the fear response. Both therapies work to soothe the nervous system and reduce hypersensitivity to pain. While PT restores normal movement patterns, EMDR addresses the emotional distress that often exacerbates chronic pain.
Case Example: A Holistic Approach to Healing
Consider a patient experiencing chronic low back pain following a motor vehicle accident. Despite normal imaging results, their pain persists, and they avoid movement due to fear. A physical therapist guides them through gradual movement reintroduction, educating them about pain neurophysiology and employing hands-on techniques to desensitize the nervous system. Concurrently, an EMDR therapist helps them process the emotional trauma associated with the accident, reducing the fear and anxiety linked to their pain. Over time, the patient experiences reduced pain, increased confidence in movement, and an overall improved quality of life.
Conclusion
Chronic pain is not solely a physical condition. It is a complex experience influenced by the nervous system, emotions, and past events. Physical therapy and EMDR therapy offer science-backed strategies to alleviate pain by retraining the brain, reducing fear, and restoring function. By addressing both the physical and psychological aspects of pain, these therapies empower individuals to regain control over their bodies and lives.
References
Lepri B, Romani D, Storari L, Barbari V. Effectiveness of pain neuroscience education in patients with chronic musculoskeletal pain and central sensitization: A Systematic Review. Int J Environ Res Public Health. 2023;20(5):4098. Published 2023 Feb 24. doi:10.3390/ijerph20054098
Vock S, Delker A, Rinderknecht J, et al. Group eye movement desensitization and reprocessing (EMDR) in chronic pain patients. Front Psychol. 2024;15:1264807. Published 2024 Feb 22. doi:10.3389/fpsyg.2024.1264807