- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together, we are the most famous physical therapists
on the internet.
- In our opinion of course.
- Today Brad,
we're gonna talk about pain after stroke.
- Okay.
- A lot of people experience pain after having a stroke.
- Sure.
- There's basically two types of pain.
One what I'd call probably normal.
What you call mechanical pain.
- Right?
- That's like joint pain.
A lot of times, for example, people get pain
in their shoulder and one of the reasons is the muscles
on the shoulder aren't working like they should
and the muscles help hold the bone
up into the socket real well.
And because they're not working anymore
the bone starts to actually kind of migrate downward.
- Hold it right there.
- Yep.
- So right here, the rotator cuff muscles,
the capsule, all these tissues get stretched
out because the muscles are lax.
- Yeah.
- From the stroke pain is caused as a result.
And that's why I say it's mechanical pain.
- Yep. It's it's not caused by the brain
which is the second one we're gonna talk about.
When you have a stroke, sometimes parts of the brain
are damaged to the point they're not receiving
the messages like they should.
The nerves go up from your hands
and your legs and go up into your spine
and up into your brain.
And if the and the brain is not handling
those messages correctly so, you might touch
real lightly here and that's perceiving it as,
ow, ow, ow, it's painful.
So that's more called central pain.
So we're gonna talk about both of them, what to do
what things to try, both central pain
and pain that might just be local.
(wheels rolling)
We'll get to this too.
Why Brad has this thing on.
- Yeah, this is
- We're keeping, you in suspense.
- It's got a reason.
- All right. The first thing that you may
want to try is what we call modalities.
Now you can try just regular heat, to try,
you know.
- Sure.
- I don't know that ice would be a lot of people,
don't like ice after a stroke.
- Yeah, you can try it, but if it does,
it's not helpful, you don't use it.
- But really the one we wanted to talk
about today was called the TENS unit.
That's T, E, N, S,
transcutaneous electrical neuromuscular stimulation.
I think I did it right, Brad.
- Mouthful!
- This one's made by EMPI.
You can buy these online without a prescription
but I'll warn you.
It seems like, and I haven't bought them
but when I read the reviews on 'em
a lot of people say, they're not very strong.
- Sure.
- Where this one's pretty strong.
You can get these quite often, you know, like Medicare
insurance will quite often pay for these,
especially if your pain's been chronic.
- Right.
- And so you get a prescription and then
and then you go through a company like EMPI
and they'll go ahead or your physical therapist
and they'll go ahead and get one for you.
- Right.
- What's neat about this.
We got some little pads here, electrodes.
- There's four of 'em on here.
We don't wanna take 'em off cuz we don't
wanna show you how to use...
- How to use on the patient, right?
- Right.
- But you have this little unit here that you just hook
up to your belt or somewhere on your body or into
you can put it in a pocket even
and you have the leads that come off here
and you hook them up to the pads and the pad.
You can, let's say you're having pain in your shoulder.
Just go ahead and on the skin
you'd put the pads on the skin, over the area
of pain and you'd hook these electrodes, the leads up to it.
And you'd have this hooked up to
like I said to your belt or in, into pocket.
- Right. You're gonna have to get trained
by someone that knows how to use them.
I mean,
- They're very simple to use now.
- They are.
- They've made, 'em very simple
- But there's some simple things as far as
- Yeah. Where to put it and what, how to try it.
But we're letting you know this is available.
- Sure.
- So you can ask your doctor about it because it's
it's a common modality works pretty good
with a lot of people. What it does,
so you're, you're getting a signal of pain from
let's say the shoulder going up into your brain.
This helps cut off that pain pathway.
- Sure.
- That's the, that's one of the theories.
It actually cuts that pathway off.
So it can't receive the signal.
The other thing it does
it's supposed to stimulate your natural opiates.
- Sure.
- What do you think about that, Brad?
- I say if they're natural, let's have 'em
- So that it's a cool device.
It's one that, the other thing is you can have
up to four pads at once and you can,
let's say you're having shoulder pain today.
You can do shoulder.
Let's say you're having knee pain tomorrow.
You can put it on your knee.
You put on your back, you know,
you can't use it for headaches.
There's a lot of things you can't use it for.
- Right.
- So, very neat device.
This is probably one of the first go-to things
I'd say for central pain.
- Sure.
- If you're having that pain, that's from the brain.
All right.
Another proper, another reason why
you're having pain quite often is just plain old,
that you're not moving the joint.
If you take your, if you take a good arm
and you just hold it like this Brad all day long
you're gonna start to have pain after a while.
- Sure.
- Joints do not like to be still.
They like to be moving.
They don't, you know, you're gonna get toxins built up.
Right? The blood's not flowing.
- Right. circulation.
- So that's why it's really important.
And a lot of times it's hard
cuz the limb hurts and people don't wanna move it.
- Right.
- But you're gonna wanna, you know
especially a tightened limb up
you're gonna wanna make sure someone's doing range
of motion to it.
- Sure.
- Or you're doing range of motion yourself to it.
Somehow you gotta get those limbs moving.
- Right. and we do have a good video
on how to perform range of motion appropriately
- Right? Like for example, on the shoulder,
just one key, by the way, when you, especially
most people do have somewhat of a
subluxed shoulder after a stroke.
We don't want you bringing it up any higher
than this.
- Right.
- Because the muscles aren't working
you actually can get pinching
up in here and you keep pinching
and keep pinching and you're gonna
run into problems. So bring it up to here,
but make sure someone is actually moving it.
So that it's. The other thing you may wanna
wear a sling when you're up, to make sure
that you're not getting that subluxation, that it's
you know, trying to help hold it up into the joint.
- Right? The subluxation of joint is being pulled
down and separated by gravity.
- All right.
The third thing you're gonna wanna do to try to
help your control your pain is positioning.
Proper positioning and even stretching.
And that's where this comes in.
This is an air splint.
This is actually what this is,
is just a tube that you blow up and you put air into it.
And if you have an arm
let's say that that tightens up on you.
This is a great way to hold it out and stretch it
and keep it out of that tightened position.
I mean, we used to leave these on for a half hour Brad.
- Sure. And this is when you were working at Mayo?
- Yeah, this is, I was working at the rehab unit
at Mayo clinic at St. Mary's.
- Okay.
- So you've had it on for quite a while.
Is yours going numb or not?
- No, it's comfortable.
You do have to make sure you don't get it too
far up into the armpit because
- That'll put pressure on the nerves
- Yep, Yep.
- And so, and you can put these on the leg.
If you have a leg that tightens up on you,
they even have one that goes down into the foot.
So we've had it, we put it on hands.
That hands that tighten up, we go ahead.
- And I think we should show 'em, how it works actually
just with your mouth, you can blow pressure,
blow air into it.
I'm gonna let the air out.
- Yeah.
- There it goes. And then you just,
- Just unzip it?
- Can you unzip that Bob?
- Yeah.
- And then you can take it out and then
- Right.
- Move it.
The idea is that it, my arm would've been straight
stretch it out, put that on, hold it in that position for,
- Right.
- You know, twenty, thirty minutes,
whatever it may be.
If it's comfortable, then you gotta take it off.
- Yeah we're trying to get it out of that
spastic position.
- Sure.
- So, another one with the shoulder, you know,
the a very basic one is when people are sitting,
you wanna make sure that arm is supported.
You don't want it up like this.
You want to try to pull it out.
You wanna make sure that the shoulder's not just hanging
like this.
There is some support for it.
We're gonna do a whole separate video, Brad,
on how to position someone correctly in bed.
Cause I didn't want to take the time on this video
to do, so that's gonna be our next video.
So make sure you watch or Brad's gonna come out
and I don't know what you're gonna do to 'em
- I'm gonna give 'em a big hug, Bob.
- Oh, that's part of the worst thing that could happen.
All right, thanks a lot