Persistent Pain – Part Two

Part Two: What To Do About It  

written by Kristie Norquay, physiotherapist

Physiotherapy is a profession that strives to help people enjoy health & wellness for the long haul.  We are trained to help with general exercise recommendations, diagnosis and treatment of your concerns.  

The clinician-patient therapeutic alliance is a key factor in rehabilitation outcome – make sure you LIKE and TRUST your therapist.  If not, find a new one! You will likely get better faster if you feel heard, valued, and your health care provider is willing to work alongside you. 

Below are some things to consider and some simple (but not necessarily easy!) ways to start improving your quality of life and reducing your pain.  

What may be affecting your pain levels:

  • environment – toxins, stress
  • diet – sensitivities, nutrient deficiencies
  • lifestyle – stress, epigenetics
  • physical trauma
  • emotional trauma
  • beliefs/attitudes
  • drugs and drug interactions
  • sleep
  • spiritual considerations
  • relationships – social connections, nurturing vs toxic relationships, support system
  • perceived injustice, forgiveness
  • secondary suffering – stress from the pain, struggling against the pain

“Work in” vs “work out” – create a balanced exercise diet.  Do a combination of physical exertion while also creating time for rest and rejuvenation.  Taking time to elicit the relaxation response is just as important as challenging physical exercise. 

Know the difference between distress and eustress – distress is bad for us, it is interpreted as a threat or loss.  Eustress is good for us, and is a positive stress, such as pushing yourself to achieve a goal.

Look after your endorphins! Elicit relaxation, perform regular sustained exercise, try things like yoga, qigong, taichi, prayer, or meditation.

Past trauma primes inflammatory response, so the Sympathetic Nervous System (fight or flight) responds more quickly.  This has been studied using the ACE (Adverse Childhood Events survey). 

Try to take part in pleasant, calming, non-threatening exercises. New exercises that you haven’t done before tend to be best – these activities won’t have a pain neurotag (the brains way of labelling whether an activity is “dangerous” or not) or move your body in a way you love and enjoy.

Body scans are a great tool if you have chronic pain – it is a good practice to feel other sensations in the body, aside from the painful part that usually gets the most focus and attention.

The nervous system can change really quickly.  The sensors/detectors on your nerves are replaced every 3-4 days. This is one of the ways that your nervous system adapts and changes. You have some influence on the sensitivity of the new sensors.  Every second your nervous system is calmer, it can replace the highly sensitized sensors with more normal (less sensitive) ones. 

Practice “constructive rest” – learning stillness.

Keep a worry journal – time set aside for worrying, write it down, get it all out, and then no more worrying for the rest of the day!

Fear – checking behaviour. Are you constantly checking to see if it still hurts? Potentially perpetuating the pain cycle? 

Secondary suffering – do you know what a Chinese finger puppet is? The paper puzzle that you put your fingers into either end? The more you struggle and pull the harder it is to get out.  The way out is to gently and easily take the fingers out.  This is a good analogy for secondary suffering, or suffering that comes from struggling against the pain.  

Allowing pain to be present (without fighting against it or ignoring it) and taking baby steps towards positive change is ideal.

Start with breath, calm the system and it will start to sort itself out.  Our bodies have an incredible capacity to heal and adapt.

Make your primary goals breathing and sleep.  Simple, right? (just kidding)

If you feel like you could work on your sleep hygiene, consider the following:

  • Do you feel refreshed, can you function well during the day?  Don’t go to bed until sleepy, laying awake because you’re not tired enough is detrimental.  “What fires together, wires together”.  Bed is for sleep – retrain that.  No tv, work, etc.
  • Circadian rhythms can be affected by light, exercise, socializing, temperature, electronics, pain/stress, meds.
  • Improve your serotonin levels – exercise to fatigue, expose yourself to natural light (and darkness).
  • No napping – this can decrease sleep drive at night.  If you have to nap, try a short nap earlier in the day.
  • Try keeping a sleep diary – the target is 90% sleep efficiency (sleeping 90% of the night).  
  • Try sleep compression – go to bed later and wake up earlier to retrain sleep patterns.  
  • Plan what you will do in the hours before bed and after waking to create healthier habits – yoga, exercise, meditate, etc.

We all know creating change can be challenging. A great way to motivate change is through CBT – cognitive behavioural therapy. How motivated are you to change your behaviour?  Why?

The Top 5: knowing that your nervous system is adaptable and can change, start with: 

  1. Eat good food 
  2. Exercise every day 
  3. Evoke relaxation 
  4. Believe you can be well 
  5. Create and maintain strong social connections

Our mental maps of our bodies begin to change within 1 minute and are changed within 24 hours.  So know there IS hope, things CAN change, and there are people out there willing to help you.  


For a personalized treatment plan, Kristie sees patients for Physio-Yoga & Pelvic Health appointments on Tuesday’s and Thursday’s at Element Therapeutics.  

Book with our receptionists by calling 250-344-6654 and asking for “Specialized Physiotherapy” with Kristie or booking online here

Kristie is a pelvic health & orthopedic Physiotherapist, yoga teacher, and Certified Yoga Therapist. Her extensive trainings in Physiotherapy & Yoga have helped build a bridge between conventional western health care and a more holistic and all-inclusive healing approach. Kristie’s goal is to help people heal, strengthen, and better understand their bodies in a whole new way so they can flourish in life.

Kristie’s post graduate studies include certification in therapeutic yoga, pelvic pain and pelvic floor dysfunction, and courses on movement system impairments, breath, and pain science. Most recently, she completed her Level 3 through Pelvic Health Solutions, focused on treating pain. Kristie loves taking a holistic approach to her clients’ wellness. She has a passion for integrating the philosophy of yoga into her physiotherapy practice, and looks at injuries or illnesses in the context of an individual’s life. There is a connection between everything within us and around us, and Kristie loves to help you create awareness of the body-mind connection.  


If you’d like to know more, here are some resources worth checking out:

Video: 23 ½ hours 

The Mindful Self-Compassion Workbook by Kristen Neff & Christopher Germer

Anything by Brene Brown – books, audiobooks, videos

Mind Over Mood – CBT Workbook by Dennis Greenburger & Christine Padesky

Ted Talk Shawn Achor – The Happiness Advantage

Peter O’Sullivan – Back Pain – separating fact from fiction