For patients who suffer from chronic pain, including symptoms related to complex regional pain syndrome or CRPS, rehabilitation and physical therapy are key to decreasing pain, increasing functionality and improving a person’s overall quality of life. But at Forté Sports Medicine and Orthopedics, we know that engaging in movement and activities alone isn’t always enough.
An additional way to help relieve chronic pain symptoms is to provide non-painful sensory signals to the brain through Graded Motor Imagery or GMI therapy.
“Patients tend to connect movement with their pain,” says Chris Gray, a physical therapist and board-certified orthopedic clinical specialist at Forté. “The benefit of incorporating GMI therapy is that it can help give those patients a positive experience with movement.”
Let’s look at the three different treatment techniques used in GMI therapy and what research shows about their effectiveness.
Left/Right Discrimination Training
The first treatment technique GMI therapy uses is left/right discrimination training. It focuses on the ability to quickly and accurately identify an image of a body part as either the left or right side. Research shows those who suffer from chronic pain can struggle with the task.
“It’s going to take them longer to identify which one’s right or left,” says Gray. “They’re going to have a higher percentage of error.”
Gray encourages patients to use the Recognise app with games and challenges using left and right discrimination. Patients can see an improvement simply by tapping on left or right images of body parts for five to ten minutes, two to three times a day.
“There’s research to show that it’s not going to take their pain from a ten to a zero, but it will bring it down on the pain scale,” says Gray. “I like to say it softens or brings down the fire just a little bit.”
Imagined Movements
A second technique of GMI therapy is called imagined movements. It involves thinking about moving a painful limb or body part. The exercise uses similar areas of the brain to those used when a person is actually moving.
“With imagined movements, we do a lot of talking about movements that are painful to the patient,” says Gray. “I want them to go through it in their head – actually doing that activity.”
Mirror Therapy
The third technique, which Gray believes to be the most powerful tool in the GMI therapy toolbox, is mirror therapy. It creates the illusion that your painful limb or body part is moving when it’s not.
Here’s an example of how mirror therapy works. A patient keeps their painful hand behind their back or out of sight while looking in a mirror and focusing on moving their good hand. If they’re close enough to the mirror image, the exercise can help trick the brain into associating the pain-free movement with their painful side.
“I have them start with active range of motion, opposition and squeezing movements,” says Gray. “Our goal is to move into painful things. If writing, keyboarding or lifting weights is painful, we want them to do that with their non-painful side to tell the brain it’s okay to move.”
The Data on GMI Therapy
Gray has seen the effectiveness of GMI therapy firsthand, and the research agrees. Data shows GMI therapy can improve pain ratings, lower disability levels, increase function, and reduce healthcare utilization, such as the need for imaging, surgeries and pain medication. When a patient receives GMI therapy in addition to rehabilitation and physical therapy, research shows the benefits are even greater.
“I look at it as comprehensive care,” says Gray. “If you combine GMI therapy with other treatments, you’re going to get the best outcomes.”
“Our overall goal is to break the pain cycle,” he says. “We want to help patients have a positive experience with movement and get them to confront the fear of bending forward, or whatever the action may be. If we can do that, we can give them a better chance of recovery.”
To learn more about Forté’s rehabilitation services, request an appointment online or call 317-817-1200.
