- Joint pain (also called arthritic pain) (18,52,88).
- Muscle pain.
- Myofascial pain (86, 88).
- Upper extremity and trunk pain usually described as aching and may indicate muscle overuse (100).
- Lower-extremity pain usually described as cramping (100).
|Location of Pain
||Mainly low back and lower extremities (knees, hips, thighs). Can also occur in elbows, trunk, neck, shoulders, and respiratory muscles (8,18,100).
- There is no known test specific for PPS, so diagnosis is made by exclusion. Co-existing medical conditions can make diagnosis and treatment difficult (86).
- Spinal stenosis, which has similar symptoms, can be confused with PPS (52).
- Many people with PPS also have fibromyalgia or borderline fibromyalgia (86,87).
- Physical exertion (37,92,100).
- Chronic overuse of less- affected muscles (1,70,87,92).
- Muscle imbalances (70).
- Muscle disuse leading to further atrophy (1,51,100).
- Aging (1,87).
- Exposure to cold weather (37,100).
- Fatigue (92,100).
- Greater residual effects from or greater severity of acute polio (1,8,86).
- Weight gain (1,70,86,92).
- Belief promoted in acute polio era that use of assistive aids such as canes, crutches, slings, braces. or wheelchairs are a sign of weakness or 'giving in' (70,86,101).
- Depression (86).
|Alleviating Factors and Treatment Options
- Analgesics such as acetaminophen or NSAIDs (86,88100).
- Antidepressants for myofascial pain (86).
- Identify and treat co-existing pain causing conditions such as fibromyalgia (87).
- Warmer climate ( 77 F) (84).
- Physiotherapy (84).
- Swimming activities (84).
- Social and local community support (84).
- Education on techniques to reduce or avoid pain and protect joints during activities of daily living may help (1,86,101).
- Assistive devices and technical aids to conserve energy and help alleviate muscle imbalances to minimize overuse. The typical approach allows short-distance walking without assistive devices for those who fight their use. NOTE: Crutches and canes can be contraindicated if shoulder musculature is very weak or would be bearing too much extra weight (86).
- Rest - orthoses can be used to rest muscles (1,37,70,88,100).
- Heat/warmth (37,86,100).
- Electrical stimulation such as transcutaneous electrical neural stimulation (TENS) or trigger point injections (86,88).
- Stretching exercises (86,92).
- Modified muscle strengthening surrounding painful joints as tolerated without fatigue and pain (86).
- Weight loss (86).
- A randomized controlled trial (RCT) of static magnetic fields (300-500 Gauss) found significant and prompt pain relief of musculoskeletal pain in PPS. More study needed to replicate results (88).
- Spinal fusion (for progressive paralytic scoliosis) (86).
- Correction of obstructive contractures (70).
|Specific Exercise Guidelines to Manage Pain
To date there is insufficient data available to offer specific recommendations on intensity, duration, frequency, and type of exercise that will benefit people with PPS. The few studies that exist are very heterogeneous in design and intervention, and mainly focus on strength gains and increases in aerobic capacity rather than pain relief. Additionally, people with PPS are also heterogeneous, making it difficult to determine the right exercise regimen to gain the most benefits with the least overwork (21,82).
- Plan exercise at time of day when pain is lowest (37).
- Find a balance between exercise intensity and avoiding fatigue (86).
- Exercise regimen must be realistic with a limited selection of muscles that will improve function without increasing fatigue and pain. If exercise intensity is too great or the number of [remaining] motor units too few, damage can occur (1,86).
- Be aware that standard measures of manual muscle strength significantly overestimate actual strength of damaged muscles (measured quantitatively) in people with PPS (1,70,101).
- Use a pacing strategy (breaking down tasks into manageable segments - multiple short sessions vs. one long one) to minimize fatigue (1,70,82).
- Allow longer rests between repetitions, sets, and exercises in strength training (82).
- Recovery may take longer in people with PPS (70).
- Use orthoses, walking aids and wheelchairs as a means of decreasing demands placed on muscles while preserving function (70).
- Gait analysis can be a helpful tool in assessing where muscle weakness exists and how an individual compensates in order to develop a multi-disciplinary plan to achieve better muscle balance and avoid further overuse/abuse of some muscles and under-use/disuse of others (51,70).
- Monitor person with PPS very closely for signs of fatigue and pain. Exercise should never be performed to point of pain or fatigue (82,101).
Aerobic Exercise / Flexibility Training
- Although aerobic and flexibility exercises are important to overall health, there was no data available in this literature search relating to pain relief benefits.
- Strength training, if possible, may help alleviate or at least not aggravate joint pain (82.92).
- Emphasize concentric contractions in strength training to minimize muscle damage (82).
- To avoid muscle trauma, a 3-repetition maximum test (3RM) may be safer than a 1RM in determining intensity for strength training (82).