Chronic Pain Management

One of the most powerful things we can do for someone with chronic pain is help them understand it. Pain Neuroscience Education is an evidence-based approach that teaches patients about the biology and neuroscience of pain, not to minimize it, but to change the relationship between the brain, nervous system, and the experience of pain. 

What PNE addresses: 

• Why pain persists after tissue healing is complete 
• The role of the nervous system in amplifying or dampening pain 
• How thoughts, emotions, sleep, and stress influence pain levels 
• The difference between hurt and harm, and why movement is safe 
• Practical strategies for pacing, flare-up management, and daily function 
• Building confidence and reducing fear-avoidance behaviors 

Understanding your pain is not a replacement for hands-on treatment, it's a foundation that makes everything else work better. Our therapists take the time to explain, listen, and educate throughout your care. 

Fibromyalgia is one of the most misunderstood and mismanaged pain conditions in medicine. Widespread musculoskeletal pain, profound fatigue, cognitive fog, sleep disturbance, and heightened sensitivity to touch and sensation, fibromyalgia affects every area of life and is often dismissed or minimized by providers who don't understand it. At Apex, we do. 

We commonly treat: 

• Widespread body pain and tender points 
• Fatigue and sleep disturbances related to fibromyalgia 
• Cognitive difficulties ('fibro fog') 
• Sensitivity to touch, pressure, temperature, and sound 
• Stiffness and reduced mobility 
• Anxiety and depression associated with chronic pain 
• Activity intolerance and post-exertional symptom flare 
• Functional limitations in work, home, and social activities 

Our approach to fibromyalgia combines gentle manual therapy, carefully graded exercise, Pain Neuroscience Education, pacing strategies, and lifestyle support to reduce the intensity of symptoms and improve your ability to participate in the activities that matter most to you. We won't push you too hard, and we won't give up on you. 

Back and neck pain that has lasted for more than three months, or that keeps coming back, is one of the most common and most disabling forms of chronic pain. Whether it started with an injury, developed gradually, or seems to have no clear origin, persistent spinal pain responds well to a comprehensive physical therapy approach that addresses both the physical and neurological aspects of the condition. 

We commonly treat: 

• Chronic low back pain with or without a structural diagnosis 
• Persistent neck pain and cervical stiffness 
• Failed back surgery syndrome
• Chronic pain following disc herniation or spinal stenosis 
• Degenerative disc and joint disease 
• Recurrent back pain that keeps returning despite treatment 
• Chronic pain with associated depression, anxiety, or sleep issues 
• Postural and movement pattern contributors to persistent pain 

We take a biopsychosocial approach to chronic spinal pain, meaning we treat the whole person, not just the spine. Manual therapy, movement retraining, Pain Neuroscience Education, and gradual return to activity are all part of how we help people with chronic back and neck pain reclaim their lives. 

Complex Regional Pain Syndrome is a chronic pain condition characterized by severe, burning pain, often in a limb, along with changes in skin color, temperature, and swelling that seem out of proportion to the original injury. CRPS is rare, poorly understood, and often devastating. Physical therapy is a cornerstone of CRPS treatment and one of the few interventions with meaningful evidence behind it. 

We commonly treat: 

• CRPS Type I (no confirmed nerve injury) and Type II (confirmed nerve injury) 
• Burning, aching, or throbbing pain in the affected limb 
• Allodynia (pain from normally non-painful stimuli) 
• Swelling and stiffness 
• Movement and gait abnormalities 
• Fear-avoidance and guarding behaviors 
• Desensitization and sensory retraining 

Our therapists use a specialized, evidence-based approach to CRPS that focuses on gently retraining the nervous system, reducing sensitivity, and gradually rebuilding movement and function. We work carefully within your limits, progressing at a pace your nervous system can tolerate, because with CRPS, how you treat matters as much as what you treat. We approach this condition with patience, respect, and a deep commitment to your recovery. 

Myofascial pain syndrome involves chronic pain in the muscles and surrounding connective tissue (fascia), often centered around trigger points (tight, hypersensitive knots that can refer pain to other parts of the body). It frequently affects the neck, shoulders, back, and hips and is commonly associated with headaches, jaw pain, and widespread discomfort. 

We commonly treat: 

• Trigger point pain in the neck, shoulders, back, and hips 
• Referred pain patterns from myofascial trigger points 
• Muscle tension and restricted movement 
• Myofascial pain associated with postural dysfunction 
• Jaw pain and TMJ-related myofascial pain 
• Myofascial components of headache and migraine 
• Widespread muscle pain overlapping with fibromyalgia 

Treatment for myofascial pain at Apex may include manual therapy, dry needling (trigger point needling), therapeutic exercise, postural correction, and movement retraining. We address both the trigger points themselves and the underlying patterns that cause them to keep coming back. 

When headaches occur 15 or more days per month, they are classified as chronic, and they can be profoundly disabling. Many people with chronic headaches don't realize that physical therapy can be one of their most effective treatment options, particularly when the cervical spine, jaw, or vestibular system is involved. 

We commonly treat: 

• Chronic daily headache 
• Chronic migraines with cervical or vestibular involvement 
• Tension-type headaches 
• Cervicogenic headaches (originating from the neck) 
• TMJ-related headaches and facial pain 
• Post-traumatic headaches following concussion or whiplash 
• Occipital neuralgia 
• Vestibular migraines 

Our therapists assess the cervical spine, jaw, upper back, and vestibular system to identify the structures contributing to your headaches. Treatment may include hands-on manual therapy, dry needling, postural work, vestibular rehabilitation, and patient education, with the goal of reducing headache frequency and intensity, not just managing them when they come. 

Hypermobility spectrum disorders and Ehlers-Danlos Syndrome (EDS) are connective tissue conditions that cause joints to move beyond their normal range, leading to instability, frequent injuries, and chronic, often widespread pain. These conditions are frequently underdiagnosed and mismanaged, and patients with hypermobility need therapists who understand the unique challenges of treating a body that is too flexible rather than too stiff. 

We commonly treat: 

• Hypermobility Spectrum Disorder (HSD) 
• Hypermobile Ehlers-Danlos Syndrome (hEDS) 
• Joint instability and recurrent subluxations or dislocations 
• Widespread chronic pain related to hypermobility 
• Fatigue and post-exertional malaise 
• Proprioception deficits and coordination challenges 
• Postural Orthostatic Tachycardia Syndrome (POTS)  exercise management 
• Strengthening without overstressing unstable joints 
• Activity pacing and flare management 

Our therapists approach hypermobility-related pain with the nuance it requires, building strength and stability around unstable joints without pushing into ranges that cause harm. We work carefully, communicate openly, and build programs that grow with you over time. 

The body's organs are not isolated structures, they move, they have fascial connections to the musculoskeletal system, and restrictions in organ mobility can contribute to pain, dysfunction, and a wide range of symptoms that traditional orthopedic approaches miss entirely. Visceral manipulation is a gentle, hands-on therapy that assesses and treats the mobility and function of the body's internal organs and their surrounding connective tissues. 

At Apex, our therapists trained in visceral manipulation offer a truly whole-body approach to chronic pain and dysfunction, especially valuable for patients who have seen many providers without satisfying answers. 

Visceral manipulation may help with: 

• Chronic pelvic pain and pelvic floor dysfunction 
• Digestive discomfort and bloating with a musculoskeletal component 
• Post-surgical abdominal or pelvic scar tissue restrictions 
• Low back and hip pain with a visceral contribution 
• Thoracic and rib pain 
• Chronic pain that hasn't responded to standard musculoskeletal treatment 
• Urinary urgency or frequency with a structural component 
• Endometriosis-related pain (as a complement to medical management) 

Visceral manipulation is gentle, non-invasive, and deeply effective for the right patient. If you've tried everything and still haven't found answers, this may be the missing piece. 

Dry needling is a technique used by our physical therapists to treat muscle pain, trigger points, and restricted movement by inserting a thin, sterile needle directly into the affected tissue. Unlike acupuncture, dry needling is rooted in Western anatomy and neurophysiology and is used as one tool within a comprehensive physical therapy plan. 

Dry needling is commonly used for: 

• Myofascial trigger points and chronic muscle tension 
• Neck and back pain 
• Shoulder, elbow, and wrist pain 
• Hip, knee, and ankle pain 
• Chronic headaches with a muscular component 
• Tennis elbow and golfer's elbow 
• Plantar fasciitis 
• Post-surgical or post-injury scar tissue and restricted mobility 
• Chronic pain that has plateaued with other treatments 

Many patients experience significant relief from chronic muscle pain after just a few sessions of dry needling, particularly when combined with manual therapy and therapeutic exercise. Our therapists will discuss whether dry needling is appropriate for your condition and answer any questions you have before beginning.