Video and Transcript: Treating Pain with Graphesthesia

Hi, everyone! Dr. Orit Hickman here from Pain Science Physical Therapy. 

If you’ve been watching my videos, you probably have seen one where I talked about that one of the things that happens with persistent pain is that you’ll end up with what’s called cortical smudging where your sensory system is no longer communicating well with your motor system. And so, the natural tendency is to ask the question, “Well, let’s say I’ve treated my motor system forever. Right? I’ve done strengthening exercises. I’ve done stability and balance training. I’ve had people work with my tissue, and that hasn’t changed anything. Well, how do I treat my sensory system?” Well, in one of my previous videos, I talked about doing an activity called Small Object Identification, and there’s another activity that we’re going to talk about today called Graphesthesia. 

So, how many of you went to camp? If you went to camp, one of the things that you might have done with your campmates when you were younger is that somebody might have drawn letters on your back, and you had to then guess what letter did the draw. Well, that is an activity that’s a sensory activity, and that’s called Graphesthesia. And, when your sensory system isn’t working properly, this is a wonderful training device to help improve your sensory system. 

So, let’s say I have low back pain. So, if I have low back pain, I would have a partner-and you do need somebody else to do this with you-I would have a partner or a friend draw letters on my back. And, they can do it through my clothing, as long as I can feel them. I would ask them to do capital-and my language is English, so I’d want them to do it in English. If you have another language that’s your primary language that you speak in and you don’t use the English alphabet, have them use those letters. For example, I also have-I’m knowledgeable in Hebrew, so maybe we would do Hebrew letters. But, English is the easier language for me, so we’re going to go with English. So, I would want that person to draw letters. I would want them to draw English capital letters one at a time. I’d want them to switch between the left and the right side of my back. I’d want them to move in my upper back, middle back, and lower back. And, I’d want them to start by being predictable. Let’s say I have pain on the right side of my low back. I’d want them to start on my left side, and they might have to go through letters a few times on the left. And, as long as I’m getting them right, ok let’s switch to the right side and see how we do on the right. 

As you do this activity, what you might notice is areas where you have had persistent pain, you’re going to have difficulty in figuring out what letter it is they’ve drawn. And, that’s ok! That’s actually really normal, but, with practice, that should get better. What you may notice is that when you’re not having pain… Let’s say you’re having a flare up, and then your symptoms have calmed down. You might notice that when you’re having a flare up, it’s really hard to figure out what letters you're dealing with. And then, when you're not experiencing a flare up, it might be easier. 

This activity is not something that can be done once or twice. It really needs to be done a lot over the course of time, so maybe two [to] three times a day for multiple days in a row to start to see a change. And, the longer you’ve had pain, the longer you need to do the activity for. So, give it a try. See what you notice. You may not notice a change in pain, but you might notice some improvement in balance [and] how long you can walk for. So, your function might start to change. And, that’s usually what we’re looking for first before we’re looking for changes in pain. Let me know how it goes. Put any comments below. And, I hope you liked the video. If you did, give it a thumbs-up and subscribe to the channel to learn more about how to treat persistent pain in the musculoskeletal system. Have a great day!