Chronic Pain/Pain Management

Riverview Physical Therapy

Riverview physical therapist take a different approach to assessing what causes pain. This enables them to not only specifically treat what is causing the pain but effectively educate patients and empower them with the tools to manage their pain after physical therapy.

Pain is the most common reason for seeking medical care. It is also the most common reason why people choose our physical therapy practice for help. If you are considering physical therapy for pain, this information can help.

Acute, Subacute, and Chronic Pain

Acute pain is common with tissue damage that may occur with a ligament sprain, a muscle or tendon strain, inflammation within a joint, or a tear of a muscle, tendon, or meniscus.

Subacute pain is pain that lasts for 3 to 6 months. Subacute pain is common with more complex conditions where there is prolonged healing (joint replacements and the pain associated with the recovery after surgery).

Chronic pain is pain lasting for more than 6 months. While the body’s musculoskeletal tissues may heal from an initial injury or degenerative change, pain may persist for months past the tissue healing process. Nearly 50 million American adults have significant chronic pain or severe pain, according to a new study prepared by National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH). (1)

IMPORTANT: within 6 months almost all tissue damage completely heals. Rarely is there a case when the body cannot heal. Rare cases of diabetes may limit the healing process; however, in almost all cases, tissue healing will occur within 6 months.

Physical therapists that are trained to help patients with chronic pain can really help patients with chronic pain. Below, we will describe how.

What is Pain? Pain is an Output, not an Input.

Pain is the combination of numerous factors that result in a conscious experience that demands your attention.

Below is a list of many of the factors that contribute to your conscious experience of pain.

In other words, pain is NOT damaged tissue stimulating pain nerves which send pain signal through pain nerves up to your brain. There’s much more to it.

The good news is that means there are lots of ways to positively impact your pain.

Chronic Pain is Complex – here’s the current model of the pain & fear-avoidance

The great news is that our specially trained physical therapists can help you understand these factors and improve, even get rid of your pain.

Here are some of the factors that contribute to your perception of pain:

  • Injury & inflammation - tissue damage itself, stimulates nerves that work through the spinal cord and may be perceived as pain.
  • Neurophysiology – the way the nervous system works, the body’s threat sensors, how they interact at your spinal cord, and the pattern of activity (pain neuromatrix), can all impact your perception of pain. Your brain also has an internal medicine cabinet that can release some of the most powerful drugs known to help minimize pain. These are called endorphins & enkephalins.
  • Pain Experience – your perception of pain. There is good pain and bad pain. Past experiences with pain matter.
  • Fear – some may have no fear of pain when they experience pain, while others may be thinking about the worst possible outcomes because of the pain (catastrophizing).
  • Helpful vs. Harmful Words – improper use of diagnoses, terms, diagnostic test results, and communications with patients can be helpful or harmful. For example, a positive MRI for a disc bulge, disc tear, herniation, or arthritis is rarely helpful. Why? Scientists have performed MRIs on hundreds of patients, THAT DON’T HAVE ANY PAIN AT ALL
  • Knowledge About Pain – understanding that pain is complex and much more than just damaged muscle, tendon, ligament, or joint tissue can help relieve the pain.
  • Avoidance of Movement - pulling back because of pain or fear of pain
  • Deconditioning – movements that are normally pain-free or don’t cause fatigue, may stimulate chronic pain. In other words, with fear and avoidance, your body can get out of shape; movements that usually don’t cause pain or fatigue, can cause pain.
  • Emotions – when emotions are low, pain is typically less, and when emotions are high, the brain may put out the perception of pain
  • Hormones – hormones like adrenalin and cortisol have been shown to impact pain
  • Stress – family, financial, and work stress all play a role in the perception of pain.
  • Contributing Health Conditions – anxiety & depression both can factor into chronic pain
  • Sleep Habits – proper sleep habits can certainly help with the perception of pain. Almost everyone has had a headache when they were tired. The headache doesn’t mean you have cancer, it means you didn’t get enough rest.
  • Nutrition – eating the proper foods can positively impact pain
  • Hormones – certain hormones can decrease or in some cases increase your perception of pain.

The Principles of Chronic Pain Treatment

New ideas studied by pain scientists suggest that there are four basic components to the successful treatment of pain.

  1. Pain education – pain neuroscience education (PNE) or therapeutic neuroscience education (TNE) helps patients understand that pain is an output from the brain, it’s complex, and not just in your head.
  2. Exercise – numerous scientific studies have demonstrated that paced & graded exercise can have an extremely positive impact on pain.
  3. Sleep Health – addressing sleep issues can also decrease pain
  4. Goal Setting – it took months, even years for your body and brain to experience the chronic pain. Setting specific, reasonable, and progressive goals are part of a successful chronic pain treatment program.

We’ve Only Scratched the Surface of All the Great Treatments Our Therapists Can Provide!

If you have chronic pain, we encourage you to set up an appointment with one of our physical therapists. We will take a thorough health history, perform a physical exam, create a custom program for you and help put you back on the road to recovery.

Call Us Today

Greg Knapton

Greg Knapton, PT, ATC, Partner
Clinic Director - Westbrook

Greg, a native of Westbrook, earned his physical therapy degree from the University of Vermont in 1992. Greg also completed a fellowship in Sports Medicine through the American Sports Medicine Institute in 1998 and has been a certified athletic trainer since 2000. He is currently the owner of Riverview Physical Therapy, established in 2002, with locations in Bath, Westbrook, Windham and Yarmouth. Riverview PT also provides Athletic Training services at both Westbrook and Yarmouth High Schools, averaging 30 hours/week during the school year.

As a runner himself, Greg has first-hand knowledge of the demands running puts on the body. Through his own experience and that of his patients, Greg has developed the necessary skills and knowledge to assist all levels of runners returning to their sport. In addition to treating patients, Greg regularly teaches runners & triathletes at area companies and specialty retail stores about injury prevention, warm-up and cool-down techniques, proper footwear and how to avoid and care for some of the most common injuries. When not treating patients, Greg enjoys running and spending time with his wife Karen and their three boys.

'Ted' Edward S. Greeley II

"Ted" Edward S. Greeley II, PT, DPT, CSCS

What led you to become a PT?

I am one of the few therapists I know that did not receive any physical therapy as an athlete through my youth. I first attended college for mechanical engineering and wanted to find a career that kept me active through the day but still challenged my mechanical mind. I eventually made my way to the career I love.

With all of the PTs available, why should a patient choose you?

I treat the whole body and multiple body systems not just the area that hurts. The main dysfunction is often not the pain location. I try to make therapy fun and have some laughs on the road to recovery.

What do you like to do outside of work?

I dabble in many things: CrossFit, skiing, rock climbing, ice hockey, camping, and hiking. I have a son that keeps me very busy and I try to pass my love of the outdoors onto him.

Catherine Heath

Catherine Heath, DPT

What led you to become a PT?

Fascination with the human body and its response to exercise led me to physical therapy. I was originally interested in professional coaching but then found I was more interested in rehabilitation.

With all of the PTs available, why should a patient choose you?

I gear every treatment plan towards an individual’s fitness level to aid them with meeting their personal goals. We are all unique individuals; therefore, your treatment should be unique to you. As an endurance athlete, I know the importance of proper care and training.

What do you like to do outside of work?

I enjoy a variety of outdoor activities Maine has to offer: hiking, camping, biking, rock climbing and skiing. I’m an avid triathlete and compete in long-distance running events.

Derek Milone

Derek Milone, MS, PT

What led you to become a PT?

I found myself injured frequently as a high school athlete which naturally landed me in a physical therapy office. I experienced the healing effects that a seasoned therapist can provide. I also noticed that all the physical therapists were having fun. This led me to pursue PT in college and here I am talking to you.

With all of the PTs available, why should a patient choose you?

I have the ability to assess both the root cause of dysfunction and empower people to find their physical and mental strength. I partner with my patients to motivate them to reach their goals.

What do you like to do outside of work?

I like to stay active whether it is snowboarding, hiking, boating, taking in a car show or hanging out with my wife and kids. I am a weekend warrior car mechanic and you can find me in church on Sunday.

Nathaniel Runge

Nathaniel Runge, DPT

What led you to become a PT?

I was a second-year pre-med major with no occupation in mind. I knew I wanted a job that was hands on and interacted with people. After shadowing many medical positions, I knew PT was the one for me.

With all of the PTs available, why should a patient choose you?

Both my patient and I can often forget we’re doing work during our interaction because we slip a lot of fun and music appreciation in with my comprehensive PT program. And at day’s end, I think to myself, “Oh, yeah, I have to document this!”

What do you like to do outside of work?

I have three daughters under the age of 10 so much of my life focuses around them. When I am not contributing to all the interactions of family life, I am volunteering for various coaching positions.

Nancy Crawford

Nancy Crawford, PT
Clinic Director - Windham

What led you to become a PT?

My interest in Physical Therapy began in High School. At the time, I was exploring possible career paths that would blend my love for science and desire to work with people. I quickly found that Physical Therapy was the ideal blend of my interests. After over 20 plus years of PT, I have not regretted my decision. I continue to find it to be a satisfying and interesting profession.

With all of the PTs available, why should a patient choose you?

I offer over 20 years of experience, not only in outpatient orthopedics but also in rehabilitation of neurological disorders. I regularly attend continuing education classes to keep my skills current and innovative. We have a strong team approach at Riverview and work together to improve our patients’ function and minimize pain.

What do you like to do outside of work?

On the weekends, I can usually be found doing some kind of activity in the outdoors. I enjoy hiking, skiing, cycling and kayaking.

Jodi Mitchell

Jodi Mitchell

Coming soon...
Matt Douglas

Matt Douglass

Coming soon...
Chris Heuss

Christine Dube, PT

What led you to become a PT?

A friend of the family who had a background in physical education led me into it. He was working with a chiropractor, I shadowed him and found that I liked being in the medical field.

With all of the PTs available, why should a patient choose you?

I think sometimes people are very fearful when they come in for physical therapy. I try to get to know them outside of the injury and that leads to developing a good plan of care.

What do you like to do outside of work?

I enjoy cooking and hanging out with friends, watching my kids play volleyball, paddle boarding, snowshoeing and walking my dog.

Michael Viricel

Michael Viricel, MSPT, CSCS

What led you to become a PT?

Growing up, I was always enjoyed math and science classes. In high school, I took an Anatomy and Physiology class, which sparked my interest in pursuing a career in a health-related profession. I wasn't sure which direction to take when looking at colleges, so I applied to multiple schools with different choices of major. I settled on Husson College and chose Physical Therapy as my major. The choice was made based on being able to live at home and maintain a part-time job while in school. I was not sure how much I would enjoy Physical Therapy when I started, but once I got into science and anatomy classes, I was hooked.

What motivates you professionally?

I really love when I can improve a patient’s quality of life and return them to pain-free functional mobility. I know I've done my job well when a former client refers family and friends to me. That’s what keeps me motivated in continuing my career as a physical therapist.

Chris Heuss

Chris Heuss, PT
Clinic Director - Bath

What led you to become a PT?

I was working as a counselor and advocate for adults with disabilities and I saw the significant benefit that occurred when I took my clients to their physical therapy sessions and I thought, “I want to be a physical therapist.”

With all of the PTs available, why should a patient choose you?

I’m very good at listening to my patients and finding out their personal goals. People seem to feel really comfortable hanging out with me and our clinic has a very friendly environment.

What do you like to do outside of work?

I like the outdoors so backpacking, kayaking and, more recently, I’ve taken up rock climbing. I like to hike in the White Mountains and the Katahdin region, and I am most happy when I’m doing this with my wife and two teenage boys.

Carrie Mitchell

Carrie Mitchell, ATC & PTA

What led you to become a physical therapist assistant?

I wanted to pursue a medically based profession. Also, I've always been interested in sports/health, so athletic training/sports medicine and physical therapy were a logical choice.

What makes you a great assistant to work with?

I have been in my career since 1990, so I do have years of experience on my side. My first job out of college allowed me to work in an environment that fostered forward-thinking and learning. I was lucky enough to work with many exceptional clinicians, one of whom is the owner of Riverview. I feel so lucky to work in a profession I love and am able to constantly learn and grow in.

What do you like to do outside of work?

I enjoy teaching Vinyasa Flow yoga and have for 4 years. I love trail running at our local land preserve all year round. My husband and two chocolate labs also love skiing, hiking and boating. We have lived in the Midcoast for 24 years and love every minute of it!


Hallee Breton, DPT

What led you to become a PT?
I grew up dancing with a focus in ballet and always had an appreciation for the human body and human movement. I learned how to use certain muscles in my body to create very specific movements and developed acute sense for body awareness which translates perfectly to physical therapy practice. I was always interested in medical sciences and knew I didn't want to have a desk job so physical therapy was a perfect fit!
With all the PT's available, why should a patient choose you?
I love getting to know people. I really try to understand people and the lives they lead and incorporate that in how I evaluate and treat my patients. Everyone is different and going through different challenges in their lives and I try to be a support for them for their physical and mental health. Plus I like to have a good time with my patients!
What do you like to do outside of work?
I am an avid snowboarder in the winter; Sugarloaf is my mountain! And in the spring and summer, I love going camping, hiking, and have taken up golfing. I love being outdoors in any way, shape, or form.