Does Mirror Therapy Help with Pain?

What Is Mirror Therapy?
Mirror therapy is an artificial visual feedback that allows you to move your healthy limb as you keep your afflicted limb hidden. As you move your healthy limb, this makes it look as if your afflicted limb is moving and changing from painful positions to neutral positions.

While mirror therapy has been used more for amputees who experience “phantom limb pain,” it has also been helpful for patients diagnosed with Reflex Sympathetic Dystrophy (RSDS) or Complex Regional Pain Syndrome (CRPS) and stroke patients. If you have suffered a hand or foot injury or had surgery on these limbs and you experience phantom pain following the injury or surgery, mirror therapy can help you as well.

How Mirror Therapy Works

Your physical therapist teaches you to teach your brain to “see” your affected limb in movement. This therapy is called “mirror image therapy,” and it’s used to trick your brain in a way that helps relieve the pain from your RSD /CRPS, amputated limb or other conditions or injuries that cause chronic pain.

When your therapy session begins, the therapist puts a long mirror or a mirror box so the mirror faces your healthy limb. You begin doing different physical exercises with your healthy limb. Because it appears to you as if your afflicted limb is healthy, the movements you make with your healthy limb seem to be made by your afflicted limb, which makes your brain believe the afflicted limb is actually making the movements. Your course of mirror therapy usually takes place for about 15 minutes daily, five days per week for about eight months. If your pain returns, you may need another round of mirror therapy.

Two theories might explain the cause(s) of mirror pain. Your vision signals and the signals from the intact neurons from your afflicted or missing limb don’t mesh correctly. In other words, the neurons from your afflicted limb “see” one thing while your eyes see something completely different.

The second theory stems from the belief that muscle memory remembers some old positions of your afflicted limb. Some of these positions were painful, which those intact neurons “remember,” even after your injury, surgery or amputation. Is mirror therapy effective for amputees? For some, it is, while others may not get the same level of relief from their pain.

Mirror Therapy and Reflex Sympathetic Dystrophy or RSD / CPRS

A young soccer player suffered an ankle sprain during a match, then developed RSD / CRPS. RSD / CRPS originates in the central nervous system, which causes the brain to send pain signals to an injured limb. The brain wants an answer back from that limb. Because of the RSD /CRPS, the brain has to be re-wired so it develops a different communication path to the affected limb.

The soccer player started working on mirror therapy and taught her brain to “see” her injured foot moving. This patient was 12 years old at the time she sprained her ankle. Because of her youth, she was able to learn how to trick her brain into seeing her sprained ankle making moves that were still physically impossible – in one therapy session. Because phantom pain in RSD / CRPS patients can return, she has had to repeat the mirror therapy two times, once after suffering a minor injury. After her original ankle sprain, she suffered from RSD / CRPS for about six weeks before beginning mirror therapy in her physical therapy sessions. Her mother is a licensed master social worker and wrote about her daughter’s experience with an injury, RSD / CRPS and mirror therapy, publishing her article on the Reflex Sympathetic Dystrophy Syndrome Association’s website.

Your physical therapist can use either a mirror or a mirror box, which is a box with two mirror on each side. The mirrors face out toward both sides of your body. You put your afflicted limb into the box so it isn’t reflected by either mirror. Your healthy limb goes outside the box and is reflected by one of the mirrors. As you start your therapy, you look at that mirror and watch your healthy limb making the movements. Because you “see” two limbs, your brain believes your afflicted limb is the one making the movements, which can alleviate your pain.

Amputees and Mirror Therapy

While it sounds odd that an amputee can experience phantom limb pain from a limb that is no longer on his body, he can experience pain. This pain can persist for years or decades after an amputation. This pain can have a definite negative impact on his quality of life and ability to function. Mirror therapy can help provide relief from the pain.

If your phantom pain originates from an amputated limb, a physical therapist, anesthesiologist or  neurologist can teach you how to use mirror box or mirror therapy to reduce the phantom pain to the point where it goes away or you can function again.

Once you learn the mirror therapy technique, your doctor or therapist can teach you how to use the therapy at home. In this way, should your phantom pain return, you can repeat the exercises you have learned at home, eliminating the need for scheduling therapy sessions and paying more money.

Because mirror therapy exposes your brain to the image of your healthy limb making movements, it gets the message that both of your limbs are moving and functioning correctly.

The Evidence

Functional MRIs done on patients suffering from RSD/ CRPS or phantom limb pain after amputation show that cortical restructuring has taken place inside the brain. From these MRIs, it appears that the brain “remaps” the body’s map of nerves and neurons as it works to rid itself of the distortion caused by amputation, illness or injury.

Below is a good video I found on how to make a mirror box, you might want to try at home.

How to Make a Mirror Therapy Box

Andrew T. Austin | Myspace Video

I have spoken to several individuals with RSD / CRPS who have found pain releif using daily Mirror Therapy.  Whether you have phantom limb pain or RSD / CRPS it appears to be worth a try.

References: RSDS Publications by K Gallagher – Reflex Sympathetic Dystrophy Syndrome Association: Mailbag: Mirror Therapy
Medill Reports Washington: Mirrors Effective in Alleviating “Phantom Limb Pain”
Oregon Health & Science University: Beth Darnall, PhD., Develops Self-Treatment Tool for Phantom Pain.