- WHAT YOU NEED TO KNOW AND WHAT YOU CAN DO

Have you ever started a workout to get in shape - only to be stopped by the same old complaint when you're just getting started? "It's my bad knee that's bothering me" or "oh, my tennis elbow is back".

Or are you at the point where the thought of exercising hasn't even crossed your mind because persistent pain takes up most of your day and limits you in even the most common everyday activities?

The truth is that pain is a stumbling block on many fronts - and has such a systemic impact on the body that it has a wide range of consequences for not only your immune system and hormones, but also your motivation and willpower to make better choices. In this way, acute, recurring and persistent pain can make it difficult for you to achieve the physical goals you've set for yourself (1).

PAIN IS REAL - BUT YOU DON'T HAVE TO LIVE WITH IT!

But pain, injuries and recurring ailments don't have to be a condition that you're subject to forever and ever. Modern pain science, led by renowned researchers Dr Lorimer Moseley and Dr David Butler, has come so far that we know that:

1. pain is a result of the judgement process that your brain (constantly) makes as it screens your body and turns the thumbs up or down on whether you are in a dangerous situation (or perhaps endangering yourself) right here, right now;

and that...

2. you can turn up and down the intensity of the pain experience by working holistically, based on a so-called bio-psycho-social model, precisely to ensure that the brain receives the right input from all sensory systems and learns to interpret the signals it receives (inside and outside, mentally, emotionally and physically) - and not just biomechanically with a focus on muscles and joints. (2, 3)

The leading international voices in modern research will therefore no longer accept that pain is a condition you have to learn to live with. Instead, it is expected that it can be treated - and that pain patients themselves can change the perceived pain intensity by educating themselves about what pain is and which factors have a significant influence.

FIRST STEP TOWARDS A PAIN-FREE EVERYDAY LIFE

The first step towards achieving a largely pain-free everyday life and freedom of movement (prerequisites for not only any training results - but also more energy in your everyday life and the energy to make better choices) is to understand just how complex a construct pain is and what triggers the inpidual pain experience (4)

Which is what I will try to help you with in this article - while also guiding you towards a few concrete tools you can try out.

PAIN DOES NOT ALWAYS EQUAL INJURY

The most important thing to know is that pain is not necessarily a sign that something inside you is broken. Just as the absence of pain doesn't mean you don't have an injury.

Pain - and the intensity of the pain experience - is a result of your overall cup overflowing. When your brain receives enough signals from your body that danger is imminent, it reacts with a big "AV!".

In concrete terms, this means that the brain (constantly) deals with inputs such as

• Did you sleep well last night? Are you well rested?
• Have you drunk enough water?
• Have you eaten regularly and enough?
• Have you eaten anything you can't tolerate?
• Have you moved today - how and how much?
• Are you peeing when you need to?
• Do you have regular bowel movements?
• Are you worried? A little/a lot/how often?
• Have you just had a conflict with your partner/colleague/boss?
• Do you feel insecure about your finances/work situation/important relationships?
• Is your blood sugar stable and within normal range?
• Is there acute or chronic inflammation in your body - joints, muscles, intestines

And many, many others...

In other words, your brain is constantly sending out a query: "How are you feeling?" and "Can you take care of yourself?" AND then it collects and interprets the answers from all the control systems your body possesses:

• The 5 classic senses: sight, hearing, smell, taste, touch - all of which are directed towards your surroundings and collect information from there.
• And the 2 lesser-known ones - balance (vestibular) and body sense (proprioception, signals from muscles and joints) - which tell you where you are in relation to your surroundings, which way is up and down and where your arms and legs are. Where you're going and at what speed and acceleration.
• And actually, there's another area of growing research interest - body awareness (interoception) - which covers your overall sense of what's really going on inside your body. Your body's internal signals of hunger, emotions, fatigue, thirst, etc. 

IS IT SAFE TO BE YOU?

Your brain weighs all the inputs against each other and assesses whether you are in a predominant state of danger or safety.

Often this judgement will be in line with how you are actually feeling. The signals you get back will be fully justified. For example, if you've broken an arm, twisted your ankle or suffered a burst fibre in your back thigh, a big "Ouch! Ouch!" would be appropriate. A reminder to stay still until your bones, muscles, tendons and ligaments have healed.

But sometimes, the brain can over-interpret some of the signals - giving them more importance than they deserve. And then it will act like an overprotective mum or dad who over-dresses their child when going outside in the early spring weeks - based on the belief that it's better to sweat than to freeze.

This means that even if your injury has actually healed (normal healing time is max 3 months - this is the dividing line between acute and persistent pain), your brain will send you overprotective pain signals to prevent you from exposing yourself to even the slightest risk of re-injury.

WHAT YOU CAN DO AFTER AN ACUTE INJURY

The key to getting rid of those overprotective pain signals after a real injury is to start moving as soon as possible. Both the injured area - just focused and in a pain-free range of motion (important!); and the rest of the body.

But again, rule #1 is that it's pain-free! No gritting your teeth, popping painkillers and training through the pain.

And the quality of your movement is far more important than quantity (see reference to the free workshop "pain-free body" at the bottom of the article).

But as you can see from the list above, there are also other buttons that you can press to reassure your brain and turn down the red warning lights. Which, by the way, don't just manifest as pain, but also as stiffness, hunger, nausea, food cravings, dizziness.

IS YOUR BODY IN PLUS OR MINUS?

If you are predominantly in the plus, your brain will have less of a need to turn up the alarm.

If, on the other hand, you've been overloaded for a shorter or longer period of time - and perhaps even missed some of the initial cautionary signals of the neglected needs for food, drink, rest and pleasurable activity - then the brain will be a bigger drama queen and more likely to intensify the pain signals.

A LOOK INTO THE CRYSTAL BALL

In addition to considering the overall health of your system in the here and now, your brain is also (constantly) predicting the future. This ability to predict what's going to happen next enables you to perform even the simplest actions and protects you from injury. It ensures that you grasp the glass with the right amount of force, thus not breaking the glass.

In order to optimally predict the future, the brain uses input from the control systems mentioned above. If one or more of these systems doesn't provide enough information or of high enough quality, the brain will first slow down the speed at which you can move and limit the force you can develop to prevent you from injuring yourself. If the overall quality and quantity of information becomes low enough, the brain will pull the handbrake and you'll experience pain - which is designed to stop the activities that your brain isn't comfortable with.

ACUTE VS CHRONIC PAIN

There is a difference between acute pain (when you break an arm, for example) and pain that has lasted longer than 3 months.

Acute pain is something you want your brain to react to. But preferably not overreact, and certainly not in the long term (such as when, for example, several years later you put a little more strain on your previously injured knee than usual, and it reacts with the same pain as when there was a real injury). And here you can turn on some of the above-mentioned buttons to make your pain experience less intense and more bearable - and perhaps eliminate it altogether if it's just the result of an overloaded brain remembering a previous injury.

But both acute and persistent pain is not necessarily a sign of real injury, just an inpidual response to danger and overload - real or perceived. And not just physical - but also very much psychological and social; mental and emotional (5)

YOUR OWN INTERPRETATION MATTERS

When your brain assesses whether you're in danger, it doesn't just take into account all the factors I've mentioned above.

It also takes into account the value you place on a particular event or situation.

A bit like when a small child hurts themselves and looks back at mum or dad to see how they react. If they rush over and look completely worried, the child will burst into tears. And if they smile and ask if you're OK, the child just crawls on.

Therefore, in addition to the various physical buttons you can turn on, it's important to notice if you have a tendency to have catastrophic thoughts about certain events that trigger pain - and try to stop the rush of thoughts and not constantly feel "does it hurt, does it hurt? Where does it hurt? how much does it hurt?" and all the things you can't do when you're in pain.

It's also important - for both the pain patient and the practitioner - to be able to move beyond the scans and the desire to link a structural misalignment or signs of wear and tear with the pain you're experiencing.

In fact, surprisingly, there isn't necessarily a correlation between the physical flaws/skews/injuries that would show up on a scan - and the actual experience of pain intensity. In other words, if you see a worn meniscus on the X-ray, it doesn't necessarily mean that the cause of your knee pain is physical wear and tear (there is a difference between correlations, where two phenomena occur simultaneously but independently of each other, and causal relationships, where A clearly leads to B). In other words, it is quite common to have "damaged" and "worn" joints without experiencing any discomfort or pain.

More and more studies are showing that the surgeries performed to correct some of what was found on the scan are no more effective than exercise.

WHEN IT ALL SHORT-CIRCUITS

That said, movement - in the traditional "exercise" sense - is often NOT an option for the pain sufferer.

In complex traumas involving concussions, major surgeries and life-threatening situations, there are so many physical, mental and emotional layers that the entire system short-circuits into a state of perpetual alert. The pain experience becomes more or less constant, but nonetheless with an unpredictable expression, appearing in different parts of the body, with different pain intensities and in different forms.

And then it becomes (even) more difficult for professionals to come up with a bulletproof treatment plan - when the pain is no longer even localised and "sits right here" (even though that's NOT what it does - it's a sign that your brain has assessed that this particular body part is in danger), but when it envelops the pain sufferer in a more or less constant fog.

What I hear from many of our severely pained clients is that traditional rehabilitation and manual therapies are not only ineffective in the long run - for many, they trigger even more pain afterwards.

Understandably, this can result in a certain degree of fear of movement and severely reduced activity. And the greater and longer the movement restriction, the more your brain will judge that any movement outside your (ever-shrinking) comfort zone will put you at risk - and respond with... pain.

Reversing the downward spiral IS possible. You can achieve a significant degree of freedom from both pain and movement. It just requires an understanding and acceptance of the key concept of "appropriate disruption". An effort large enough to create a desired change, but small enough not to trigger the brain's alarm system.

RESOURCES:

If you want to learn more about what pain is and what you can do about it - the book "Explain Pain" by D. Butler and L. Moseley is a great resource.

I also recommend these two short TED talks, which explain what pain is in a fairly accessible way:

TEDXADELAIDE - LORIMER MOSELEY - WHY THINGS HURT

Pain, Is it all in your mind?: Silje Endersen Reme at TEDxNHH

 

SPECIFIC EXERCISES:

NOTE: Remember that more is not necessarily better when you need to convince your brain that it is out of danger. Find 3-5 exercises that you respond particularly well to (e.g. achieve instant flexibility and a good degree of pain relief) and do them a little but often every single day.

REFERENCES:

1. On the systemic impact of pain on the body: Boron, W. F., & Boulpaep, E. L. (2012). Medical physiology, A cellular and molecular approach (Updated Second Edition ed.). Philadelphia, PA: Saunders Elsevier.
2. The bio-psycho-social model: George, S. Z., Staud, R., Borsa, P. A., Wu, S. S., Wallace, M. R., Greenfield, W. H., . . Fillingim, R. B. (2017). Biopsychosocial influence on shoulder pain: Rationale and protocol for a pre-clinical trial. Contemporary Clinical Trials, 56, 9-17. doi:S1551-7144(16)30445-1
3. Neuropathic pain vs. nociception: Thakur, M., Dickenson, A. H., & Baron, R. (2014). Osteoarthritis pain: Nociceptive or neuropathic? Nature Reviews.Rheumatology, 10(6), 374-380. doi:10.1038/nrrheum.2014.47