Pain Does Not Mean Broken

 


​Once upon a time, it was widely believed that the sun orbited the earth, and not the other way around. This was a perfectly logical assumption, since that is what it looks like from our vantage point on Earth. It is also a good example of the fact that, sometimes, assumptions that seem perfectly logical can actually be wrong.

The experience of pain, and the assumptions we make based on it, can often fall into this category. When you feel a sharp pain in your back, it is easy to make two assumptions: something in the back must be injured, and the safest thing to do must be to stay still. In most cases, both assumptions are incorrect.

Why does this even matter? Whether right or wrong, you’re still in pain. The reason it matters is that understanding what is going on “under the hood” helps you take the appropriate steps to feel better, whereas operating under a false assumption can lead to more, and even chronic, pain.

The scientific term for believing that we are vulnerable and should avoid movement to protect ourselves from further injury is Fear Avoidance Beliefs .These beliefs have been shown to be strongly correlated with the transition from acute to chronic pain, and can therefore literally be hazardous to our health. 



A functional model of pain

The view of the body as consisting of separate parts that malfunction, predictably cause pain when they do, and, in order for pain relief to be possible, should be exchanged or repaired like car parts, is called the biomedical model. This model is considered a bit outdated, and has been replaced with the biopsychosocial model of pain, which takes several other relevant factors into account.

Pain can of course be caused by tissues that are ailing, but it can also be decreased or increased through independent functions of the nervous system, even without any physical damage being present at all. This is termed neurogenic pain. Our beliefs, fears and other psychological factors can also turn the volume of the pain signal up or down.

The pain caused by tissues that are being irritated, inflamed etc is termed nociceptive pain . Sometimes this is indeed caused by something breaking or wearing down, and even exercise soreness is, on a microscopic level, happening due to inflammation caused by small tissue fibers breaking during a workout. While this may sound like a bad thing, it is actually the first step in a chain of events that lead to muscles growing stronger. In the majority of cases, however, the solution to musculoskeletal pain isn’t waiting passively for tissues to heal while avoiding movement, and in cases of chronic pain this is even easier to understand - if waiting for healing would have helped, you’d be healed by now.

So why are you hurting, chronically or often? More often than not, the underlying cause is to be found not in whether the tissues are broken or not, but in how they work together. Knee pain is a common complaint, and when certain movements cause a sharp pain behind the kneecap, it’s easy to understand that the instinct may be to minimize or avoid movement of the leg altogether due to fear that something must be damaged, and more movement may damage it even more. But the truth may be that the pain, or dislocation, if that is the chronic concern, is happening due to hip or buttock muscles not working correctly and failing to stabilize the thigh bone, which in turn makes the kneecap move incorrectly in it’s groove. The solution to this dilemma is education and exercise, not inactivity. While it may seem like a good short-term solution, avoidance of movement will soon result in ever weaker muscles and more pain.

This functional lens can help with pain anywhere in the musculoskeletal system. Back pain? More often than not muscles triggered into a spasm due to insufficient muscular stabilization of the spine. Shoulder pain? Maybe your humerus, or upper arm bone,  is not moving correctly in it’s joint due to weak rotator cuff muscles and poor positioning of the shoulder.

When we start to understand that the various component parts of the body not only need to be healthy but also need to work together, as a system, it makes sense that pain can arise as a result of a system failure, and that, through appropriate and specific exercise, training the system to work correctly is the solution. Studies show that wear and tear of tissues is predictable and increases steadily by every decade of life, but this wear and tear correlates very poorly with pain. In other words, you may have significant degenerative changes in any given body part without any pain at all, and intense pain is often experienced in parts of the body that look fine on x-rays and MRIs.

This does not, however, mean that pain should be disregarded as something to be pushed through or walked off. Exercise should never hurt, and pain is always a signal -- we just need to interpret it correctly. A skilled physical therapist can help you by evaluating you and guiding you through a gradual progression of exercises that will, when appropriate, normalize the functioning of your body to first eliminate and then prevent pain.

The hypermobile body heals more slowly than other bodies, and strength gains also take longer to become apparent. This calls for both persistent adherence to the exercise program and a lot of patience, but the rewards are always worth the effort. Avoidance of movement can only lead to an ever-shrinking tolerance and ability, and if you paint yourself into too small a corner it may be hard to reverse the dysfunction.

Let your body -- slowly but surely-- surprise you. You may be able to feel and function much better than you ever believed you could. What’s the worst thing that could happen? Preventing an otherwise predictable, slow decline, and that’s a worthy goal in and of itself!

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