Pain is extraordinarily complex. There are so many different factors that play a role in how we perceive pain, how it manifests itself and how it influences our lives. In this blog series we attempt to help you understand pain and why you may be dealing with the same pain for such a long period of time.
We’ll also discuss what you can do to rid yourself of that persistent pain as well as how you can prevent a minor injury from exceeding the expected timeline and turning into something more chronic and worrisome in the future.
We hope this helps lead you to less pain, better function, and gets to back doing the things you love to do again.
Why is it important to understand pain?
Chronic low back pain is the number one leading cause of disability worldwide. Over 80% of people suffer from back pain at least once in their lives and over 80% of those people have recurrent, chronic low back pain. Back and neck pain is what I see most commonly affect people long-term followed by frequent cases of knee and shoulder pain. And all too often I find that my patients have been suffering in pain for months or even years and just trying to manage it before finding the help they need and deserve. This is no way to live!
As a movement specialist, I often explain to my patients the WHY of their pain. I think this is absolutely necessary and managing and healing from chronic pain.
For someone that has dealt with their pain for a long period of time, I often find asymmetries in their movement. I’ll find that this muscle is weak, or this muscle is tight. I'll notice that this joint is stiff or that movement pattern is uncontrolled and uncoordinated. And these objective findings are likely contributing to their repeated bouts of pain and disability, but truthfully, this imbalance of strength, mobility, and coordination is only a small piece of the puzzle.
Pain is much more complicated than simply equating, “I have some form of tissue damage here, therefore, I am in pain here”. It is multifactorial. To help yourself begin to rid yourself of chronic pain, you must, in my opinion, have some level of understanding of how pain works and why you continue to suffer from it. Without at least a rudimentary understanding of pain science, it is hard to deal with it and unfortunately it can take over your life in many ways…maybe some of which you are not even aware.
Pain is Normal. Pain is Protective
The first thing about pain that I want you to learn from this article is that pain is normal – in fact pain can be viewed as a good thing depending how you look at it.
Pain protects you from threats to your health. For instance, if you put your hand on a hot stove, the pain alerts you to a potential threat of a burn and injury to your skin. But when pain is persistent and repetitive it can take a toll on our health not only physically, but psychologically as well. And this is when it's hard to see that "pain can be a good thing".
Pain is a normal response to what your brain interprets as a threat to your well-being. It’s a remarkable system which alerts you to potential physical danger. And the larger the threat to your livelihood, the greater the level of pain can be.
For instance, a jammed finger on the hand of a professional pianist may hurt differently than the jammed finger of a professional soccer player simply because the painful and dysfunctional finger is much more threatening to the livelihood of the pianist compared to the soccer player.
The exception to the rule is a stubbed toe! Because that causes and unreasonable amount of pain no matter who you are! hahaha
Pain isn’t really something we FEEL, it’s something we PERCEIVE
You’re probably thinking the statement above can’t be true, right? “I feel my pain right now!”
Well, yes that seems true, but scientifically speaking it’s not. Let me explain...
When you burn your hand on the stove or stub or toe on the coffee table, you definitely feel pain. But pain isn’t really a sensation that our bodies detect.
We have little sensors throughout our skin, muscles, tendons, and ligaments. All different types of sensors that are responsible for detecting different things. These sensors detect things like if something is hot or cold, sharp or dull. They detect pressure, stretch, and compression. Our bodies use something called nociception to sense noxious stimuli and turn it into something we recognize which is pain.
So, when you put your hand on that hot stove your body doesn’t “feel pain”. It feels how hot it is. And based on your knowledge and past experiences, in a matter of milliseconds your brain interprets this level of heat as a potential threat to your skin and your well-being. As a result, the brain supplies an output of pain to alert your consciousness so that you do something about it to protect yourself such as move your hand away from the heat.
Therefore, pain isn’t a sensation, it’s a perception. Hence why we all have different pain tolerances and deal with pain differently. It’s why some of you may love a deep tissue massage to the point where you’re in minor pain and some of you can’t understand how anyone in their right mind can enjoy a deep tissue massage at all.
How Past Experiences Can Influence Our Pain
As I alluded to previously, our past experiences play a HUGE role in how our body perceives pain.
There’s a story told by a physical therapist named Lorimer Mosely out of New Zealand. He is a PT whose career is focused on researching and learning about pain.
He tells a story of when he was hiking in the woods years ago. And while on this hike, he felt what he assumed was a twig brushing against his ankle and thought nothing of it – he just kept on with his hike.
But an hour or so later he began to have intense pain about his ankle. When he pulled up his pant leg to examine why he was in pain, his leg was swollen, and bright red. Some of the tissue was even turning black and necrotic - the tissue was beginning to die. His pain was growing by the minute. It turns out he was bitten by a venomous snake. He rushed to the nearest hospital and fortunately survived but as he tells it, he almost lost his life that day.
Several months later well after he was fully recovered, Lorimer went on his first hike since the incident. As he was hiking, all the sudden, he felt something touch his ankle again and dropped to the floor in what he described as the “worst pain he’s ever felt”. Even worse than the snake bite that nearly took his life several months earlier.
He dropped to the floor and looked at his ankle thinking somehow, he had another snake bit him. But it appeared to me nothing more than a twig brushing against his ankle. This goes to show you that pain is multifactorial to say the least. And past experiences and the potential threat to our livelihood lead to the perceived level of pain.
This example demonstrates next major point that I’d like you to learn from this blog series -
Just like in the above example where the snake bite didn’t hurt as badly as the twig rubbing against Lorimer’s ankle. But the tissue damage from the snake bit was obviously worse in terms of tissue damage.
There’s a study I often refer to when speaking with my patients about pain. And this study looks at two factors I’d like you to understand. The fact that tissue damage doesn’t equal pain like we just discussed as well as an MRI is not the end all be all when it comes to accurately diagnosing where your pain may be originating from.
The study looked at MRI imaging of common everyday individuals in fender benders that sustained relatively minor neck injuries. Essentially these people sustained whiplash injuries which is a minor sprain of ligaments in your neck. Usually, this type of injury can easily be recovered from, however, as we’ve discussed it can affect someone differently based on how it affects their livelihood. They compared these individuals MRI scans to that of MRIs of the necks of Monster Truck drivers.
Monster Truck drivers make a living off flipping and crashing their trucks into each other. We can assume there is much more force that goes through the joints in their necks from repeated crashes at high rates of speed compared to someone in one single fender bender.
Not only did the study compare the MRI images, but they asked the participants to rate their pain on a scale of 0-10. Ten being enough pain to go to the Emergency Department and zero being no pain at all.
The results showed that the Monster Truck drivers’ MRI imaging shows much more damage to discs and spinal joints compared to the fender bender g
roup as you might guess, however, the average pain scale score for the fender bender group was substantially higher than the Monster Truck drivers’ scores.
It’s all in how they perceived their pain. Monster Truck drivers loved crashing their cars…I mean you’d have to love it to do a profession like that right?
But the average fender bender individual had just enough pain to affect their ability to work. Or to care for their children. Maybe the inability to work led to a financial issue. Maybe that led to tension between them and their spouse. Stress then goes through the roof. These factors then lead back into our perception of our pain. If your pain is now affecting all of these important aspects of your life, then this leads to feeling more pain. Again, pain is multifactorial.
So, if you are someone whose back or neck pain has kept you from performing your duties at work well, or taking care of your kids, or being able to enjoy certain hobbies, then the inability to function and live a higher quality of life will affect the perception of your pain and can be one of the factors that contributes to developing chronic pain. This is how the vicious cycle that is chronic pain can begin.
Look out for our next blog post in the series where we discuss how your body becomes overly sensitive to pain and how you begin to subconsciously develop fear and apprehension surrounding repeated pain and injury.
If you’ve been dealing with the same injury that has prevented you from doing the activities you love for far too long, then reach out to us and let us help you return to doing what you love!