My chronic back pain is no secret. In fact, it was one of the reasons I started to exercise. I was told I had Ankylosing Spondylitis (albeit a mild form) and that exercise would “stop your spine from fusing”. The doctor did a good thing encouraging me to move more, it’s just a pity he also didn’t explain how pain works. Perhaps I can use my experience with pain to help others who have pain in a way I could never have done before. What I am going to share over the next few weeks aren’t just 5 things that have helped me (although they have); these are quite possibly some of the best options out there to help your current pain or any future pain.
Before I begin I want to underline something very important: these methods don’t work overnight and ought to become part of every day life so that you can begin to change how you think and respond to pain. When I first saw some success from these methods, I was filled with hope and confidence in them and I felt “cured”… but what I hadn’t adequately prepared for was the occasional relapse. It is during the “bad” days that you need these strategies to be well ingrained and for that faith in the process and the journey to keep your nerves “intact” (pardon the pun). It’s very easy to allow the distress of pain to rob you of hope in the bigger picture and for you to fall into the trap of assuming that you have regressed to square one and you no longer believe that the strategies are working. That is why it is so important to always count your blessings and remember each improvement and set your mind on positive things, rather than always on thoughts like “am I still in pain?”.
I wanted to make this one blog post, but after writing out the first strategy, I realised it might be better to split this information into smaller parts to help you assimilate it all. It can be a lot to take in.
1. I learned more about pain
For years we have heard from Doctors, Physios, Chiros, Massage Therapists, and even Trainers (and I am guilty too) of spreading misinformation about the causes of pain.
“Your leg length is off”
“You have flat feet”
“Trigger points”
“Your pelvis is out of alignment”
“you’ve blown a disc”
“Your back is a ticking time-bomb”
“I just have to look at you squat and my knees hurt”
“Watch you don’t wreck your back when you deadlift”
“Your diaphragm is dysfunctional so all your pain stems from there”
“You have bad posture and that’s why you have neck/ shoulder/ back pain”
“Oh, you have back pain? Your Glutes are weak and you have tight hip flexors.”
The list of things I have heard is endless.
Basically, what seems to happen is that therapists correct what they think is “off” and pain might initially improve. So they rationalise this like so:
– You have pain and X is tight
— Work on X’s tightness
— pain improves
—-therefore X was the cause of pain
Bingo!
Hmmm, NOPE!
There is a rather large body of evidence that now shows us that posture, structure and biomechanics are poorly correlated with pain. Meaning, they are unlikely causes of pain and improving or “fixing” these play less of a role in healing pain than was believed for a long time. And, if someone tries to explain your pain’s origin as a tightness, imbalance, weakness, poor motor recruitment, poor breathing, poor alignment – close your ears. Treating said tightness etc might help, but that is not proof that it was the cause!! This is very important to remember. Think of it this way: Are you sore because you’re all twisted up or are you twisted up because you’re in pain?
Being somewhat lazy and a little rusty on how to reference properly, here are a few blog posts that have great authors who did that work for me. If you’re anything like me, you might appreciate reading a blog article that is making sense of the research, rather than reading the research itself.
– The Real Reason You Still Have Back Pain
– Does Posture Cause Back Pain?
And, of course I enlisted the help of my very smart and handsome husband, Dr Jonathan Fass, DPT in an effort to iron out some commonly held myth-beliefs about pain and injury. Find that HERE and remember to check out the list of resources at the end of that article too.
Yes, there are other resources, but I like these ones because they cover all the basics. And that is always the best place to start. Lay the foundations and build the rest as you begin to understand it.
So what is Pain?
I felt it was important to talk first about what pain isn’t (a signal that comes from the muscles, joints or bones) so that we can better grasp what pain is (a signal that comes from the nervous system, and is governed by the brain). Pain is not always indicative of tissue damage/injury, and it is not proportional to damage. If you have more pain today than yesterday, this does not mean there is more (or any) damage. When you have pain, your brain has received danger information from one or many locations within your body (via the vast network of nerves) and has decided that it warrants some pain to change your behaviour and protect you from something that is *perceived* as a threat.
And I get how confusing that is!!!
When I first heard this stuff (a couple of years ago) I failed to assimilate it because I got defensive and thought it was suggesting that my pain was all in my head (as in, imagined). But actually, *all* pain from is the brain (and nervous system) – even if it’s just a stubbed toe.
At this point I want to highlight something so that you don’t misunderstand me. I am not saying that pain is somehow not physical. It is physical, but these physical changes and responses happen within the nerves and brain. Before, I always thought pain came from damaged tissue and it told my brain it was in pain, but this is not the case. The nerves deliver a message about what’s happening (toe got stubbed on the table) to the brain and the brain then decides whether pain is needed. However, sometimes this system doesn’t operate as we would expect.
For example:
You stub your toe just as a lion jumps in the room. Are you going to have pain in your toe? NO WAY! Your brain will delay that until you are safe enough to tend to your toe.
And there are many other times when the brain and nervous system respond in ways that really do not make sense if all pain is from injury:
Have you ever discovered a cut or bruise that you didn’t know how you got?
Does your pain get worse when you’re stressed?
Does your pain get worse when you’re tired?
Ladies, do you feel more pain before or during your period?
So, pain is a response (like an alert) from the brain to a danger signal from the body. BUT, the “alert” may be very very quiet (only a little pain) or VERY VERY loud (lots of pain). And if you’re like me, and your pain seems to get worse for no apparent reason, it can be very disconcerting and cause much unnecessary confusion and angst. This is why knowing how the nervous system interprets information will help reassure you that when you get a bad pain, it may not be because something has gone seriously wrong.
So what amplifies that “alert”?
Now consider each of these things potentially “ramping up” your nervous system’s alarm sensitivity, making that alarm ring a little bit louder:
– Not knowing about how pain works and what it means
– Stresses (family, work, money, health worries or fears)
– Thinking the worst (catastrophising)
– Fearing movement because you believe it is causing damage
– Depression and lack of sleep (this can be a vicious cycle for someone who already has pain)
– Loss of motivation to train (maybe because of fear or depression or hopelessness – or being told not to train by a well-meaning physio or doctor)
– More pain
– Fear of pain itself
– Beliefs about your pain and/or diagnosis
– Oh and even hormones, temperature and your immune system can contribute to your pain *experience*.
There are more things that could potentially go onto this list, but you get the gist.
Factors like these can play some sort of role in your pain experience. Even if you do have an acute injury, it is still helpful to understand why some days your pain may seem worse, even when healing is under way. Pain does not mean something isn’t healing. The body is very good at healing its tissues, but sometimes after an injury the nervous system becomes more sensitive as a way to guard from a repeat injury. After all, if anyone has ever been in severe pain, you’d do anything to prevent it happening again, right? So, depending on your circumstances, your beliefs, your history etc etc your pain experience will differ greatly compared to someone else. But you also have a lot of control over many of these factors – and that is great news! And even if you can only influence your knowledge about pain, that has been shown to help pain.
Pain as an experience.
No one has the same experience of pain because there are so many factors involved in pain’s creation: memories, beliefs, smells even. But guess what? That means *you* (the person dealing with pain) have more control over it than you may know. It is quite helpful to become proactive about your pain triggers – without obsessing on them. If stress is a trigger, then you can use some of the other strategies to help with that. If beliefs are an issue for you or fear, then this educational strategy will really help.
For years I expected someone else to fix me. Either by massaging away my tight fascia, teaching me “good alignment”, correcting my “dysfunctional breathing or movements” or by prescribing me better medicines. These strategies are called “bottom up”. While many of those things can help pain, they don’t get to the root of it and you often end up seeking more treatments and getting more investigations, which don’t have as much success long-term. Since pain is governed by the brain, then surely we ought to focus our attention there to see what can turn down the alarm. The best pharmacy, after all, is right between your ears.
By using the next 4 parts of this series, you will learn a total of 5 “top-down” strategies (education is also a “top down” approach) to radically influence your pain.
Life and death is in the tongue.
Do I still have pain? Yes, but it is MUCH better than it was, but the main thing is that I don’t respond the same as I always did – which was the belief that there was something wrong with my tissues, joints, posture, breathing etc. I thought I was broken and I was at odds with my body. But now I see that my body is healing and movement is good. Avoiding movement (and this happens if you begin to believe that some movements or postures are “bad”) can actually cause you to have the very pain you are trying to avoid.
Which brings me on to another issue that comes from the words and reactions of therapists, doctors, trainers, and even the beliefs within a society about pain. There is a good amount of research into something called the nocebo effect (the opposite of placebo). Basically this means that the beliefs you have about your situation can make things worse. For example: If someone is told they have “blown a disc”, how do you think that will affect their beliefs about their back? It could potentially make them fear moving their back (because they believe pain = damage) and this fear increases the alert which increases the brains output of pain to protect that “weak” and “vulnerable” area. Pain is protecting against a false danger. This person could live for years in chronic pain because they started to fear moving their back. And they may actually begin to get other pains (in their hips, down their legs or their sides) because they have become so stiff and “braced” in order to support their back that these muscles never stop bracing. Can you imagine clenching your fist all day every day? That would eventually hurt, right? So these words can have real negative effects on people’s lives. Instead of being told that discs herniations are very common, that they heal and movement is good, they are told never to lift or flex their back again. Plus backs are strong and the disc may have had very little to do with their original complaint.
But don’t take my word for it – read the articles and set yourself free from believing all pain is caused by tissue damage.
Here’s another little list from smarter people than me who have listed the research.
– Nocebo Effect: Your Power of Suggestion May Harm Clients
– Spinal Discs, osteoarthritis and degenerative joint disease with pain
– First, Do No Harm – language can harm!
Now you have 1 major tool to help you reduce your pain. Just understanding pain has been shown to reduce it.
Pretty awesome, right?
I expect there will be a few questions after reading through some of this material. Feel free to ask and I will try my best to clarify anything.
Also, if you want references for anything I have said, I will be happy to provide them in the comments.
Additional Reading Material:
– Therapeutic Neuroscience Education (2013) by Adriaan Louw
– Explain Pain (2013) by David Butler and Lorimer Moseley