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Research in pain indicates that the signals from an injury do not of themselves always say “pain” to the brain. The same signals triggered in the body that say “pain” today may just be translated as “frustration” tomorrow.
In other words, pain is cognitive: it’s an interpreted event in which the brain takes in many signals – including physical, social, psychological input – and then decides whether the combined output says “pain.”
At its most basic level, we can say that:
1. Pain is not the same thing as injury.
2. Pain takes place not at the site of injury but in the brain.
Research also tells us that the brain interprets a particular input as pain when it perceives something interfering with the body’s balance (homeostasis).
Likewise, the role of pain seems to be an action signal: a signal that, if perceived, means something needs to be changed to restore the body’s homeostasis.
3. Pain is a signal to change.
One of the challenges for rehab is that the site of pain is not always the source of pain. While pain is a brain signal, it does not necessarily tell us what is wrong. All we know is that our brain thinks something threatens our homeostasis.
Movement is the key….
Pain is an action signal.
Pain a signal to change, but not a prescription for rehab.
Pain is the brain telling us that something is threatening our homeostasis; it doesn’t tell us specifically what is wrong or what to do about it.
Pain is often described as acute or chronic. And for those of us who work out or play physically, acute or chronic pain seems to be par for the course. Acute pain would be like experiencing a twinge in your back during a squat or banging your knee into the bench. Chronic pain is the shoulder or back ache that has been around for year.
Unfortunately, the two most common sports responses to pain – work through it or stop moving until it goes away – are both largely wrong. Turns out, we need to keep moving, but, unless it’s life and death, never move into pain.
Movement we know is a key part of health. Because of how we’re wired, movement (not into pain) actually plays an important role in pain management.
Movement is a key signal to our bodies about how well we’re doing. We are designed as “use it or lose it” systems, constantly adapting to what we do.
Our bodies adapt to the demands — or lack of them — they experience. If we don’t move something for a while, our bodies begin to adapt to support that lack of movement. Unused bone disappears. Unused muscles atrophy.
Our bodies compensate in other ways too, to make up for the lack of mobility. We often get new pain as a result of those compensations. For instance, our joints may swell, or muscles may complain when asked to do work for which they were not designed.
For instance, let’s say you have pain in your right hip. You start favoring your left leg to compensate. While this makes your right hip feel better (sort of), you eventually get pain in your left leg and hip, because you’re suddenly doing much more unbalanced work on the left hand side. Then, maybe your right shoulder starts to hurt, or your neck, because you’re walking around lopsided like a boat with one oar, and it’s pulling on your spine.
Here’s another common example. Your back hurts. So you go to bed. After a few days of lying around, you feel worse. Now your shoulders and neck hurt too. Your hips hurt from the pressure of lying down. Not a great solution!
Thus, immobilizing oneself can create a vicious cycle. Compensating for one painful movement induces other restricted movements.
By staying as mobile as possible, at every joint, without pain, we signal two things.
First, movement says we are still using this part of our body and thus this body part needs resources for healing and growth.
Second, the movement signals themselves can overwhelm a pain signal to say there’s more right than wrong going on in the area: there are more nerves that tell the body how we’re moving than nerves that say there’s something wrong.
Let Pain guide you….
In the gym or on the field, if we experience a twinge, we often ignore it until it becomes a scream. The best response to an immediate pain, however, as soon as it happens is:
1. Stop what we’re doing – whether it’s a muscle cramp or just a twinge.
2. Reduce speed – recheck.
3. If there’s still pain, reduce load – recheck.
4. If there’s still pain, reduce range of motion.
5. If there’s still pain, do some other movement that incurs no pain.
In each of these tests, the advice is NOT to stop moving our body but where possible to keep moving the affected body part without pain. Find a pain-free way to move.