My pain stops me from going to the gym. I used to be able to play football with the kids but can’t anymore because I know it will hurt my back. I had to can’t run anymore because it was causing more damage. I have been told that rest is best for me. Don’t want to keep irritating it. It’s just going to get worse over time.
Sound like anyone you know? Sound like you? Ever wondered why despite all the rest, stopping of all the activities you love and continual lifestyle changes, your pain continues to get worse?
Surely if you didn’t do the things that cause the pain the pain would get better right?
Well not really. Today I am going to let you in on a little secret. A secret which scientists have known and been researching for years, a secret which all good therapists are aware of but struggle to communicate to patients, a secret that can change your life, decrease your pain and get you back to some of the activities you love.
Do you want to know that secret?
Of course you do so here it is.
THERE IS NO SECRET!
Now I know that you are probably a little disappointed with this but trust me it’s a good thing that this is not a secret. Despite it not being a secret you may not have not heard this principle before and/or have not had it communicated to you from a healthcare professional.
The principle is simple………..Focus on what you can do and not on what you can’t. You are probably wondering why you have stuck around to hear such a simple principle. Well let me tell you. The magic is in the application of this principle. The benefits are in the application. The pain relief, the improved function, the life changing results are all in the application.
SCIENCE EXPLAINS WHY!
Let me introduce you to the concept of “fear avoidance”. Fear avoidance is quite simply, not doing certain activities, movements, sports, postures etc due to the fear of pain being associated with that activity. There is ample published research which concludes that patients who adopt pain behaviours inclusive of fear avoidance are at higher risk of pain chronicity (long term pain).
Just because that activity produced pain at some point in your life, it does not mean that you have to write of that activity for good. Let me tell you about a recent example of a patient I had in clinic.
Here is the condensed version of the story.
Patient B came to me with a 6 month history of knee pain which was made worse by running. When presenting to me the patient had rested his knee from running for the last 5 months. In fact the patient had stopped exercising entirely. Since stopping exercise this office based gentleman had developed lower back pain, despite no history previously. He was also still aware of his knee despite limited pain, feeling “not quite right”. I assessed his knee, reassured him there was nothing to worry about and after a little treatment he was back running the next day. No knee pain and the back settled within the next week.
Yes I really am that good. Now bow down to your lord and saviour! ; )
I am only messing about. In this instance it was not his pain or disability which was preventing him from running and it certainly wasn’t my treatment which got him back on the road either. The fear of pain related to his running stopped him from doing that activity.
Now how many of you have stopped an activity you love because it was causing you pain? How long has it been since you have tried that activity? Days, weeks, years, decades? Go out and give it a try!
REST IS NOT YOUR FRIEND
Conventional wisdom would state that if you are in pain the best thing to do would be to rest and wait for that pain to go away. Well conventional wisdom is wrong……..very wrong. Over the last few years pain management has evolved to the point where it is very rare that I would advise complete rest when in pain. Instead of rest it is much more appropriate to use what I like to call “activity modification“.
Activity modification is about carrying on doing as much as you can without leading to further pain. Activity modification allows you to function and work around your pain. If you are getting pain 26 minutes into a run and normally run 5 x 50 minute runs a week, activity modification would mean running 10 x 25 minutes instead.
If you are getting pain in your back after sitting for an hour. Activity modification is about changing the way you sit or getting up and having a sitting break before the pain starts to kick in. There are endless examples about how this can work in practice and trust me when I say this method is a highly effective way of managing your pain in the short term.
The long term goal of course is “activity reintroduction“. This is a process of slow reintroduction to activity which allows you to return to the thing you love in a pain free way. I won’t blabber on too much but these are 3 of the steps I use to manage a lot of my patients and get them back to full health.
1. Activity Modification
2. Activity Mimicry – Using pain free movements to mimic similar movements to the activity causing them pain.
(Steps 1 and 2 dones simultaneously)
3. Activity Reintroduction.
PAIN CORRELATES TO TISSUE DAMAGE
This common myth is something that I have to dispel every single day in clinic.
“What have I done?”
“I know it must be bad.”
“I have really done some long term damage this time, I can feel it.”
Let me reassure you quickly. Pain does not correlate to tissue damage, not even in the slightest. This concept is relatively clear in the scientific research.
If you MRI scanned a slice of the population, many of the people scanned, despite no pain at all, would have tissue which would think would cause pain. Disc bulges, osteoarthritis, ligament strains etc etc all conditions which are associated with pain but in this instance no pain associated with the condition.
So what is going on here?
Pain is very complex. More complex than we can give it credit for. Despite it’s complexity we now understand this phenomenon better than we have ever done in the past.
What happens at tissue level does matter. If there is damage to your tissues, irritation, inflammation your nociceptors (sensory receptors in the tissues) will send signals to the brain for processing. The most important thing though (in terms of pain), is what the brain decides to do with these messages/signals.
Are they perceived as a threat? Is there fear associated with these signals? Is there a memory of past trauma to the area? If so these messages are more likely to be interpreted as pain. If the opposite occurs and there is no worry associated with the signal, no past trauma, no memory, then the signal is likely to be taken less serious. I know this is a hard concept to grasp so let me word it a little differently to see if it makes more sense to you.
Let’s use two people. Bill and Bob.
Bill is a 45 year old, self employed bricklayer. He works long hours, 6 days a week to feed and house his wife and two young children. Bill lives by each paycheck and has to go to work every day just to survive. Bill has had previous back pain and had to take 2 months of work last year with the pain. Bill bends over one day at work and strains his back. He is immediately in intense pain.
Now let’s look at Bob.
Bob is a 45 year old, retired banker. He now spends his time playing golf with his friends and occasionally does some consultancy work to keep him busy. Bob also has a wife and young children but is financially very secure. Bob has never previously had back pain. Bob bends over one day picking up a golf ball and strains his back. He is immediately in intense pain.
Both Bill and Bob visit an osteopath and are both given a diagnosis of L5 discogenic pain. For the sake of the example an MRI was also taken and both injuries were shown to be identical.
Who statistically, will be in more pain and whose pain will last longer? Bill or Bob? Same injury? Same age? So who do you think, Bill or Bob?
Congrats you guessed it, statistically Bill is likely to be in more pain and likely to suffer for a longer period of time.
The emotional attachment related to the pain is much more significant is Bill’s case. Bill needs his body to work, without work Bill gets no money, without money Bill cannot pay his mortgage or feed his family. Bill also has a previous history of back pain, pain which caused him to take 2 whole months of work.
The emotional attachment related to the pain is less significant for Bob. Yes, he loves to play golf but actually as the season is coming to an end now is probably a good time to go on holiday anyways. With no history of back pain and no financial commitments, the back pain is less concerning to Bob.
Can you see how these two scenarios despite having similar injuries, may cause each of the above to experience the pain in slightly different ways? An ankle sprain might concern a professional footballer more than an accountant. A sore throat is a bigger concern to a singer than a dancer and so on……
IF IT HURTS I SHOULDN’T DO IT
This is always a very interesting thing to discuss. There is lots of logic behind avoiding activities that hurt and I am going to agree if something causes you pain then you may need to modify or mimic that activity first before returning to it fully.
But what about if the activity is only causing a little bit of discomfort. A slight pull? A small ache? Should we still avoid this activity? I would say NO! Lot’s of the time, these small aches and pains are simply caused by muscle tightness and tension. The best way to relieve this tightness is quite simple……Move the area more!
I will use myself as an example here.
If I spend long periods of time sitting (writing a post like this for instance), I start to get some stiffness and discomfort in my lower back. If I didn’t know any better, this discomfort might start to concern me. In reality this discomfort is of no concern at all. All that is happening is my muscles are tightening up from prolonged sitting in an awkward posture. Once I get up, move about and stretch the areas I know are tightening up, the discomfort goes away.
When I am stretching the muscles it is not always comfortable. It pulls, feels tight and awkward as my muscles try to resist the movement. Once I get the movement back however, all the discomfort goes and I am free to slouch again for another few hours ; )
Restoring movement in the area is extremely powerful. Good efficient movement is what the body likes, it is how we were designed. When you are moving better this information is fed back to the brain and you are rewarded with less stiffness, less anxiety around those movements and ultimately less pain.
LET’S RECAP QUICKLY…..
Take away one of these 4 points and you will be one large step closer to decreasing your pain.
1. Don’t be afraid of moving due to fear of pain
2. Modify your activities instead of resting
3.Pain does not correlate to tissue damage
4. A little bit of discomfort is okay
Act today and get back to living your life. Pain does not have to dictate what you do with your life. If you let it, it will. You are in charge of your body. You are not controlled by your pain. Most can control their pain with the right actions!
THINK CAN NOT CAN’T
If you would like more specific advice on any musculoskeletal issue feel free to give us a call (01582 433758) or book in to come visit us at the clinic.