The pain game. Wake up, try to avoid pain, hurts anyways, go to bed. Wake up, try to avoid... you know what I'm talking about.
It's outrageous to think that pain should be such an imposing nuisance on our lives. We have things to do. Sports to play, events to train for, kids to care for and co-workers and bosses to impress with our awesome personality. Pain somehow puts a damper on all of these things. When it hurts, nothing is as good. Going out to eat sucks because who knows what kind of chairs they have, visiting friends sucks because sitting on that airplane is going to be hell the rest of the day. Even your job sucks....but that could be for a different reason.
My goal as a health care practitioner is to bring people back down to reality. Certainly I have been caught with my head in the clouds once or twice but the nonsense that gets thrown around daily by other HCP's regarding pain and movement needs to vanquished (clearly a huge Harry Potter guy). Let's discuss why you are having pain, then maybe you might be able to reconsider your relationship with that recurring nagging nuisance that is quickly becoming normal in your everyday life.
Disclaimer: this will not be a pain science blog, merely a practical approach to explaining human nature.
As humans, we are a series of feedback loops with constant adjustment and adaptation. You sense hunger, you eat, you get full, you stop eating. You eat for energy to be able to acquire food. It's genius. What a perfect creation of nature or god or both (I am not just riding the center line, I believe in both) that allows us to continue to survive in a world where a ton of things are edible.
Buttttt.... what about obesity and all the adverse effects that come with it?
You sense hunger, you eat, you get full, you stop eating....but somehow you've eaten more than your body is able to utilize and therefore stores for later. Is that a faulty feedback loop? Is our genius human system all of a sudden broken? After surviving 10's of thousands of years (goes without saying, everyone believes in dinosaurs) we happen to suck at how much we should eat??
Or.... is that feedback loop just fine. And maybe the external pressures of our society influence this feedback loop. A society where easily acquired, high density foods that taste A-FREAKIN-MAZING are readily available and consumed in settings where distraction from sources like TV, work, driving (Jesus help us here in Dallas) are there to take up brain waves that should be monitoring our food intake.
hmmmmm idk, I'm just a physical therapist...SO GET TO THE PAIN AND MOVEMENT STUFF THEN NERD.
Pain is a feedback loop. You bend forward and your back hurts, you don't bend forward and your back doesn't hurt. Does that mean that bending forward is bad? Or that any activity that requires this motion is "inherently bad for the spine" ABSOLUTELY F****NG NOT. There is nothing wrong with flexing or side-bending or twisting your spine. You need to and cannot truly avoid it without the surgical intervention of rods and screws that always seem to put their recipients in the same place, the PT office. But why does it hurt then?
It starts hurting because something you did, or do, causes it to hurt. It might be a prolonged posture, it might not be. It might be your squat technique, it might not be. It might be a number of small things that would not hurt someone else, but it hurts you, and now it won't stop hurting. The feedback loop isn't broken! You are either continuing to do the same things or... just like the TV and the guy in that Lexus flipping you the bird, you are distracted! Distracted from your normal regulatory system. The easy fix, stop bending forward for 3-5 days, then ease into it. If it helps keep on, keeping on, your fine. If it's not working, then we need to slowww it down and take a look at your regulatory system.
Regulatory system you say? That's not something my doctor mentioned. That's because your doctor thinks he/she is your regulatory system. High blood pressure, here go take this, your back hurts, here go get one of these, your knee is bothering you, this should help "keep it in place." (For clarification, quotes are to signify bullshit). Your regulatory system is comprised of your heart, lungs, organs, skin, muscles, and oh ya, everything else in your body. They are all connected by the power of your brain and its ability to appropriately send signals in the form of nerve signals and hormone release into the blood stream (other things send signals too, back off trolls). If your nervous system is overloaded because of stress, stress from work, kids, pain, exercise (that's right, exercise is stress, no this isn't bullshit), lack of sleep, eating high density carbo-loaded meals 4-5 times per day...you might need more than a cortizone shot and some home exercises.
On top of that, though not to frighten you, your body has this amazing ability to pair feedback loops with movement patterns. If bending forward hurts, you start stiffening up your back and refusing to round it. Your brain literally begins to perceive you bending down, rounding your back, even though you are not. You begin to adapt! Amazing!!
Not so amazing is the way that it feels. It feels like something has changed and it is not advantageous. I refer to these as compensations (busting out the italics out of nowhere). Compensations arise to keep our bodies mobile, make us energy efficient in the tasks we most often perform, and avoid experiencing pain.
So now what do we have. We have a painful, compensatory movement pattern with no solution. Or is there a solution, and only some wise gurus have it? Where can I find one of these gurus? I recommend the Mike Myers Film "The Love Guru" (help Averill I cannot remember what goes around movie titles " " or ____). I recommend this movie not because I genuinely believe its hilarious. If you have 87 minutes to sit down and watch a film that got a 17% on Rotten Tomatoes, then you most definitely have 60 minutes to evaluate your life and legitimately seek to understand why you are in pain. Let's start again...
Are you exercising? Is your exercise routine enjoyable? Is your exercise routine varied? Is your exercise routine causing you pain?
3 yes's and one no. Perfect.
Are you taking time for yourself? Do you pray or meditate? Do you fear any of your normal activities (pain related or not)? Do you think positively about those closest to you and yourself? Do you feel overwhelmed by any one, or combination of situations in your life?
Doing good on these too? Great.
Do you eat sensibly (meat, vegetables, grains)? Do you eat meals with other people? By yourself?Do you eat while distracted by TV, work responsibilities or stressful situations (like your brothers eating faster than you to get down to the Nintendo first)? Do you have any idea of what is considered to be "processed" food and do you avoid it like the plague except maybe once or twice a week if you are a model student in all other categories?
Doing well on this one too huh?
Do you sleep? Is it 7-9 hours per night? Do you wake up feeling tired as heck or refreshed and ready? Do you have a reason to go to bed, or do you go because you are tired? (This question I recently started asking because when I am tired, I sleep great, when I have to because I have work in the morning, I can be exhausted. The solution, get up at the same time everyday so you are tired when you have to go to bed). If you follow 90-minute sleep cycles are you getting to bed 20 minutes before the first cycle in order to really wind down and go to sleep?
Still doing good? After all those you must be kidding me. Most of those questions were landmines, nobody walks over all of them. I am impressed. Are you still in pain?
If you have a near perfect life, and all you are experiencing is pain, then that might be the newest red flag. Red flags indicate serious issues. If you have been checked for serious issues (cancer, fractures, etc) and you have had this pain for several years. Then you are still not an anomaly.
Persistent pain has the ability to teach our brain. (Oh no, you said this wouldn't be a pain science blog, damn nerds!) The same way that doing a deadlift over and over can improve your deadlift skill, feeling pain over and over can teach your brain that there is pain there, even with no associated damage. So what do we do?
First we slow it down. We perform techniques or exercises that eliminate unnecessary tension. Then, we get moving. We identify everything that you want to be able to do, and we work up towards it, mainly with strength and conditioning concepts. We take a big goal, say, to be able to run, and break it down into smaller goals. The ability to mini squat, the ability to stand on one leg, to hop on one leg, to hop scotch like school yard boys and girl, and then we teach you to run. Just like you learned to run, ride a bike, play baseball whatever!
But what if it hurts?
Did you ever fall off a bike as a kid? Did your mom give you a percocet and say stay off it for two weeks? NO. Because there IS ABSOLUTELY NOTHING WRONG WITH PAIN. It is a feedback loop. If something hurts, we back off of it. Assuming no major damage (swelling, red skin bruising), we gradually move back into the same thing that taught your brain it hurts. This process will help you brain to desensitize and learn that it doesn't hurt. It should go without saying that more is not better in this case, but nothing at all is definitely worse. And no, running most definitely does NOT wear out your knees. If might hurt it you haven't done it in a while, but that doesn't mean your "knees can't handle the impact" (the bullshit quotations again).
Moral of the pain story, stop fearing pain. You don't fear hunger, or thirst, we just respond to it. If your response is so severe that you feel it's out of control, get it checked out, then get it moving again.