Pain gets a bad wrap. Its something every human is familiar with and has experienced at some point in their lives and even though our understanding of it has come a long way in the past quarter century many people (yes, that includes health professionals like physiotherapists and doctors) don’t understand it very well. Many of us view pain as the enemy – an annoyance, an inconvenience, something that needs to be pushed aside or covered up with drugs but pain is a valuable adaption that needs to get the respect it deserves. This article aims to clarify why we get pain, how it gets transmitted in the body, how to use it to your advantage and how to conquer it.
Why do we get pain?
The concept of pain is easier to understand when you know its purpose. Put simply, pain is an evolved adaptation designed to protect your body and its purpose is to motivate behaviors to protect the body from perceived threat. When you touch a hot object, heat sensing nerves relay an alarm signal to your brain which emits the feeling of intense pain in your finger and triggers you to withdraw your finger to avoid further damage. Its like the alarm system in your house – when it detects danger it signals the need for protective action. Its so valuable that if you were unable to feel pain (an actual disorder in some humans), you probably wouldn’t survive very long.
The sad truth is that most people live with pain on a daily basis to varying extents. Ask a group of 100 people to raise their hand if they are painfree and you will be shocked at how few hands actually get raised. Why are so many people in constant pain? Here’s a simple answer: Most people look at pain as an inconvenience that needs to be silenced with pills, injections, surgery etc. They don’t look at pain as a smoke signal that something in your body is not functioning optimally and that if things don’t change serious injury will result.
Someone running with knee pain will buy a new pair of shoes, get orthotics, get a cortisone injection, take some advil or train through the pain until they just can’t do it anymore and then go see a doctor or physical therapist. By then they’ve blasted through the cartilage at 5x f the normal rate, have to cut their running career short and could live with knee pain until they go under the knife and get an artificial joint. Option B: At the first sign of knee pain, review your running form and muscle imbalances and correct the way you run. Disaster averted. Moral of the story – look at pain as your engine light turning on and address the issue before your engine explodes.
Pain is in your brain
All pain comes from the brain. Pain – a bad feeling – is a signal emitted from your brain to your body based on a perceived or actual threat. PERCEIVED is the key word there because pain can exist without physical injury and injury can exist without pain. Saying that pain is in your brain is not to say its not real and that you can just think it away. Its means that pain is a conscious experience created by your brain and not simply from damage to the body.
Here’s an example: a man is admitted to the emergency room with a nail through his boot and is in excruciating pain. The boot was removed and revealed that the nail narrowly missed his foot and his pain disappeared. If you think you’re injured you will feel pain. If you THINK you feel better you will literally feel less pain. Another example is phantom limb pain – someone with an amputated leg can have intense pain sensation in the limb that has been removed because the brain signaling pathway for pain in that leg is still active.
Pain is also a very complex phenomenon. Receptors within the body are only one source of information that the brain considers when deciding to create a pain signal. Many other factors are also considered by the brain when computing whether a threat is real and how severe it is. A few examples of these other factors are: memories of past of injuries, emotions, stress level, opinions from professionals, anticipated consequences, and your knowledge about the body. A broken finger will likely be a much more painful injury for a professional baseball pitcher than a professional cyclist.
Its all about perception
Perception is the organization, identification and interpretation of sensory information in order to represent and understand the environment. Magicians use misdirection and distraction to create the perception of something that isn’t. Just like we can be tricked by magicians, our brains can sometimes misjudge the severity and reality of a perceived threat which is then reflected in the pain we feel.
Just like the guy with a nail in his boot, if the brain thinks a threat to your safety has occurred, it fires off pain impulses. Pain protects against “perceived” threat, not actual threat – that’s a very important point because if you change the way your brain perceives an injury or a movement, you change the way it reacts with pain signals. A good example of this is a low back muscle strain that becomes intensely debilitating. The muscle strain is no catastrophic injury but if the brain perceives that tissue damage as potential threat to the health of your spine, it will stop you in your tracks by creating intensely painful jabs with every step you take as a way to force you to rest.
Convince the brain a previously painful movement is now safe and you have removed the perception of threat and the need to create pain.
How you perceive an injury also plays a large role in the psychological contribution to perception of threat. If you think something is going to hurt a lot – it will be more painful. If you foresee serious consequences from an injury – it will be more painful. If you feel you have no control over your pain or your ability to recover from the injury….it will be more painful.
The meaning you associate with a particular stimulus also makes a difference in how your body perceives it. When you roll a lacrosse ball over a tender and tight area of muscle, if you feel it’s a beneficial type of pain it will be less painful. If you think its damaging your tissues it will be more painful. Humans have a surprising amount of influence over our experience of pain, we just need to realize it.
Longstanding pain becomes a learned pattern
The body learns through repetition and this principle applies to pain just like any other movement or motor pattern. If every time you squat or run you get knee pain, the body learns to associate that movement or activity with pain at your knee joint. The more repetitions you put in with pain, the harder it is to break the learned pattern and the pain signal becomes more easily triggered.
Learned pain patterns can become so deeply ingrained and wired that a movement being done without creating any actual damage signals pain because the two are so tightly associated with each other. I spend more time in clinic working to reverse these ingrained patterns than I do working on tissue healing.
Easy way to avoid these painful patterns: address the pain as soon as it starts. The longer you wait the more work and pain you need to endure to reverse the issue.
Avoiding serious pain
Not all pain can be avoided, random injuries and mild issues are part of being a human but there are things you can do to reduce your chances of developing serious pain that interferes with your life:
- Screen your movement. Muscle tension, imbalances, poor movement patterns, poor lifting technique. These are all precursors to pain and are things that can be addressed before pain starts. Getting a movement screen from an experienced physiotherapist can spot issues before they become painful. A good physio will let you know what needs to be worked on and teach you how to correct the issues.
- Don’t procrastinate in dealing with pain. The longer you wait the longer it takes to get rid of
- Make time to maintain your body. We do a lot of things our bodies aren’t designed for. First and foremost is sitting. Reduce your time in a chair and learn how to do basic maintenance on your body to reverse the effects that sitting is having on you.
- Take steps towards healthy habits. This is a big one for both avoiding pain in the first place and also helping to get out of pain. Eating better, sleeping better, reducing toxins, reducing stress, healthy relationships – they all go a long way.
- Pain isn’t always bad, what you do with it determines your fate
- Use pain as an indicator of issues that you need to address
- You can have pain without injury and injury without pain
- Pain is an output from your brain and not a direct signal from your body about tissue damage
- Your perception of an injury plays a big part in how much pain you feel and the speed at which you recover
- Get a yearly movement screen, spend time maintaining your body, adopt healthy habits and a painfree life can be yours
Better knowledge about pain – why we get it and learning to use it to our advantage – is a powerful element in becoming painfree. Knowing you have power over pain reframes your perception of it and puts you back in the driver seat to steer towards optimal health and eliminating pain. I hope this article changes the way you see pain and gives you a sense of control over your body and quality of life.