When I talk to patients in my clinic, the majority of them hold the belief that hurt equals harm. They are a little taken aback when I say that pain is normal, expected in certain circumstances and doesn’t always mean that movement is going to cause more damage.
This can be quite difficult to get your head around. Surely pain is there to stop us, prevent us from doing more damage and to protect the tissues. Yes, in some cases this is true but in most cases the body also needs movement and gentle activity in order to heal, but this thinking goes against the grain.
We have probably heard a million times that pain means damage, or have been told to only work within pain limits or stop when you get pain. This view may be reinforced by health professionals, family members, even strangers in Tesco who appear to become experts in pain science (other supermarkets are available). Over time. we build up an understanding of what pain means and most of the time we worry if it doesn’t settle. One of the things most people do in this situation is to reduce activity, we feel in control if we do that. Someone told me once that if they felt they were “creeping around pain”, if they moved slowly and carefully the pain wouldn’t notice the movement and therefore wouldn’t hurt!
Think about it though, the body is designed to move. It moves, not only to reduce joint stiffness and prevent muscle wastage but also to help the nervous system and the immune system to direct cells to where they are needed in order to promote healing. The body needs movement to tell other systems what to do and hopefully they will mount the appropriate response for recovery. The body relies on this feedback system to be healthy and maintain homeostasis and balance in all systems. An alteration or perturbation in one system will likely have an effect on another. This naturally causes worry and concern, ‘what’s happening?’ ‘why does it hurt when I reach forward?’, ‘it hurts to drive the car and I need to get to work’. The common reaction is ‘well I won’t do that activity then’. Suddenly we link to bigger things as the fear of pain may have far reaching consequences.
We fear what we don’t fully understand and to be fair, pain science isn’t really explained that well in many cases and if you Google search info on pain it can be confusing and not that accurate in the advice it provides.
In the book Explain Pain by David Butler, there is a lovely picture of the twin peaks where tissue tolerance and pain are depicted and it explains beautifully how reducing activity can further reduce our tolerance to activity and pain may be felt earlier than pre injury. If we do less, we get pain earlier, so we do even less and so on. This is a common mistake which causes more worry and stress.
But don’t panic because there are ways we can increase tolerance to activity once again and get back the confidence to do more without damaging the tissues, or worrying about damaging the tissues. I am by no means saying that it should be ‘No pain, no gain’ but pain doesn’t’ have to mean STOP. We can de-threaten using a little graded exposure, gradual movement and education can help restore that balance in our body and its integrated systems. Slowly, with tolerance and by pushing a little further each day the tolerance level gets higher, step by step we can do more before pain sets in.
It’s amazing how simple reassurance and supported rehabilitation with education and understanding can get people back on track. They no longer have to stop or avoid certain activity, they can push the limits and get back to normal. It’s no longer a stop sign, just a give way.