*Disclaimer, this blog is addressing non-specific, atraumatic, and/or chronic pain.*
I tweaked my hip squatting; I hurt my back a long time ago; I made an awkward movement while overhead pressing and hurt my shoulder; my knee has gradually gotten worse over the last couple of weeks while running; what could it be? I get asked questions like these everyday. The answer may be that sometimes it doesn’t matter. Pain science would say that pain cannot always be trusted. But what is pain science and what does it mean?
Sometimes it doesn’t matter
Pain science is a fairly new branch of modern medicine that is concerned with what pain is, why we experience it, what systems are involved, and how can we treat pain. Remember that pain is a normal sensation, we don’t like it, but we also have to accept it as normal. In any case, the most widely accepted definition of pain in the scientific community is:
“Pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms.”
Key points in that definition: that pain can be related to emotion and that it can also be related to potential tissue damage. Pain science has also uncovered truths about pain, including that pain can be heightened by:
- Emotion
- Stress
- Fatigue
- Memory
- Sleep
- Decreased blood flow
Pain can be biased. If you think something is going to be painful, you will experience pain while you attempt to do that one thing; and the more painful you think it will be, the more painful the experience will be.
Even worse is, if your pain has gone on for a long time, you start fearing movement (fear avoidance behavior) and catastrophizing (thinking it’ll never go away, there’s nothing that can be done to improve it). All those things will feed on themselves and not only propagate pain but can make it worse. And this all goes on despite the fact that if your injury is older than three months any tissue damage has most likely healed. That’s correct, there is no longer physical damage but you can still be having pain in the case that it has persisted for more than a couple of months.
Let’s go back to the beginning. Sometimes what structures are involved in pain may not matter? We’ve learned that pain cannot always be trusted and can be related to numerous other factors. We learned that it isn’t always related to tissue damage or severity of tissue damage and it can persist after the tissues have healed. But then how do I stop it from hurting when I try to do what I want to do? A health practitioner can help you with that by introducing these 4 important topics:
1) Graded exposure
2) Noxious input
3) Appropriate programming/loading
4) Education
It has been argued that most non-traumatic injuries are a result of programming mistakes, meaning that you exercised too hard and have now developed non-specific pain.
If you think that something is going to be painful, you will experience pain while you attempt to do that one thing…
To sum up: 1) pain can be created by your brain and 2) pain is related to your memories, stresses, emotion, sleep, and fatigue level. Pain cannot always be trusted and isn’t always related to tissue damage or severity of tissue damage. This is all good information, but why and how does it matter to you? You might be still in pain and can’t do what you would like to do. We can help with that.
How I can help get you back to doing what you want to do?
1) Assess and evaluate your pain
2) Change your pain experience
3) Education on what you can do to help your pain
3) Help you program your fitness activity as to not overload the system
As always, I hope this helps! If you have any questions or would like to read about certain topics, send us an email at TeamSP@SportsPerformancePT.com.
-Dr. Nick Schroeder, PT, DPT, CSCS
