In our last post, Dr. Zak Gabor and I, attempted to challenge your current understanding of pain by explaining how the context of a situation can affect how one perceives pain. We also left you with a couple of questions:
If structural damage to your body was the only cause of pain, why do people have such difficulties recovering from surgery after the underlying “injury” was corrected?
If two people have the same diagnosis on an MRI, why would one of them potentially have pain, and the other one not?
In this post our goal is to answer these questions we posed to you and help improve your understanding of pain.
You have been dealing with low back pain for the last month and decide to finally go to the doctor. He looks at you for a few minutes, orders some X-Rays and a MRI and tells you to come back in a week.
You return to the doctor’s office to find out you have a herniated disc at L4-L5 and that you should go to physical therapy.
In the matter of 5 minutes you went from having pain in your back, that you thought may eventually just go away with time, to finding out your spine has structural damage and you need to seek another health care provider to help you.
But the reality is this, MRI or not, what will help decrease your pain is not any different.
Not sold yet?
A study in the New England Journal of Medicine found that 64% of asymptomatic (not having any pain or symptoms) people had a positive finding on their MRI for a herniated disc.
And it wasn’t just one study that suggests this. A study in The Orthopaedic Journal of Sports Medicine took 53 subjects that had no shoulder pain and did an MRI. If you just guessed a lot of those people had damage, well, you are right. The results showed that 55% of asymptomatic people had labral tears in their shoulders.
So then what explains these discrepancies between tissue damage and pain?
The body regulates pain similarly to an alarm system. The nervous system is an extensive network of nerves that connect the body with the brain. It’s essentially a highway in the body with roads going TO the brain (input) and roads leaving FROM the brain (output).
These nerves all have a built in “alarm system” that helps the body protect itself. These special nerve highways that send danger signals into the brain are called nociceptors.
Every tissue in the body has a resting threshold for nociceptive signals. When there is enough stimulation to these nerves that exceeds this threshold, signals get released; as would an alarm going off when someone breaks into your house when you’re not home.
When there is enough sensory information to an area that exceeds our danger threshold, our brain gets that input and sends an output of “pain” to warn us that the body feels threatened.
If you do nothing to take away the “threat” to the body, that same stimulus continues to happen. The body will now lower its threshold to set off the alarm as a protective mechanism. Simply put, it takes a lot less stimulus to set off that alarm.
For instance, you step up to the barbell and deadlift 415lbs for the first time. In the process, you felt a pinch in your lower back. You effectively kicked in your bodies natural alarm system during this process.
You do a bunch of foam rolling, start to feel a bit better and go deadlift 415lbs again. Once again, pain happens. This time your pain takes longer to go away. Next thing you know, your back hurts every time you bend over.
This is a simplified example of your alarm system re-calibrating to a lower stimulus. Instead of 415 lbs causing you pain, now simply bending causes an increase in pain officially causing #alarmsystemprobz.
So now if we take this alarm system explanation into account, we understand that sometimes, sensitivity can play a huge role in the pain experience. In our last post, we discussed how context and emotion can play a role in pain experience as well.
Let’s bring it back to our friend who was just told he has a herniated disc at L4-L5. Where he might be experiencing some #alarmsystemprobz already, now the MD just told him he has structural damage as well. How individuals understand their injury is huge component because fear and catastrophizing of pain might make this individual's back pain worse (adding to the sensitivity problems).
This helps us further understand how two people with the same imaging might have two completely different pain experiences. Context (in this instance the dead lifting pain) paired with emotion (negative beliefs associated with structural damage), can lead to inappropriate pain experience for individuals.
What you will see in the final post, is how things as simple as language, changing thought processes and graded movement can help, at the very least, to make a dent in your pain.
Move Well, Stay Strong.
About Dr. Zak Gabor
Dr. Zak Gabor is a 2015 graduate from Ithaca College where he earned his Doctorate of Physical Therapy. Prior to that, he earned his Bachelor of Clinical Health Science degree from Ithaca College in 2013. Zak is also a Certified Strength and Conditioning Specialist (CSCS) through the National Strength & Conditioning Association (NSCA), and a Sports Performance Coach through USA Weightlifting (USAW).
Follow him on IG/FB/Twitter @SimpleStrengthPhysio