What You Should Know About Pain: Part 3

In our last post, Zak and I helped you create a better understanding of what pain actually is, and why two people with the same injury may have different levels of pain. 

This is the final post in this series, in which we want to give you some actionable steps that you can take to help decrease your pain.

Having pain can be very frustrating and discouraging.  Learning ways to help manage your pain can help you return to the things you love to do most. 

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The research shows us that our motor cortex (the part of the brain that controls movement) gets distorted when we have pain.  This alters our movement patterns in order to avoid the painful stimulus.  The combination of having pain and the use of aberrant movement patterns continues to feed into the painful response (Rio, et al. 2015).

Combine this with negative language from medical professionals, the web, and fear avoidance, we now have to deal with the wrath of a difficult negative feedback cycle.

So how can one effectively correct their #alarmsystemproblemz?  It starts by teaching the body that the area it perceives as a threat, is really not a threat. 

How do we do this?

The good news is, research tells us that understanding what pain is, can actually help break the cycle and potentially decrease pain. All you lovely readers graduated from this portion thanks to part 1 and 2 of this series!  But let's get into some more physical examples to apply.

Zak and I both use the concept of creating a novel stimulus to help decrease our patient's pain.  It is well documented that people enjoy things that are novel, and so do our bodies.  This is why such things such as light touch, kinesiology taping and movement all help us improve our pain thresholds.  

One easy way to add a novel stimulus to the body is through movement. Let's take our deadlifter from last week's post as an example. 

After several times deadlifting, our friend, let's call him Clinton, now has pain every time he tries to touch his toes.  

On a daily basis, Clinton bends forward in all sorts of ways in order to try and stretch out his discomfort.  As he continues to bend forward and stretch the area, he continues to further make his pain worse. 

Why?

As you stretch into your discomfort, you continue to feed into the #alarmsystemproblemz we discussed last week.  Not only are you feeding into your pain, but you continually unload the tissue.  

And one thing we know about pain is that you don't like to load those areas causing aberrant movement patterns.   

The actual fix: Start extending your spine.  This may seem counterintuitive but stick with us.  If Clinton starts to move through pain free spinal extension, his body is getting a new stimulus that is not perceived as a threat and begins to add load to the structures that are painful.  

By adding load to the area, the body slowly starts to see that the threat to the area is not there and slowly builds the pain threshold back up over time.  

Another favorite of ours to decrease pain is isometrics.  By creating strong muscle contractions in pain free ranges of motion, we again teach our bodies that the threat to the area is not real. 

By creating isometric contractions we are able to add load to the tissues and start to decrease the inhibition of the motor cortex that lead to poor movement patterns. 

Through stimulation of the muscles, we are beginning to teach the tissues that they there is no longer a threat and slowly raises back up the pain threshold.  Isometrics are also documented to have an analgesic (decreasing pain) effect, similar to how a pill for pain might work. 

Once pain levels start to decrease, we use graded movement to progress your tissues appropriately (aka move from the LEAST threatening position to MOST threatening positions).  If we look at the 4x4 matrix popularized by the Selective Functional Movement Assessment (SFMA, we can have a big take away, so let us break it down for you:

  1. Supine (lying on your back)
  2. Quadruped (on hands and knees)
  3. Kneeling (1/2 kneeling or tall kneeling)
  4. Standing

As simple as this sounds, having an understanding of these basic positions can help you prescribe strengthening in these positions to help begin graded movement.  To reiterate, if you can find a non-threatening position to begin in, you can build capacity in this position, decrease threat and instill confidence to your nervous system, and ultimately progress to a more "threatening" position.

Now that Clinton has used extension as a novel stimulus to decrease perceived pain in the area, we can try and apply isometrics and graded movement to restore his full function; no pill needed (woop woop)!

For example, understanding that being on your hands and knees is less threatening than being upright we can take advantage of this position two fold. 

A) We can begin to re-introduce spinal flexion by rocking back onto your heels, this might be a friendly way to show the brain "Hey dude! Look at me flexing my spine without pain!". A movement that should technically "hurt" now does not because we have decreased the threat associated with it. 

B) We can use isometrics, such as abdominal wall bracing in quadruped to help create a pain reducing stimulus, as well as begin building tissue capacity.

In conclusion: These posts are not the definitive guide to dealing with pain, BUT, our goal was to give you some easy and actionable takeaways to help begin dealing with pain.  Our goal was to also get you thinking differently about pain, and encourage you to continue reading and learning more about it!

Disclaimer: For anyone out there dealing with pain please seek appropriate medical professional help.  We encourage everyone to try and get away from the use of painkillers and combat pain with your brain and movement!

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