When it hurts to move something has to change
“Changing anything changes everything ”
-Ericka Thomas
Transcript
Ep 220
When it hurts to move something has to change
Chronic pain and mobility
One of the biggest myths about movement is that if it hurts you shouldn’t do it. And if we’re talking about an acute injury like a broken arm or torn acl then yes that’s true. In the acute phase of an injury we need to hit pause. But what if the source of our pain isn’t known, or the treatment isn’t knowable. I’m talking about the kind of chronic pain that our medical professionals can’t find a reason for or have no cure. That’s our work IN today. We’re discussing the connection between mobility and chronic pain and how we can use movement to change our experience in the body.
Let’s face it once we reach a certain age things start to hurt for unknown reasons. You go to bed feeling fine and you wake up hobbling around like you are 80 years old. Sometimes it’s a sudden appearance of joint pain in a knee or a shoulder, sometimes pain can resurface around an old injury that hasn’t bothered you in years but often times it can sneak up on you as a small ache that you don’t pay a lot of attention to at first that over time becomes constant and normal. The truth is pain is normal and we all get to experience it from time to time. There are too many sources to enumerate here and that’s really beyond the scope of this podcast. What we’re really interested in is how to make it go away, right? No one wants to live in chronic pain. One of the reasons for that is that it makes us not want to move.But not moving for too long when something hurts (outside of injury) can shorten range of motion, affect stability, mobility and flexibility and increase the risk of falls. As well as limiting our activities of daily living.
Before we dive in let’s talk about what current pain science tells us about pain in general and chronic pain specifically.
If you’re interested in learning more about chronic pain and pain care for body workers I highly recommend my friend and colleague Colleen Jorgensen. She is an amazing Trainer and also check out Pain Care Aware as a program. Links will be in the show notes.
First, this is an evolving field and researchers are learning more every day. In 2018, the IASP slightly revised it’s definition of pain to: "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."
Key words there are actual or potential.
There are several categories of pain:
Neuropathic pain
This type of pain is categorized into 2 types.
Peripheral neuropathic pain.
Examples include:
Postherpetic neuralgia
Diabetic neuropathy
Pain following chemoradiation therapy
Complex regional pain syndrome
Central neuropathic pain.
Examples include:
Pain following a cerebrovascular accident sequella (lacunar infarct)
Multiple sclerosis
Spinal cord injuries
Nociceptive pain
This type of pain results from actual tissue injury. Examples include:
Burns
Contusions
Sprains
Postoperative (surgical) pain
Musculoskeletal pain
This type of pain arises from muscles, bones, joints, or related soft tissues. Examples include:
Back pain, including radicular pain following a dermatomal distribution
Myofascial pain
Inflammatory pain
This type of pain is caused by activation of the immune system in response to injury, infection, or autoimmune conditions. And I would throw in hormone status that no one talks about. Examples include:
Autoimmune disorders
Rheumatoid arthritis
Fibromyalgia
Gout
Infection
Cancer-related pain
Psychogenic pain
This type of pain is primarily influenced by psychological, emotional, and behavioral factors. Examples include:
Tension headaches
Functional abdominal pain
Somatization disorder
Mechanical pain
This type of pain results from structural distortion or compression of tissues. Examples include:
Expanding malignancies
Benign tumors
Advanced ascites
Fractures
Retained hardware pain
Chronic pain is anything lasting longer than 3 months and beyond tissue damage. 20% of the US population suffers with it costing 500 Billion $ annually.
Chronic pain,even when we know the source, is complex, often systemic . In other words it is rarely limited to one area of the body. It’s often associated with multiple comorbidities including major depressive disorder, anxiety as well as other overlapping pain conditions. It can be seriously frustrating chasing symptoms around the body with no relief in sight.
Regardless of the source, pain is a perception of some kind of threat. It’s a protective response that is trying to get us to change. Like a fire alarm blaring in the middle of the night that gets you out of your house. The fire alarm senses the smoke but it isn’t necessarily anywhere near where the actual fire is. Pain is the alarm. It doesn’t always indicate actual tissue damage. And what we feel as pain is actually a signal sent from the brain. So when you wonder if it’s all in your head, it is. But it's also very real. It is 100% protective.
The longer we’re in pain of any kind or the more experiences we have with pain, the better our system is at sending that pain signal out. Our security system gets more and more sensitive to the potential for danger and so it sends pain signals sooner. It would be like your fire alarm going off when you light a candle.
This sounds so simple. But it isn’t. Several years ago I lived in a house with an integrated fire and security system. It had glass break sensors on the windows that would go off randomly that was fun. And then one day I left a pot on the stove once and burned some sausage. It filled the place with smoke and set off the alarm. It was so loud I couldn’t even hear the security person talking through the system and the touch screen wouldn’t respond to the code to deactivate the alarm. And of course they sent the entire fire department to my house. I was so angry we cancelled that security company. Not because the alarm went off but because it wouldn’t shut off.
Pain in the body is good unless it gets stuck on. And unlike a security system we can’t fire it. We need to find a way to convince the body and the brain that we can turn down the volume of that alarm. There are a lot of ways we can do that when we harness a biopsychosocial approach. Because pain can come from the body but not only there, the immune system, but not only there, the musculoskeletal system but not only there, the mind but not only there. Just like everything else in the body there is a network of networks. But affecting any one of them will affect all of them in some way. Changing anything changes everything.
When it’s stuck on we forget how many options we have to change it in some way. Instead we fight it, we get angry, we stop moving, we self medicate, we literally turn against ourselves. Which is understandable but not really helpful in the long run.
Part of this is that for some reason we have a belief that pain is not something we should ever feel. That being pain free is the ultimate goal. I don’t know if it is possible for human beings to live pain free. At least not for very long. Aside from the fact that pain is a personal perception unique to each individual, that perception can and does vary depending on many many things. And those variations are the very things that can help us manage, improve and sometimes even eliminate chronic pain.
But the first thing that we need to practice is directing our awareness with curiosity. Pain, regardless of it’s source, will pull all of our focus, making the mind believe that everything hurts. The question to ask ourselves in that moment is…”Ist that true?” Rather than doubling down on attention to the place that hurts, we can scan the body for all the places that don’t hurt. Where do we feel good? Where do we feel strong? What is working for us? This attitude of bodily curiosity starts the mindfulness ball rolling and gives us access to several tools that can change our perception of our pain experience.
Movement
Because so much of our perception of pain lives in the body, let's start with the physical. When we feel pain in a particular area of the body the first thought is injury. Let’s take the knee for example. Personally, I’ve had chronic pain off and on in one knee or another since I was in my 20’s. I've had many xrays, MRI’s and physical therapy, even a couple of injections. The only thing that made an actual long lasting difference was physical therapy that I still do to this day.
When we’re in pain anywhere in the body, there will be a physical reaction. You will find tension somewhere, maybe around that area but definitely other areas too. The body tries to brace itself and compensate for this perceived injury, whether there is one or not. This compensation can lead to a lot of incorrect movement patterns within the body that cause pain.
That tension may be amplifying the sensation of pain. One of the first things we can do when we are experiencing pain is to find that other tension and soften it a bit. When we do that it tells our system that there must be less danger. That is an important pathway to practice. Remember we need the alarm system but we also need to be able to deactivate it. So softening physical tension is a way to begin. Changing the speed and range of motion is another. Creating predictive errors in our movement patterns is how somatics releases tension and makes the brain and body let go of old habits.
Another physical way to reassure the body that it can turn down that alarm is moving through an appropriate range of motion. Many many people suffer from joint pain and the first response is to hold still. But most if not all of our joints benefit from movement and actually depend on movement for the circulation to heal. Arthritis is a prime example. Arthritis is inflammation due to deterioration in a joint. If you’re alive you probably have some somewhere in your body. Arthritis doesn’t guarantee pain though. I have arthritis in my knees according to x-rays but I haven’t had knee pain in years. I sometimes wonder if it’s arthritis if I don’t have pain. Arthritis gets better when you move. Walking, cycling, swimming, dancing, pickleball, hiking, whatever it is your entire system will thank you. Exercise is an anti-inflammatory. It can actually mitigate and buffer other sources of inflammation like poor sleep. I think that’s amazing.
When we hurt the last thing we want to do is move. And if you’re sick or the pain is from an acute injury that hasn’t healed yet you shouldn’t but once the tissue has healed movement should be back on the table.
The breath can be a powerful way to soften that physical tension. Any change to how we are breathing in the moment has an effect on the heart rate and nervous system, specifically the vagus nerve. That stimulation of the vagus can calm our entire body and mind. Let me say that again…ANY CHANGE to the breath can help.
Thoughts - What is the story that we carry about the pain we are experiencing? We all have one. For some of us it’s an integral part of our identity. Our mind is the ultimate meaning maker for any and all physical sensation coming from the body. But those thoughts may not still be true. It's worth questioning some of the thoughts racing through our brain when it comes to why we believe what we believe.It’s important because the body believes what the mind tells it (and it can’t tell time). So if we want to change our experience we can start by adjusting what we tell ourselves about our experience. It could be that our very thinking about our pain is reinforcing that pain.
Emotions Every time we feel pain there is an emotion that accompanies it. Stop and notice what that emotion is. Acknowledge it. Speaking for myself when I first feel a particular nasty emotion like anger, rage, fear, my gut instinct is to try to stop myself from feeling it. Because I “SHOULDN”T” feel that way. But what if we lean into that emotion and let yourself feel it in the moment. Allow it. And then allow it to dissipate. Emotions as we understand them (as an interpretation of a physical sensation) only last 90 seconds after that we are making a personal choice to stay in that state. And if we can acknowledge the truth that sometimes it feels good to feel angry, or self righteous or guilty or afraid or whatever we’re feeling I think it makes living in our own skin a less adversarial relationship. It can allow those sensations to change.
None of these tools are an instantaneous fix. Pain Free is not actually the goal in the human body because the sources of pain are protective, complex and sometimes unknowable even by the experts. Noticing variability of symptoms can help within each of these tools. In fact none of them work if we can’t stay present in the body and are willing to be curious. Practicing these tools and then reinforcing new movement patterns over time can give us an entirely new experience in our own skin.
When we are in pain it pulls all of our focus. And sometimes that means trying to escape the present moment. But if we stay with the sensation with curiosity, even momentarily and notice any variability in those symptoms, physical tension, our breath, thoughts, and emotions and practice changing those things that can go a long way to turning down the alarm when it hurts to move.
Thanks for listening.
Connecting the dots for your personal health and professional wellness can be daunting. You don’t have to go it alone. Head over to savagegracecoaching.com/theworkin you’ll find all the show notes for this and other episodes plus lots of free resources including a link to book a 30 min fitness strategy call with me. And of course I’d be ever so grateful if you would take a moment to like and subscribe to this podcast wherever you’re listening.
And remember stop working out and start working IN.
Hey there!
I’m your host Ericka Thomas. I'm a health coach and trauma informed yoga professional bringing real world resilience and healing to main street USA.
I offer trauma release + yoga + wellness education for groups and individuals…regular people like you.
Book a call to learn how I can help.