How Chronic Pain Works


by Brent Redpath February 19, 2017

Injuries and lifting go hand-in-hand. It's rare to find a seasoned gym goer who hasn't had an injury.

Often people are plagued with niggly injuries that cause them grief throughout their lives. Backs that just won't stop aching and sciatic nerve problems that flare up. Shoulders that click and pop and prevent people from doing the exercises they love or training to the best of their ability. They can also affect their personal lives, relationships and careers. 

A few years ago I bulged my L-5-S-1 disc moving a pallet. A year later, even picking up a 20kg weight plate and putting it back on the rack sent shooting pains down my right leg. I had tried everything, I thought. I had seen professionals who told me that deadlifts and squats were out of the question for the rest of my lifting life.

I just didn't understand, though. I found I received mixed feedback when talking with people who had experienced similar or the same injuries. Some casually said ''Yea; I have done that a few times now'' and yet they were still deadlifting and squatting like nothing had happened. How was this the case when I found it hard to clean up my weights without feeling pain? 

On the other hand, I spoke to people with similar injuries who lived a life of pain. How could the same injury produce such different outcomes in people?


Pain And The Brain



Most people have the following idea of how pain works: you hurt something, pain receptors send a signal up to the brain and then wallah! You feel pain. Just like flicking a light-switch, the wire sends a signal to the light, and the light turns on. In model of pain it's believed what you feel is relative to the severity of the injury, i.e., if you had your arm cut off it's going to produce a lot more pain than if you had a small scratch on your finger. Unfortunately pains a lot more complicated than this. 

If pain worked like the above, you wouldn't hear stories of people being admitted to the emergency room with significant injuries and them feeling little to no pain. You also wouldn't have people feeling pain in limbs that don't exist or people with major dysfunctions such as bulging discs and torn muscles who feel no pain. 

One hundred percent of pain is constructed in the brain and isn't produced by the tissues damaged. To cut a long story short, once the body sends a message to the brain to tell it that it's experienced a potentially dangerous sensation, the brain decides what kind of pain response to illicit based on the perceived danger, past experiences, environment and many other factors. This is explained in-depth in Lorimer Moseley's TED talk here: 

 


The Disease Of Chronic Pain 

Now we know that pain is in the brain and it's a lot more complicated than we thought; what does this mean for chronic injuries? A lot actually. People who have persistent pain - pain that exists for months and years develop what is called 'chronic pain'. This can persist even after the original injury has healed. 


As explained above the body sends signals to the brain. If an injury persists, the body continues to send these signals. However, the body becomes much more efficient at sending them as time goes on sending more and more. The threshold at which these receptors send signals becomes drastically lowered. Meaning that less stimulus in that area is required to cause pain (in other words, you feel pain a hell of a lot easier around that area).

The end result is the brain becomes extremely good at triggering and maintaining pain. This creates a feedback loop that leads to debilitating chronic pain long after the injury that first caused the pain has healed. In these cases, pain can become its own disease, independent of the original injury.


So Can It Be Fixed? 



As I said before, pain (including chronic pain) is a product of our brains. This means that many psychological factors such as emotions play a large role its severity and duration. As we are talking largely about chronic pain as it pertains to injuries caused by and affecting exercise, we are going to talk about ways to fix these problems specifically. 


One method is to treat the tissue which reduces the signals that cause the pain, which can be done by various manual therapies such as trigger point therapy, soft tissue therapy, etc. 


Another method is called the Graded Exposure Approach. This approach involves gradually exposing oneself to activities that you are fearful of and that cause/caused the injury in the first place in a controlled manner. An example of this approach in practice is the following:

Someone hurt themselves performing a heavy deadlift. They give themselves sufficient time for the injury to heal but they continue to experience large amounts of pain every time they try deadlift significant weight. This may be largely due to the psychological fear associated with performing the exercise. Over time, they gradually expose themselves to deadlifts again, starting off extremely light and slowly increase the weight, stopping just before they feel any significant pain. After a few months, they can deadlift again with little to no pain. 

This is just one oversimplified example, but you get the idea.


In Conclusion


When you say pain is all in your brain people have a tendency to get offended, thinking you are somehow demeaning it. That's not the case at all, all pain is real. The pain you feel when you break your arm is as real as the pain you get from an injury that has been plaguing you for years. It's just that in the latter case, the tissue may have healed. 

The fact that pain is ''all in your head'' so-to-speak is not take anything away from the importance of being sensible, practising correct form and working on your mobility. Prevention is always better than cure. 

What is being said, though, is that if you suffer from a chronic injury that has been plaguing you for years, there is hope. 

For more information on managing pain, check out the discussions on  www.somasimple.com.

Also, check out Elliot Krane's TED talk on the topic here: 



-Gym Meals




Brent Redpath
Brent Redpath

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