From my experiences with my patients over the years, is that they tend to reach a functional capacity in which they are able to return to pre-injury duties for work or perform activities of daily living. However, there are some cases where the patient will report that they are continually experiencing pain. My job as an Accredited Exercise Physiologist is not only to provide and guide my patients through their specialised exercise rehabilitation programs but to also educate and empower them to self-manage their injuries. The following are some of the key take-home message I focus on with my patients:
- Understanding your pain – Pain can be helpful and unhelpful
Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Simply put pain is your body’s protective mechanism. There are two categories of pain; acute and chronic. Acute pain occurs following trauma or surgery and lasts for a short amount of time usually less than 3 months. It is helpful as it encourages us to protect the injured area, this prevents further tissue damage and allows time for the injured tissues to heal. Chronic pain usually lasts greater than 3 months or beyond the time expected for healing following trauma or surgery. It is unhelpful as there is no longer the need to protect the injured area, and yet the pain persists without a clear explanation.
- Pain is not just in your head
Pain is very real and is not just in your head! All pain no matter where or how it is felt, is produced by the brain. The brain decides on how much pain or protection is required. Factors not related to tissue damage such as individuals’ pain beliefs and fear-avoidance or fear of movement, tend to become more relevant the longer pain persists.
- Pain is not a measure of tissue damage
Chronic pain is less to do with the injury in our bodies and often has more to do with the changes in the central nervous system (CNS). The injury would have healed as much as it can, however, the body still sends signals to our brain alerting us of pain; this could be described as the CNS becoming more sensitive to pain, which can be unhelpful. The CNS becomes more sensitive to potential danger and pain may be experienced during functional movements that were previously pain-free.
As such, chronic pain is not a good measure of tissue damage. It is important to understand that it is safe to move, even though you are not completely pain-free. It is important to change your belief to overcome the fear of pain, fear-avoidance or fear of movement and gradually return to pre-injury duties at work, activities of daily living and recreational activities.
- MRI and CT scans can be misleading
Pain does not show up on scans, as we are not able to pinpoint where the pain is originating from. Both individuals who are symptomatic and asymptomatic to pain will have indications of tissue damage shown in scans. A study showed, 80% of 50-year-olds have a disc bulge and 60% of 50-year-old have disc degeneration. However, none of them ever had back pain!
Have a read of my previous blog explaining how MRI and CT scans can be detrimental to your recovery.
- Pain is multidimensional
Pain is multidimensional and is based on the association between biological, psychological and social factors. Pain is influenced by the individual’s attitudes – fear of movement or fear avoidance, beliefs of pain, poor coping strategies, physical inactivity, emotional and social factors can affect them physically, their emotional and mental wellbeing. All these factors play a part in how much pain the individual may experience, and the likelihood of the pain will persist.
- Benefits of exercise
Beginning to move again is also another step in the right direction. An Accredited Exercise Physiologist can not only help you understand your pain but also assist in exposing you to pain-free range of movement, fear avoided movements in a controlled approached through an exercise rehabilitation program. Exercise is a vital part in feeling stronger, more confident, have more body control and less fear avoidance. You may feel stiff or sore after exercise, however, this does not indicate tissue damage to your body, it simply reflects your body not being used to the activities or certain movements. Underused muscles get sore more quickly than healthy muscles.
- Focus on function
It is important to understand that pain does not have a direct correlation to your function. This means as your function improves, it does not necessarily mean your pain symptoms will reduce immediately. Hence why goal setting is important, as the focus is on improving overall function (what you can do) rather than focussing your overall pain symptoms (what you can’t do).
If you would like more information on pain visit the Pain Australia website or watch a short video on Understanding pain in less than 5 minutes and how what to do about it!
If you or anyone you know is suffering from chronic pain and need assistance in managing their pain through a holistic approach please contact Absolute Balance by via firstname.lastname@example.org
Daniel Nguyen (B.Sc. Exercise Physiology)
Senior Accredited Exercise Physiologist (AES, AEP)(ESSAM)
- Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816
- O’Sullivan, P., and Line, I. (2004). Acute low back pain. Beyond drug therapies. Pain Management Today, 1(1), 8-13
- Tasmanian Health Organisation South. (2014). Understanding Persistent Pain _ How to turn