Saturday, 29 September 2018
PAIN.....The first real episode was after lifting far too much weight during a squatting session when I was 15... the second major one, years later, lifting a patient who decided they didn't want to stand anymore. After numerous sports injuries, four babies and 21 years of lifting my disabled daughter (HENI) my back was pretty much shot to pieces. I, like many of you have suffered chronic pain for years. Even though looking in from the outside I can still run and exercise etc, there hasn't been a day in a very long time without feeling Pain. I understand pain intimately, (experientially as well as academically) and I've worked hard (since Heni passed away) to reduce it, and hopefully eliminate it from my life once and for all.
Pain is perhaps one of the most common reasons for someone to visit a physiotherapist such as myself. It can come in multiple forms and be associated with a range of injuries and musculo-skeletal conditions/ disorders, ranging from arthritis, to the most common neck, headache and back issues (like mine). It's something that most of us experience at some point in our lives and is something that practically everyone would like to do without... me included!
Pains main job is to serve as a positive alarm, to notify us of a problem that needs our attention. Most people just shut the alarm off by taking pain killers, but if we heed it and listen, and take it seriously, it can be an empowering motivator to "wake up". It can help us find answers how to change and do things differently... to create healing and be rid of this friendly foe once and for all.
If we fail to heed its message it can stay around and linger far longer than it is welcome and become difficult to eradicate.
Some types of pain like my initial "squatting injury" can be created by tissue trauma and local inflammation. In my instance, lifting incorrectly with too much weight, an immature body and with faulty bio-mechanics. It took a while to heal but I never really sought any good quality treatment back then and it was never quite the same again. I was left with a deficit in flexibility of some spinal segments and lacked strength. But loss of strength and movement was not the only cause as to why it continued.
Subsequent fear of further pain, avoidance of moving normally, and anxiety about what the pain means personally in our lives can compound a simple injury and make it worse.
You may recognize this in yourself? After an injury have you ever asked yourself the questions...can I still exercise? How much pain is ok? Will it ever be the same strong back again?
We tend to think of pain being located in an area of the body that hurts (e.g. the back)... the pain signals go up to the brain from the hurt area and we become consciously aware of it (bottom up route). However, regardless of what the cause of the pain, or where in the body it's felt, signals are all processed within the central nervous system and brain. Therefore other areas of the brain that are associated with our thoughts and emotions, can also become involved in the process. This series of connections can fire together and highly influence how the signal of pain is perceived and can be just as responsible for intensifying or even creating it (top down route).
Hence subsequent bouts of pain and memories of the previous physical pain, together any emotional type pain can increase the sensation of how it is felt. Negative thoughts about life events can lead to stress hormone production which can also wreak havoc on it.
The "positive pain" signal from an acute injury, if not stopped over time, can lead to chronic pain and "central sensitization" where the brain intensifies and creates pain long after the local trauma and inflammation have healed and gone. This misfiring of information can mislead the person to the pains true whereabouts. The injury may be fully healed locally but pain can still be felt there.
Other types of pain can stem from systemic inflammation which is at the root cause of most chronic diseases. It can be created by the foods we eat, food intolerance, nutritional imbalance, extra weight, environmental toxins, genetic susceptibilities etc. Belly fat in particular is metabolically active and creates inflammatory chemicals and hormones which increase pain. A viscous cycle can arise from pain and a sedentary lifestyle which can lead to further weight gain and even more pain. If not stopped this can become extremely challenging to manage and reverse ...often the cause of pain is not as straight forward as we think and can be due to a mix of a number of the above factors. But do these varying pathways to pain have to be this way and do we have to suffer endlessly?
Pain is a purely subjective phenomena ... making it rather difficult to measure and as mentioned above it is reliant on a persons thoughts, experience and perceptions. Only the individual knows exactly how much pain is present! (unless you visit a neuroscience lab where researchers are making headway in documenting pain brain patterns!)
The International Association for the Study of Pain defines pain as both "...a noxious SENSORY and EMOTIONAL experience." therefore if you only treat pain from a physical viewpoint you will be missing a lot of the picture.
The pain I experienced required a multi-pronged attack. Here are a few of the things that helped:
1) Physiotherapy...mobilizations to address physical limitations such as loss of spinal segmental movement and range, and worked on gaining back strength through a graded regime from gentle to more vigorous rehab with exercise programs including hydrotherapy and...
2) Pilates... for core control, strength and flexibility
3) Diet...was equally necessary to make sure the right nutrients are available for healing
4) Nutritional deficiency testing.... together with a supplementation program (I used vitamin and mineral supplementation, homeopathic and herbal products when appropriate)
5) Food intolerance testing... and elimination of foods causing immune triggers.
6) Hormone balance testing
7) Water ....not missing out on the equally important factor of working on hydrating the body properly.
8) Stress Management..... was and still is a key issue. Mindfulness, meditation and modalities like CBT(Cognitive Behavioural Therapy) and counseling (I chose to seek grief counseling to help with the processing of emotions of life with Heni and her death) can all be useful tools to help look at thoughts differently, create self awareness and release of false beliefs/fears.
9) Sleep...to get enough rest and repair...(probably the hardest for me)
10) Find and work with people who know what they are doing.
11) Faith, Hope and Prayer that pain can and will improve.
My back has come a long way... It still needs me to address some residual issues, but all of the above are important adjuncts to purely physical treatment.
If you have been in pain for longer than you would like to be, I recommend that you listen with interest to it and explore the different aspects of your life that may be out of balance and need some attention.Take a step back and look at the bigger picture!
It can be a good idea to find a therapist that can help you or guide you in the right direction. It's often overwhelming to find information and work everything out by yourself. Knowledge is power and the greater understanding you can gain about health and healing will always stand you in good stead.... however, there is no substitute for application and consistent effort in putting that information to good use!
So if you are interested in learning more, come back soon to read the next blog post in which I will be sharing a few of my favorite resources that I've found useful for learning more about pain and how to get rid of it.