Professor Lorimer Moseley delivered Musculoskeletal Australia’s annual Koadlow Lecture in 2019. He talked about “Pain, the Brain and your Amazing Protectormeter.” There was a lot of critical information in that to help people move towards recovery from persisting pain. We’ve asked some of our expert clinicians and researchers (who are part of the 2019 Rural Outreach Tour in Tasmania) to add some more details to the short video clips, so you can fully understand the reason these concepts are so important for people in pain.
Watch the video below and read the post written by Physiotherapist, Jack Behne. Jack is returning for a second tour, back for more training, riding and teaching in 2019. He has written about his experiences on the 2018 Tour here, and read below as he expands on Professor Moseley's information in the video about pain as a protector.
We often think of pain as an alarm signalling damage to the body.
Injury. Boom! Pain...simple, right?
Maybe not. We have all felt pain at times where there is no injury - this isn’t some nervous system quirk we only observe in the lab. Have you ever been out in the cold and banged your knuckles? Or stubbed a toe and momentarily lost the ability to walk or use clean language? Or even the other way around - have you ever noticed bruises or cuts that you don’t recall receiving?
In the clinic, we see many cases where people are suffering tremendously without clear or identifiable damage to their body. This may include widespread pain like fibromyalgia, headaches, or even a lot of back pain. If viewed from the notion that pain requires some kind of harm or lesion to the body, these people’s pain seems perplexing. They may have been told it’s ‘psychological’, all due to stress, or worse: implied that it’s all made up.
So if injury doesn’t match that well with pain, what does?
Staying Safe and Healthy
If we’re wondering what this all has to do with buffers though, all we have to do is ask: how good a protector is pain if it only occurs once we’re injured?
Think about our other wonderful protective responses. It would be silly to start feeling hungry after we’ve started experiencing the effects of malnutrition and starvation. If you hold your breath (and are not some kind of fish), you will notice the overwhelming desire to need to breathe well before you pass out from lack of oxygen. And in an ideal system, you get an urge to pee well before your bladder explodes. Hopefully.
So it stands to reason that pain kicks in before we do harm. It gives us leeway to take action to keep ourselves safe. But how much wiggle room should we have? How big a buffer is appropriate? This is where it may get a little tricky...
We can imagine that with a big buffer, our body parts are super safe, but this comes at the expense of function and enjoyment in our lives. On the other end of the scale, we can have a teeny weeny buffer, but there’s much less wiggle room, and we are more likely to really cause harm.
Could Your Buffer be Keeping You Too Safe?
So what determines the size of the buffer? Well we can examine all the pain science literature since about 1965, and study it for ten years, or just step back and realise - it is determined by literally anything to do with danger, threat, safety and survival. That simple.
After we’re injured we can see and measure changes in the danger message processing and pain system that gives us a much larger buffer so we protect a vulnerable and healing body part. Which is why it often hurts after an injury. This can be significantly affected if we’re particularly worried about the body part, otherwise stressed, or experiencing system-level buffer expanding challenges (like a lack of sleep).
Sometimes there can be so many factors contributing to a large pain buffer, that it doesn’t take much extra load to tip us into it, and start to experience pain without any apparent harm or insult to the body itself. This pain is as real as any other pain, but presents a challenge to the people looking for an injury.
Protective Buffers are Always Changing
So what? So how does this change anything? What does knowing about these buffers do for the person with pain?
Firstly, it gives us confidence that we can do things that challenge our buffers, knowing that we can be sore but safe. Without going too gung-ho about it, we can start testing the limits and gradually increasing our activity with confidence. Having some guidance here can be really helpful, so it is a great time to get yourself a coach who is also confident in helping you explore your buffer.
Secondly when we realise that lots of different things may be contributing to a bit-too-big buffer, we have lots of things we can work on! We can start examining the Safeties- and Dangers in Me (SIMs and DIMs) which balance out to adjust the size of our buffers. These may be the things we say or think; what we do and where we go; the people around us; or even stuff that’s happening in our bodies.
Certainly there are things in all of us that we can’t change, but the great news is that we don’t have to change everything to start to feel better. It’s important to realise to these SIMs and DIMs can hide in hard to reach places, which is another reason a little help from a coach may be worthwhile. What is something you can change today?
The best thing is that we have excellent research that tells us that just understanding about protective buffers reduces them! I hope that either make your head spin, or start to feel a little better, because knowing about buffers gives you a good dose of hope that your pain CAN change.
All our riders on the Rural Outreach Tour pay their way for the ride, take a week off work AND we make them fundraise to support the Local Pain Educator Program. Jack's almost made it to the $3000 target we set for each of the riders, and if you liked this post, you can add your donation to his account.
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