Professor Lorimer Moseley delivered Musculoskeletal Australia’s annual Koadlow Lecture in 2018. He talked about “Pain, the Brain and your Amazing Protectormeter.” There was a lot of important information in that talk that helps 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 clip below, and read the post that explains why this is so important for people in pain to understand.
This post is written by Canberra-based Physiotherapist Melanie Macoun, who is joining us on the 2019 Tour. Melanie has a passion for education, both with her patients and with the physiotherapy students she teaches, and she sees the life-changing effects that understanding pain can have on people’s lives affected by persisting pain.
Pain is a Protector
Those people who live with persistent pain would probably think “I WISH” when they hear about people that are born without the ability to feel pain.
Imagine that – no pain!!
But imagine the baby who doesn’t cry to tell you his bottom is sore from nappy rash? What happens when his skin breaks down and gets infected?
Imagine the toddler who touches a hot oven and badly burns her hand because she doesn’t get a message from her hand to her brain to make her pull away in time.
Imagine the preschooler tumbling through the playground who doesn’t know he’s broken his arm. How is his bone going to repair properly if it’s not set in plaster? How will that effect the growth of his arm, and the function of his nerves and muscles around it?
Normally, a preschooler doesn’t tell you that they’ve broken their arm. They cry. They tell you that it hurts. The alarm system in their arm plays an important role to inform their brain that something is wrong, and their brain makes it hurt so that everyone knows about it! The pain will also make them hold their arm and protect it from further damage. Imagine a primary schooler who can’t tell you that her tummy hurts when she has appendicitis. Or that she’s been bitten by a snake. Most people who are born without the ability to feel pain don’t make it through childhood.
Pain is a critical lifesaver. Pain lets us know when we are, or might be, in danger. Without the important danger detectors in our body, we don’t know when we are injured, when our bodies are under strain from a heavy or repetitive load, or even just when it’s time to change position. We don’t know when it’s time to get moving, or when it’s time to stop.
Without pain, there’s nothing to draw our attention to the simple things that keep our body in good health. There’s nothing to protect us from harm.
We NEED pain to get us out of danger. What we DON’T need is pain that no longer serves this purpose.
Persisting Pain is Different
Pain is not helpful when it persists beyond normal healing times. Even if your healing from an injury was “sub-optimal”, you may be left with a body tissue that is stiff, tight or weak. It doesn’t have to hurt. Stiffness needs movement, tightness needs stretch, weakness needs loading – how are you going to do these things to make your tissues healthy again if pain is stopping you?
Pain is not helpful when it is constant. If you hurt no matter what you do, and even when you do nothing, then pain is not serving to protect you. Quite the opposite. You will get stiffer and weaker if you don’t keep active. It’s even bad for your bone density, heart, lungs, immune system and mental health (to name a few) if you aren’t getting enough healthy movement.
Pain is not helpful if it never lets you rest. For some people, they are constantly on the move because it hurts too much to stay still! This is very tiring! Every body needs “down time” in order to rejuvenate – for the cells to nourish, repair, heal and refresh. People trapped in constant activity are in just as much trouble as those who can’t move.
Pain is not helpful if it is out of proportion with the true “danger” inside. Every body tissue changes with age and recovery and resilience can slow down. Some people are blessed genetically to get older more gracefully but ageing tissues don’t have to hurt just because they are adapting to life! However, if your brain is overprotecting you with high levels of pain in response to danger signals from a normally ageing body tissue, then this is not useful. Especially if the pain stops you from keeping that body part as healthy as possible by keeping it strong and active.
The good news is, there is nothing stopping a poorly healed, constantly painful, restless or degenerative body from getting stronger, more active, more rejuvenated and more resistant to “danger signaling” if you go about it the right way.
Re-Training Pain is the Way to Get Moving
The short answer to this is: “graduated activity, starting from a low and achievable baseline and building up slowly.”
The trickiest part to this is finding your “baseline” or starting point. If you are struggling with persistent pain, it helps to get a good coach to give you specific, personal guidance for this (a physio, EP or doctor, for example; someone who understands chronic pain and can explain pain mechanisms to you in more detail).
Everyone’s starting point is different, because it depends on how the pain is affecting you, how limited you are to start with, how the problem is presenting, and what it is you want to work on first.
Some examples of baselines I’ve prescribed, just to give you an indication or the individuality, are:
- Vacuuming just one room of the house everyday
- 500m gentle walk on a flat, even surface once/day
- 20 seconds of quiet, motionless supported sitting, 5 times/day
- 6 wall squats, 2 sets, once/day
Diverse, isn’t it?
Baselines are not about getting fit again, they are about reducing the over-protective response of a sensitized system. Fitness comes later.
When you understand pain better, you can recognize the critical role pain plays in protecting you from danger. You can understand when YOUR pain is not serving this purpose. You can start to learn when a pain response is a “reasonable” response to the potential danger in your body, and when it is an overprotective response serving only to disable you.
Understanding pain is a powerful tool for recovery as you can learn how to return to normal activity in a safe and sustainable way without fear of harm. Be GLAD that you CAN feel pain, even as you work to recover from the interruption it causes to your life.
We're heading out on the road for our annual Rural Outreach Tour March 16-32rd in Tasmania. These are the sponsors that get us on the road, and we couldn't get out to rural and regional Australia without their help and support.