Pains that Sneak Up on Us

Why does something I've done hundreds/thousands of times without any issue all of a sudden start hurting?

I get asked this question a lot, and I understand why.  We experience pain and want an answer as to why, because if we know why, we can do something to fix it; right?  Sometimes it's easy, ie. you stub your toe on that brick that is slightly higher than the rest, and break your toe...simple.  But what about those times when there is no simple reason why you are now in pain, and the longer it goes on the harder we search for answers.

The strain that accumulates in our body has 2 main avenues of becoming problematic;

1. Increasing the amount of strain we place on our bodies without allowing it time to accommodate.

2. Not taking care of our bodies when we are placing more strain on them.

Now, it is a multi-factorial issue and does not just include the actual strain on our tissues; stress and anxiety, lack of sleep, and poor diet/nutrition are a few things that can also play a role, but lets look at those 2 causes.

1. Our bodies are awesome and capable of so much; just look around at what our fellow human beings are able to accomplish.  However, you have to give your body time to adapt and accommodate to new things or risk injury.  If your idea of running is to catch a bus, you need to start small and slowly increase the amount you run before attempting a marathon.

   This is a simple example, but try to put what you do into that context; relative to what your body normally deals with, what are you asking of it?  Does it seem like a big jump it what it has been used to?  Its the relative increases that I'm talking about here, it may not seem like much, but if you keep piling on additional strains without giving your body the chance to increase its tolerance, you will get closer and closer to your pain threshold.

2. The other side of the issue is when something you have done seemingly forever, all of a sudden is painful.  This fits most times when people "throw their back out" (a term that generally annoys me, because their back didn't actually go anywhere, or change in structure, but that's another blog post).

   Your daily routine hasn't changed for years, but all of a sudden what you normally do hurts, it is most likely due to the fact that you haven't taken care of those muscles and joints properly.  Muscles get tight with use, even healthy ones, and if they stay tight enough for long enough, they can prevent joints from functioning properly, which can lead to increased sensitivity and pain.

If you are experiencing pain, then it is best to see a physiotherapist to help you, but if you haven't had pain yet, then there are some simple things you can do to help prevent pain from showing up.

• Move; if you adopt 1-2 postures all day, then you need to start adding 'movement breaks'; 1-2 minutes every 20-30 minutes to perform a few simple stretches or exercises.

• Take 10 minutes a day to perform muscle releases on tight/knotted muscles that can cause pain (if unsure where to start, come see us and we can help).

• Ensure you get enough sleep; this can seem overly simple, but a good sleep can positively affect numerous areas of our lives.

• Improve your work-life balance; ensure that you take time for fun/enjoyment, again this seems overly simple, but it's important for stress/anxiety management to have fun.

• Get active; physical activity/exercise is by far the best medicine known to humankind; study after study have proven that this is the best investment we can make in our bodies.

Remember, our bodies are amazing and have almost limitless potential, but they won't get there overnight, and as even the finest sports car needs maintenance, so do we.

Normal Aging, How Does it Look on the Inside?

A lot of my patients have to me come with a scan (X-ray, CT Scan or MRI) they have had done because they had some pain somewhere and a helpful doctor has referred them for imaging.  Not in and of itself a bad practice per se, but sometimes it can lead to people thinking they are more frail than they actually are.

Now, medical imaging is a GREAT tool available to us, and can absolutely pick up things unseen by the naked eye, things like tumours, cancer, growths, broken bones and stress fractures, etc.  When patients exhibit a certain set of symptoms, referral for imaging is paramount, and I am not questioning this.

What I am questioning is when someone has some pain that does not necessarily point to sinister pathology, but gets sent for a scan.  The problem, is that there is absolutely no scan in the world that will show pain, so what often ends up happening is the doctor/radiologist makes a comment on what they see in the scan and presto, that is the 'cause'...

Now, the doctor or radiologist is not wrong in what they see, but the connection between what is in the scan and your pain is not clear.  As an example we'll use back pain (but the same things happens with the neck, knees and shoulders); disc bulges, decreased disc height, thinner cartilage, 'degenerative disc disease' are all comments that can be made after an X-ray or MRI of the low back. 

What happens though when someone WITHOUT pain gets imaging?  A series of studies were done that looked at exactly this, and what did they find; almost exactly the same amount of 'disease' and 'degenerative changes' as people with pain.  So what causes all these changes? In a word, aging.  It happens to all of us eventually right, just like grey hair and wrinkles, it is inevitable, but it DOES NOT mean that you are guaranteed to have pain because of it!

This is a very important point to make, because pain is multi-factorial, and beliefs about what causes pain does in fact affect what pain we feel.  Our brains are very powerful, and if you believe something is going to hurt, guess what, it will.

So what can we do?  Move; exercise is paramount to reducing your risk of pain, especially joint pain, because our joints are supported by and moved by muscles.  The stronger our muscles are, the more support our joints have, plus you will get all the ancillary benefits of exercise.

It sounds simple, but it isn't necessarily easy, so if you have any questions, please see your physiotherapist about getting you moving again and giving your exercises to help reduce your risk of pain.

Pain; It Hurts When I Poke It...

We've all heard this joke right: Patient: "Doctor everything hurts when I touch it"  Doctor: "Your finger is broken, stop poking things".  Although sometimes it is that simple, pain is a complex animal, and has MANY contributing factors, one of which is tissue damage...ONE!

If you get a charley horse it hurts, but will fade in a few days time; this is not the type of pain I'm talking about.  I'm talking about pain you experience months or years after the initial injury. 

This type of pain is affected by stress (social or work), depression/anxiety, your beliefs about pain, sleep habits, diet/nutrition, lack of exercise, previous experience with pain, and yes, tissue damage.

One of the best authorities on the subject is Lorimer Moseley and he and his colleagues performed a study on healthy individuals not experiencing pain.  They used a -20°C rod placed on the patients skin together with either a red light or blue light.  They were told that the red light would be hot and blue light cold, when in fact, they were both cold.  The red light group reported significantly higher levels of pain and discomfort than the blue light group...because they BELIEVED it was going to hurt more, it did.  This is one reason why I am very careful 'diagnosing' people, or labeling what they 'have' without giving a clear explanation and teaching them a little bit about pain science.

What can I do if I have pain?  I will not try to pretend it is easy to solve, and usually the longer you have had the pain, the more factors need to be addressed.  First thing to do though, is understand that inherently your body is strong, adaptable and capable of great things.  Believing that you can get better AND taking steps to help yourself is a great way to start.  Often the hardest thing to do though is to get moving, especially if we have associated movement with the pain, but this is paramount.  Our bodies are meant to move; moving our joints helps with joint lubrication and swelling management, using our muscles helps improve circulation, as well as modulate pain signals.  Now I'm not saying run a marathon and 'push through the pain', but find some pain-free movement that involves the affected area.  Even if this movement is small and not very meaningful, it starts a feedback cycle involving your most powerful weapon; your brain! The more we are able to do that doesn’t cause pain, our dysfunctional pain system gets re-wired to NOT expect pain.

If you have pain that is persisting, it is best to make an appointment with your physiotherapist, as they are an expert in movement and can help you take the first steps to reclaiming your life.