Pain in a Nutshell

An old 5 minute video that describes pain in simple terms without getting too bogged down with all the neuroscience:

"Most things in the body are healed as well as they can be in 3-6 months. So, ongoing pain being produced by the brain is less about structural changes in the body and more about the sensitivity of the nervous system."

Oftentimes people with chronic pain feel like the source is due to some structure being "out of alignment" such as vertebrae in the back being "stuck". Other examples include hips that feel "misaligned" that need to be "popped back," or worked-up muscles that people feel need to be "dug out" as with deep tissue massage or foam rolling. While structural or physiological changes can be part of the equation and do need to be addressed, managing recurring pain can be even more effective with a shift of emphasis towards the neuro-physiological model described in the video. Part of the job of the nervous system is to take information from the environment and send it to the brain so that our bodies can produce the appropriate response. If stimuli from the environment is excessively (or in some cases, erroneously) interpreted by the brain as noxious, then pain, which is an output of the brain, can be modulated by managing how we sense that environmental information.

But how do we do that? Well...you get moving!

"From the brain's perspective, getting moving at comfortable levels without fear and where the brain does not protect by pain is best, and you'll gradually restore your body's tissues."
In other words, break the vicious cycle of: pain --> fear of movement --> decreased activity and range of motion --> atrophy --> more pain. Redefine healthy function by using corrective exercise and new movement strategies while decreasing exacerbating behaviors.

In the clinical setting, I've found that sometimes a patient won't feel like their pain has been appropriately addressed unless if they definitively feel the intervention they are receiving. This can be particularly true for people who have received excessive hands-on work (such as deep tissue massage) which may have reduced symptoms in the short run, but received inadequate interventions to address the source of pain (i.e. exercise, movement re-education). These are important opportunities to explain how progress and effective pain management is more than just getting a sore muscle pushed upon or getting your back cracked. At some point gradual, tolerable and progressive exposure to movement must be re-introduced to the patient which should decrease the perception of threat and diminish pain.

“At some point gradual, tolerable and progressive exposure to movement must be re-introduced to the patient which should decrease the perception of threat and diminish pain.”