It’s 3 in the morning. You awake from your sleep with a loud bang. What was that, you think to yourself. The noise was too loud to ignore, so you slowly creep to the top of the stairs. That’s when you see them – hooded silhouettes carrying your TV out the front door. Your heart starts racing and you feel the pounding in your chest as you dial 911. Bright blue lights flash through your front window, as police cars surround the house, but it’s too late. You were robbed…
3 months after the incident, it’s 3 in the morning. You awake from your sleep with an undistinguishable noise on the floor. This is familiar, you think to yourself, and you think back to the robbery that occurred previously. How do you respond? How hard does your chest pound? Do you check on the noise? Maybe I should call the police? You’re overwhelmed with emotion and you can’t think. Instead, you impulsively open the second story window and jump. Why? Was this the best thing to do in this situation?
This is how most of us respond to musculoskeletal injury. The robbery is similar to primary and secondary injury. When we feel pain our first instinct is to overreact, similar to jumping out of a window after suspecting an innocent noise in our home to be a robber. The reality of it is, there wasn’t a robbery the second time. It was just your cat, Bono, inspired by your new purchase of a BeachBody subscription.
If we suffered an injury previously, it’s hard to avoid anxiety when we feel aches and pains in a similar region. That initial injury we suffered, picking up that box in the garage, was scary and painful. That doesn’t mean, however, we should avoid picking up boxes for the rest of our lives, or walking into garages for that matter.
In chronic pain, this concept is exaggerated. There is no robber, but every time we hear a noise downstairs, we think there is one. It may not even be nighttime, or a noise in our own house. The cat running on the floor, the wind outside, any sensation startles someone with chronic pain into thinking there’s serious injury (or a robber in the house). But there’s no robber. That was months, maybe years ago, but he’s gone now.
HOW DO WE CONVINCE OURSELVES THERE’S NO “ROBBER”? WALK AROUND IN SUPERMAN PAJAMAS?
Well, not exactly. The most challenging way to break this pattern is to convince the brain to check on the “noise downstairs”. It’s challenging. We’re scared. We’re afraid we might get hurt if we move, or lift, or run. But if we never check on the noises in our house, we’ll never know the cause. We’ll continue to fear that every sensation we feel is associated with injury. That little twinge you feel in your back is not the robber. It’s just that pesky cat addicted to late night exercising.
Most importantly, we must begin slowly. If you heard a light gust of wind as opposed to a loud bang downstairs, which would cause more fear of a burglary? The brain is the same way. In Explain Pain, Butler and Moseley discuss ways to activate portions of the brain responsible for bending your back, but in a way that is non-threatening and safe. It’s a way to call the police to check on the noise rather than jumping out the window.
Here, I will outline three ways to ease the brain into movement:
The first way to access these parts of your brain is through imagination of movement. Schnitzler et. al (1997) found that the areas of the brain responsible for movement activate when movement is imagined. We do not have to physically move to activate these areas. What’s also interesting is that the areas of the brain responsible for sensation were not activated. If we imagine movement, we separate pain (sensation) from movement. Give it a shot!
The second way to break your brain’s association to painful movement is to perform a certain movement in a different position. If you struggle with chronic pain, you may associate everyday activities such as lifting, bending, reaching, etc. with pain reproduction. What if you sat on the floor and brought your knees to your chest? Your lower back is performing the same movement, sending the same signals to the brain, but in a different environment. How about sitting on a chair and slowly reaching towards the floor? Or touching your toes in your while suspended in your local pool? Play with the possibilities and be creative. Take your body back.
The third way to alter your environment is to increase distractions through the eyes and ears to break the usual pain association. For visual distractions, try bending towards the floor with your eyes closed, or looking at yourself in the mirror when performing the same tasks. Have you ever heard a baby cry on an airplane? It’s so hard to think of anything else! Take advantage of how distracting noise and vision are. You don’t have to listen to a crying baby to get results, but you can use noise to distract your brain from pain anticipation. How about turning on your favorite song? Favorite TV show? A sappy movie? Then try moving. Slowly but surely, IT DOESN’T HURT.
We never know if a robber is in our home if we don’t investigate it. Pain, especially chronic pain, is the same way. If we do not check on the area that is causing pain by moving it, we will never rid ourselves of discomfort.
HERE’S A QUICK SUMMARY OF THE CONCEPTS DISCUSSED TODAY:
- Understanding pain is the first step in reducing it. Those who understand pain can quickly reduce the intensity of their symptoms.
- Don’t Jump Out the Window! Investigate the sound in a way that doesn’t put your body in harm’s way.
- Imagining a movement as pain-free is a great step towards initiating painful movement patterns.
- Challenging the spine by performing different movements in different positions is another strategy to inhibit your pain perception.
- Adding visual and auditory inputs can distract the brain into decreasing pain outputs.
Brendan Glackin, DPT, CSCS
Glackin Physiotherapy, LLC
Butler, David S, and G L. Moseley. Explain Pain. Adelaide: Noigroup Publications, 2003. Print.
Bunzli S1, McEvoy S2, Dankaerts W3, O’Sullivan P4, O’Sullivan K5. Patient Perspectives on Participation in Cognitive Functional Therapy for Chronic Low Back Pain. Phys Ther. 2016 Sep;96(9):1397-407
Louw, Adriaan. Why Do I Hurt?: A Patient Book about the Neuroscience of Pain. Orthopedic Physical Therapy Products. 2013
Ostelo Raymond WJG, van Tulder Maurits W, Vlaeyen Johan WS, Linton Steven J, Morley Stephen, Assendelft Willem JJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews. In: The Cochrane Library, Issue 3, Art. No. CD002014.
Schnitzler A, Salenius S, Salmelin R, Jousmaki V, Hari R. (1997) Involvement of Primary Motor cortex in Motor Imagery: a Neuromagnetic study. NeuroImage 6(3), Pg 201-208