You can’t really tell accurately what’s going on underneath the surface based on how you feel. Your pain experience may make you feel a lot weaker or injured than your body actually is.

Pain science is the subject of understanding that the amount of tissue damage alone does not correlate strongly with the amount of pain a person will experience. As Paul Ingraham writes in ‘Pain is Weird’, there is ‘no pain without the brain’. Our brains dictate how much discomfort we will experience in any given physically compromised situation. It does this by processing signals from our nerves, some of which indicate danger – these, in high enough numbers, will then get transmitted to our consciousness as pain.

The first thing that I think is worth noting about pain is that the brain signals it to us before we experience damage. This is so we can do something to prevent hurting ourselves. Very often a person experiencing chronic pain in one area has gotten themselves stuck in overusing a certain body part and underusing another so the overloaded tissue signals pain but isn’t necessarily broken in any way. Another way a person may unduly experience pain is if the body or specific body part has experienced significant trauma to the area and now is sensitised. This means that it will signal pain to you under less stress than before (despite it being just as strong).

This image shows this well from Runners Connect:

Image result for threshold pain damage

Unfortunately a lot of people get into the cycle of resting to avoid pain and therefore never strengthening their brain’s concept of what its real limits are.

So what are the factors that can contribute to an increased sensitivity to pain?

 

Social 

Social pressures are omnipresent. In all our behaviours, there tends to be some little part of us that makes decisions based on how we think people will perceive us. Sometimes this leads us to improve ourselves, such as doing your team’s assigned workout even when you really aren’t in the mood and would rather crash on the couch. Other times however, a person may be labelled with a penchant to overreact to injuries and unfortunately may live up to this standard because they think they are expected to. Similarly, they may be seen as ‘constantly injured’ and struggle to let go of this identity. It’s a mixture of the Galatea and Pygmalion’s Effects.

Here’s a different but classic example of social effects: a child falls over and there’s a moment of hush. The child looks over to the adults to see how he should respond. If he finds worry and anguish on the faces of the adults or if an adult rushes over, then he is most likely going to start bawling. If the adults looks at him calmly, or indeed act as if they haven’t even noticed the incident, he is more likely going to respond more proportionately to whether or not he is actually hurt. Unless…

Previous injuries

Taking the same example above of the child falling, if previous falls or knocks have given him a learned behaviour to cry whenever he trips, then this is likely to happen regardless of the amount of tissue damage sustained.

For adults, often a fear can be built up around a previous injury. The rehabilitation process for an ACL repair is long and arduous and for a person to truly return to where they were before, they must overcome a mental battle to reinstill their confidence in their abilities to withstand high load and force. For some, they may worry every time they feel a bit of a pinch or ache around their knee and think they need to rest or not push themselves. Before their ACL tear, these trivial sensations may have gone unnoticed. Which leads me to…

Fear avoidance

This is a common term to describe when a person actively avoids a movement that provokes pain for them. Now, this is obviously just plain wise to do – why be in pain at all if you can avoid it? But unfortunately if done past the point where it’s necessary, it may lead to longer term issues. This commentary piece from pain science researcher Lorimer Moseley describes the current model’s definition as follows:

‘This model argues that it is the overly fearful people who end up with chronic pain: they avoid movement and activity so as to not provoke pain and this in turn leads to disengagement from meaningful activities, disability, and depression.’

We should be careful not to look at this too catastrophically – getting an injury doesn’t mean you’ll end up in chronic pain and depressed! But if we imagine there is a spectrum between blissful pain-free, fearless movement on the left and chronic, stressful, debilitating pain on the right, injuries tend to shift us to the right. Some people unfortunately keep going right, whereas others bounce back to the left in reasonable time. Lots of little things in life can continue to edge us to the right and left. Bringing some awareness to ourselves about this can help us manage and reduce our pain.

 

I actually have so much more I could talk about (hormones, pain maps, SIMs and DIMs, central sensitisation – to name a few) but I’m going to leave it at just one more – an extremely common self-limiting concept I hear far too often so I have to make sure to include it! This is:

Expectations

Are you hitting your 40s and starting to say that it’s normal to start feeling pain all over? Do you think she believed this? 😉

Image result for old woman gymnast

When asked if she feels pain in the morning, she responded: ‘Not at all, as soon as I wake up, I’m an early bird so my morning routine is running up and down the stairs.’

Do you think you’re destined to have arthritic pain* because your mother did? Have you been told (as I was by unqualified people) after a fracture that you’re going to get early arthritis**?

Do you think because you work at a desk that you should feel pain or have ‘poor posture’?

When we instill these beliefs and expectations in ourselves, we remove our sense of power to actively reduce our risk of pain, injury and movement variability. If it’s going to happen anyway, why do anything about it? Well, not everything is set in stone when it comes to biology. Even if you are more genetically predisposed to a certain physiological response because your family has it, epigenetics  will dictate whether or not you actually end up with the same heart disease, ankylosing spondylitis and other apparently genetically linked pathologies that your family members have had.

Live your own life and accept only the best outcome for yourself! Do what it takes to keep yourself active and pain-free and set no unnecessary limits.

*We all have osteoarthritis from our 20s on, so you’re correct if you say you have arthritis.

**FYI my fractures were extra-articular so in fact I should have no increased risk of early arthritic pains – be careful not to listen to opinions rather than proof!