One of the most common issues I treat in the clinic is persistent pain. Many of my clients arrive at the clinic after years of suffering. This is often a residual pain that started as a result of a traumatic injury… a muscle strain, or a broken bone. However, years after the injury has healed there is no reduction in pain – despite all the injured tissues healing and normal activities are resumed.
One of the biggest frustrations I hear is that many of these clients have been to multiple therapists to resolve their issues. A lot of the time, they describe some short term pain reduction. But ultimately their pain returns within a few weeks or months of being discharged from treatment. It is puzzling for the client. They feel that they have exhausted all their options.
The definition of insanity is doing the same thing over and over again, but expecting different results.
In my view, often the pain returns because treatment modalities provided at the time can only offer short term changes to the nervous system (i.e.: sports massage, acupuncture) and a number of other variables have been neglected in the design of the treatment.
Below are three key variables that I believe are essential to managing and preventing pain – particularly in the absence of recent traumatic injury.
STEP 1: Changing the nervous system’s response to stimuli
We often adapt our movement in response to pain caused by an injury. Over time, we can develop movement patterns to avoid pain – even after the tissue has healed. The areas in our brain assigned to bodily regions where an injury has occurred may become more sensitive to any sensory input. Here is a wonderful TEDx Talk by Professor Lorimer Moseley who explains this concept so much more eloquently (and humourously) than I can. In a nutshell, we need to reduce sensitivity through increased exposure to movements and sensations that we have come to incorrectly associate with danger.
STEP 2: Changing the load on the tissues
To quote Albert Einstein, “The definition of insanity is doing the same thing over and over again, but expecting different results”. Yet, it is incredible how this rule of thumb evades us when we have a recurrent pain or injury issue. We can influence our nervous response with soft tissue treatments like sports massage, foam rolling, hot and cold treatment, etc. However, if our injury is caused by repeated over-loading and/or under-loading (i.e.: sitting at a desk all day and running or training intensely once a fortnight) then we need to alter how we load our bodies. A good therapy intervention for persistent pain includes changes in daily movement and activity.
The good news is that we don’t often have to stop training to recover. Quite the opposite in fact. We need to ensure that our weekly average of our training load is no more or less than around 20 to 30% greater than our monthly average. You can read more about managing your training volumes to reduce injury risk here in this thorough blog post on ‘Acute: Chronic Workload Ratio’ from Science for Sport.
STEP 3: Improving the function of the tissues
So far we’ve calmed down the nervous system in STEP 1 and moderated our training load in STEP 2. But it’s critical that we don’t forget the importance of being able to do our activities of daily living too. For example: it’s all very well to adjust our training load so that we can get through a hefty 3-hour training session without shoulder pain. But it’s problematic if we still can’t tie our laces, re-rack the plates at the gym or put our seat-belt on in the car! All the treatments and programming used to help a person get out of pain should also target improvement in the function of the affected area. This means that we need to look at the quality of movement required to undertake our activities throughout our entire day. These activities count towards our overall ‘training volume’ too. We must build targeted exercises in to our daily and/or training routines that become more challenging over time – AKA ‘progressive overload’. Without progressive overload, we cannot improve our function and performance.
To recap, if you have been experiencing a pain issue for some time and haven’t found a long-term solution then try out all three of these steps. If you would like to discuss your pain symptoms in any further detail then please feel welcome to get in touch using the Contact Form, or social media using the links below.
Looking for more info? Move Well Workshops on pain and injury management…
I will be running workshops on the topics of managing pain and injury throughout the year. Take a look at the Workshop Page to find out more.