I was down at Manly Beach the other day sucking in some big ones having been worked for 90 mins solid by my beach volleyball coach Martine and couldn’t help but overhear a conversation two men were having. As a long practicing physio there are a few buzzwords I can’t help but tune into and when bloke 1 said to bloke 2 “hopefully my back sorts itself out soon, I haven’t had a surf in months” I was instantly hooked. Unfortunately, it’s common for me to see new clients who have been suffering a form of chronic pain or immobility due to a condition or injury for months, even YEARS, but every time I’m still shocked. Look, I know not everybody loves seeing the GP or attending to annoying medical issues when there are other things going on in life, but chronic pain is not something anybody should be living with for any extended period of time. It’s not only uncomfortable at the time, but chronic pain and the underlying causes can eventually cause permanent physical and even neurological damage to parts of the brain if left undiagnosed and untreated.
What is pain?
The simple version of pain as endorsed by The International Association for the Study of Pain is that it is as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. But pain is not simple. Pain is not only a physical sensation, it can be influenced by a number of external factors such as personal attitude, personality, resilience and has the ability to negatively affect emotional and mental wellbeing. For example, take two people suffering the same ACL injury – they are experiencing the same condition, yet their experience of living with the pain will be vastly different and their recoveries will differ based on their physiological make-up along with their psychological attitudes.[1]
There are two main categories of pain that physiotherapists see and treat: acute and chronic.
Acute pain only lasts for a short time but can be incredibly intense. Commonly occurs after surgery or due to physical trauma such as a motor vehicle accident or a sporting injury. Acute pain is the body’s warning alarm telling you to seek help. Although acute pain usually improves as the body heals, sometimes it doesn’t.
Chronic pain is the type of pain that stays with you long after surgery or an immediate injury and is commonly caused by underlying conditions. Conditions like migraines, osteoporosis, arthritis and other musculoskeletal issues are all commonly diagnosed chronic diseases that musculoskeletal physiotherapists see all the time. Just to keep us on our toes, chronic pain can exist without a clear reason or underlying cause. Remember the definition above of pain; actual OR POTENTIAL tissue damage. Yes, you can have pain without any damage! Chronic pain is commonly a symptom of other diseases but can actually be a disease in its own right, caused by changes within the central nervous system.
How does pain work?
Your lower back pain, knee pain, neck pain, ankle pain and every other pain all the way to your little pinky pain comes from the brain itself. Pain is the end result of your brain evaluating information and coming up with a best guess of how to translate that information and to where. Your body contains nerves called nociceptors that detect any dangerous changes in temperature, chemical balance or pressure in your body and send alerts to the brain, but the pain you feel is all in the brain and controlled by the brain. Thanks heaps brain.
Most of the time your brain gets it right, but sometimes it doesn’t. For example, referred pain in your leg is common to experience when it is actually your lower back causing the issue. Another example of the brain’s power is phantom limb pains commonly experienced by amputees in limbs that are no longer there. If that’s not the perfect example of the power of the brain, I don’t know what is. They have pain when the limb doesn’t even exist!!
How can ignoring chronic pain lead to more problems?
I’m sure other physiotherapists on the Northern Beaches are just as sick of hearing ‘no pain, no gain’ applied to every painful scenario as I am. Even during and after short term bouts of experienced pain, your brain increases stress hormones in your body, which can make it harder to think, cause anxiousness, lethargy, fatigue, slower recovery and lead to muscle tightness. Even that “dicky knee when it gets cold”, that “sore back” or “dodgy shoulder” is capable of causing long term physical and psychological effects. Pain affects the proper functioning, strength and efficiency of the human body. This often leads to altered movement patterns, compensatory tightness in other areas of the body, limb weakness and can cause chronic stiffness and exacerbate the pain.
It is imperative to address any pain as soon as you realise that it is not just going to disappear in a couple of days. Your GP will agree with musculoskeletal physiotherapists that the evidence supporting early treatment in almost any acute injury or painful condition is well documented.
Don’t let your pain today progress and evolve into more than something that can be relatively easily fixed with physio intervention. Instead of thinking “no pain, no gain” when you get an injury, focus on allowing yourself to understand that we need to heal, we need to relax and we need to look after ourselves because putting your body and brain through continuous pain is doing much more harm than good.
[1] McArdle S. Psychological rehabilitation from anterior cruciate ligament-medial collateral ligament reconstructive surgery: a case study. Sports Health. 2010;2(1):73–77. doi:10.1177/1941738109357173
