Pain, Re-framed.

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I had chronic low back pain.

Had.

The first incident was years prior in college: randomly getting up from a nap on the couch (college!) and my back grabbed me and put me on the floor. 9/10 P! Never happened before, so I just lay there for a bit and crawled around until I could relax enough to stand.

Fast forward: after college I would try to stretch my back in the gym, it never really bothered me, per se, but I felt the need to specifically address it.

More forward time-travel: Two years before DPT school. My activity level was high.  I was dead-lifting, squatting, Oly lifting, doing pull-ups, running, teaching an Abs Class, etc… full on healthy stuff.

During this time my back was starting to hurt again. This time I had L5-S1 pattern tingling and burning. It went on like this for months.  I eventually got foot drop as well, which is a very strange feeling indeed.  At the time I was working in a PT clinic with McKenzie practitioners. I was given a quick assessment and explained the dynamic disc model and then I worked, almost daily, on my posture and repeated extensions program. This lasted for about two years of varying forces, me learning about side glides and figure four, or road-kill, position and things of this nature. I was taped for proprioception, got the lumbar roll for the car and was very vigilant about “neutral spine” during workouts and activity.

I was managing, but was not free.  Not free to move… I see that now, looking back, how that rigidity was always part of my movement plans. “Don’t bend wrong.” “Don’t, or you’ll hurt it again.” I don’t remember if anyone actually said that to me, but I said it to myself.

I was living the dynamic disc explanation. I have a very lively imagination and abstracting brain, so when I heard that “the jelly was coming out of the doughnut” I was on it. In my mind’s eye I was imagining the doughnut squeezing with every extension repetition, every force progression.. I was putting my nucleus pulposis back in there! Now, dammit, stay in there!

I remember sitting at stop lights in my car and completing TrA contractions the whole time just willing, with all my effort, for the disc to stay put.

This was indeed an active way to combat my pain. I was given things I could do to not re-injure my doughnut. But I still had pain… for these two years.

What was the game changer?  How am I able to sit here, slouched over a laptop, and say “had” chronic pain? Back to the timeline…

Enter: education.

I started DPT school, still minding my positions. Although much of the irritation was reduced (as was my physical activity… thanks for using all my energy, Brain!) I soaked the curriculum in, just as everyone else did, until…

This video: VS Ramachandran presenting 3 Clues to Understanding Your Brain

 

Mind blown. New interest sparked! And then… because, as Dr. Spencer Muro says, “Bed time is TED time” I found this TedTalk: Why things Hurt via Lorimer Moseley

 

Never going back now, the search was on…more TEDtalks, youtube… I found articles: Vlaeyen et al 1995 and on… I found blogs: Your back is not out of alignment, BodyInMind.org, I read Forward Thinking PT‘s posts, at the time about perception and our limitations and biases in what we know, etc. I watched less Kelly Starrett/ Mobility WOD videos and I read Diane Jacobs, Silvernail, BBoyScience more Moseley, I’m not sure I could list all the influences…

My frame of reference changed… and for a long time I didn’t notice… my back was not bothering me.  At all.

I am only noticing this in retrospect. I did not watch Moseley talk about the Lada Niva and then suddenly have no lower extremity parasthesias. I did, however, gain the information needed to understand pain and as that happened I had a reduction in pain. Caveat: I was not thinking of myself at first when learning the material. It was just information. The idea that it would help me in some way and that education was what I needed to address my personal issue was not the goal.

I was also sloughing off the biomedical-pathoanatomical-structuralism explanations of things. I can look back and see how beneficial the dynamic disc model was for HEP compliance and it was easy for me (a patient) to understand. I also clearly notice that there was subtle movement fear mongering occurring, and I ended up with a subconscious internal view that I was broken and needed constant vigilance to maintain neutral or I would have pain again.

Let’s say that all this education on how the brain produces pain was not the cause of my new found relief. Fine, I fully understand Maturation, Regression to the Mean, Natural History, etc… but this knowledge has seemingly helped me prospectively.

I now go for a run (or a brisk walk because “I’m old and live in the suburbs”) and my knee might hurt. Or I will lift weights and my periscapular muscles will tense up, or I will surf and I will get a sharp pain in my lower trap, so I am not about to say that this information has made me Wolverine or immune to pain or anything…

But I do, consciously, talk to myself about the feeling that my brain is producing about that body part. I re-frame it.  I put those feelings in a different box. Not in the “oh no, I am damaged!” box, or the “I knew it, shouldn’t have done that, what have I done now?!” box. It goes in the “It’s just my brain making feelings” box.

Literally in my head yesterday on a run. The anteromedial joint-line of my right knee starts to burn or ache. I say to myself “hmm, that’s interesting, I wonder what my brain thinks is going on down there that needs my attention?” In admitting that I hope you don’t think I’m a weirdo… I am into mind-over-matter concepts, but positive talk is not magic. I share that as example of re-framing. The point being, I don’t jump straight to “ARTHRITIS!!”

Anecdotes on anecdotes? You bet. This is my story with my explanation of how these events have come to pass. I have not been collecting data or completing an RTC. My fascination with the topic creates a wonderful bias.  Yes the physical aspect of McKenzie or manips or strengthening and general healthy exercise, yoga, movement for the sake of movement are all at play.

I have had no pain of significance since this educational change, perspective change, adaptive change. I like to think about why that might be and how far it could be taken. How much does Moseley hurt? Is there a prospective protective aspect to understanding pain?

So far, 2 take home points: 1) Pain can be re-framed. 2) And it likely isn’t going to happen in an afternoon.

Matt D

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6 thoughts on “Pain, Re-framed.

  1. But isn’t there a fine line here? Pain is often trying to tell us something and if we ignore it we risk injuring things further. I understand with chronic pain, figuring out a way to mentally change perception is important but if someone has genu valgum and it’s causing knee damage, ignoring that pain isn’t helping matters.

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    • Robbie nowhere was it mentioned that you should ignore pain. Pain isn’t necessarily a measure of tissue damage but can be correlated to it. If you wake up in the morning and your back hurts does that indicate great tissue damage done over the night? If you are out for a run and your knee hurts did you suddely break a bone? While it is possible in most cases it is unlikely and in my view there is a trade off for the better not worrying the instant we feel pain and attempt to make a critical evaluation of the pain (you need to understand pain to do this).

      Let’s use the example of genus valgus – many people has this and no problem. I would like to see any studies that this is a problem if you can provide this? However there is studies that shows when landning with excessive genus valgus can be predictor of injury. If a person is born with a structure that gives that person genus are they born to “damage themselves”? If they during their life has changed their habits and now has more genus valgus is that also damaging them? Is there no natural adaptation to our habits?

      Looking forward to your reponse

      Kind regards,

      Simon Kirkegaard

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