Categories
Myth Busting Pain

I’m in pain because of my posture… and other flawed language

At Health Blogs

Andrew Terry

Andrew Terry

Share

Share on facebook
Share on twitter
Share on linkedin
Share on google
Share on reddit
Share on whatsapp
Share on email
Share on pinterest

I’m in pain because of my posture… and other flawed language

Custom caption = click on image > Content > Custom Caption.

why is language in pain important?

I want to talk a little about language today, and why it has such an important role on the journey out of pain. Medical professionals (osteopaths included), have often been so keen to explain to patients their findings that they can leave them with a feeling of dread about their body. We show them scans, talk about their “bad posture” (more on this later), and things being out of place (as if somehow a body part can be lost within its own body) that even if they manage to get them out of pain initially, the patient is left with the feeling that something was really wrong and can often become fixated with their diagnosis. They may seek constant treatments to fix their perceived ailment, or be on the lookout for future pain. The problem with this is, and patients who come to see me know I say this a lot, is that pain comes from the brain, so if you’re on the hunt for pain within your body, more often than not you will find it. Understanding of this intricate link between our psychology and pain is growing by the day, with more and more studies suggesting that negative pain beliefs have a direct correlation with our levels of pain. 

So I want to talk about some of the flawed language you may have heard in relation to pain. Whilst I’m not going to sit here and say that these hold no importance at all, their perceived importance and actual importance are often further apart than you think.

Custom caption = click on image > Content > Custom Caption.

1. I need to strengthen my core

Another version of this is “I am in pain because I have a weak core.” I often wonder how this one started. I would imagine it’s because of the huge prevalence of back pain in Western culture and our need to find a common cause. There are a few problems I have with this statement, like, “why do so many people with a “weak core” have no back pain?” Or on the other end of the spectrum “why do so many people with strong cores have back pain? “At what point is a core considered weak?” And “why if a strong core is so important (it’s not), is this not important for other parts of the body?”

But most importantly, it’s the fact that those who feel they have a weak core then think that their back is weak and fragile. Even worse, you may even stop moving about as much because you’re worried that your back will let you down. So let me say this now, your back is AMAZING. It’s incredibly adaptive and strong, and in my years of practice I can probably count on one hand the number of times I have said weak muscles in the back may have been a contributing factor towards their pain. In fact I would say I spend more time fixing tight muscles in backs than I do weak ones. The studies that have gone into comparing exercises that stabilise core muscles in comparison to general exercise or manual therapy have shown that they have little affect, and only marginally better than placebo (Ferreira, Ferreira et al. 2006, Ferreira, Ferreira et al. 2007, Costa, Maher et al. 2009). So please, do not stress about your core, just make sure you move around as much as pos

2. "My back goes out of place every now and then"

Custom caption = click on image > Content > Custom Caption.

You can add to this, “my hip pops out,” “I have a slipped disc” and “my <insert body part here> is out of place.” My usual response to this is “where did it go?” Now I’m aware that this is a common phrase related to having back pain (or whichever body part you’re referring to) that reoccurs, and I also know this pain might be excruciating. But I want to reassure you that your hip or back didn’t actually pop out. It might have felt like that, you may have heard something click and you felt pain, but it hasn’t literally slipped out of place (Palsson, Hirata et al. 2014). Again this might seem like I’m being a bit of a pedant in my use of language, but this is what this article is all about, how language influences your pain. You’ve injured yourself. That’s it. Some of these may be more serious than others, but you do not need to go down the path of thinking that your body has given up on you or it’s broken. The anxiety of thinking that parts of your body may pop out when you move can lead to. It’s why I always tell my patients that I am an osteopath that believes in homework. I want to reassure them that their body is fine, and that the most important thing they can do is to keep moving within pain-free levels, or what I like to sometimes call, comfortably uncomfortable ranges of movement. The best route out of pain is an active one. 

3. "I know I'm In pain because of my bad posture"

I actually like my patients to have good posture, but it’s probably not for the reasons you think, and this is definitely one of those ones where perceived importance and actual importance are much further apart than you realise.

The reason I like my patients to have good posture is actually partly down to aesthetics. If you think you look good and enjoy having good posture, then it’s likely you’re going to have a more positive relationship with your body, and I want to promote that as much as possible. But in reality the most important thing in regards to posture, is to not be in the same position for extended periods of time.

Our body is constantly repairing itself, and these new tissues get aligned through movement. The key word here is movement. If you have perfect posture all the time, but don’t move much, then you’re still going to develop restrictions, which mean you’re likely to be less dynamic and are then much more likely to experience pain. In fact you’re just as likely to experience pain if you have perfect posture but don’t move, as someone who has poor posture and doesn’t move. Our bodies are a bit like pumps. Changes in pressure are occurring all the time, through a mixture of breathing, movement and other clever processes that allow everything to flow throughout your body, from blood to lymph, and keeping this flow healthy is extremely important in helping us reduce the chances of pain and discomfort. So the next time you’re worried about poor posture, just get yourself up and about rather than stressing about the best position you should be in. There is no poor posture, only a body that lacks movement.

Custom caption = click on image > Content > Custom Caption.

4. "I've had a scan which shows degeneration so I know I will always have a certain level of pain"

As modern medicine has progressed, our eagerness to use scans as a means to get a diagnosis have increased. The problem with this is that even scans can throw up a few problems of their own (if you’d like to read more on scans you can read one of our other blogs). Let’s dissect a couple of the most common issues. 

They show you everything that has happened to your body:

There have been numerous studies into abnormalities found on scans in asymptomatic people. One found that 37% of 20 year olds, and 96% of 80 year olds had some form of disc degeneration. What’s important to remember in this study is not how many people have some form of disc degeneration, but how many people have something show up in a scan but have no pain at all. If so many of us have degeneration but no pain, how useful is it to be told that degeneration is the cause of your pain?

You might get a different diagnosis from different physicians from the same scan. 

When you go and get a scan you would expect a degree of consistency. After all it’s just an image. However different diagnosis from the same scan can vary dramatically. Take a study of a 63 year old woman with chronic low She had 10 different scans at 10 different facilities, with the result yielding 49 distinct findings. So is one right and the rest wrong? Or are all of them right? How would you feel if you were given 49 different diagnosis? Scans are of course a really important part of modern medicine, but we might be overusing them. Pain is complicated and it’s important we don’t associate our levels of pain with scan results.

5. "My glutes aren't firing"

If you’re able to walk, then your glutes are “firing” just fine. This term has become dramatically oversimplified, and is often linked with running or squats. Running, and even squats are actually rather complicated movements for the body, with chains of muscles working together. For any number of reasons, sometimes these chains can become out of sync, but this doesn’t mean that something isn’t working properly, it just needs a little guidance in getting back in sync, either through treatment, dynamic exercises or ideally a bit of both. 

6. "I've been told it's all in my mind"

Custom caption = click on image > Content > Custom Caption.

This is something that you may get told after you’ve had scans that have yielded no meaningful results. And whilst technically it’s accurate, how useful is this information unless you’re given an explanation as to why this might be happening, coupled with guidance in how you might overcome it. Just because it might be “all in the mind,” doesn’t make your pain any less real. Our job as primary healthcare practitioners should be to explain to you how and why the brain creates pain, and then offer you support so you can begin to make the steps towards being pain free. 

Here’s a great Ted Talk by the amazing Lorimer Mosely who explains this better than I ever could.

If you would like to know more about your pain, what might be happening, and how you can go about getting pain free then please don’t hesitate to get in touch. 

You can call us on 0208 088 0533 or book online and have a chat with one of our osteopaths. 

Subscribe to our newsletter for new content

Categories
Myth Busting Pain

Pain Is An Opinion

At Health Blogs

Andrew Terry

Andrew Terry

Share

Share on facebook
Share on twitter
Share on linkedin
Share on google
Share on reddit
Share on whatsapp
Share on email
Share on pinterest

Pain is an opinion, and like an opinion, it can be changed

The Builder & The Nail

Take a moment and imagine a 15cm nail. That’s a pretty big nail. Now picture jumping off a wall, onto the nail, and watching the nail go completely through your work boots. For one unlucky 29 year old builder, he didn’t have to imagine this scenario as he watched the nail go right through his boot just next to his steel toecap. Being in agony, the man rushed himself to hospital. As the smallest movement was too painful for the man to take, he was sedated, and the nail was removed from his boot. What happened next appeared to be a miracle. As they took off his boot to look at and then treat the wound, there was none. The nail had gone right in between his toes, he was completely uninjured.

Custom caption = click on image > Content > Custom Caption.

Pain Doesn't Always Equal Damage

This is what is meant by the phrase “pain is just an opinion.” The man landed on the nail, watched and likely felt the nail go through his boot, and then his subconscious brain took over. His brain analysed the situation, processed the fact that it had just witnessed a nail go “into his foot,” likely sensed the cold nail between his toes, and his brain came to the opinion that in order to protect his foot further, a pain response was required. This sort of reaction, although extreme, is actually not as uncommon as you think. Have you ever been walking along and bumped your leg or arm into something, and just shrugged it off as nothing serious. You then maybe catch a glance of it later on in the day, perhaps as you remove an item of clothes that was covering the area, and you notice there is a big cut or bruise covering the area. A few things might happen upon noticing this. You may just carry on doing whatever it was you were doing and just be surprised that there is now this big cut or bruise and wonder where you got it from, OR, it might suddenly start really hurting as you become acutely aware of the injured area.

Through research we now know that pain, 100% of the time, is created in the brain. We know there is no such thing as a pain receptor or a pain pathway, and we know that whilst there is sometimes a correlation between an injured body part and a pain response, we also know that just like the case of the 29 year old builder, we can have a pain response when there is no injured body part at all.

So what does this information mean for you as a person in pain, particularly for someone in chronic pain? The first thing that should hopefully give you comfort is that because ALL pain is created in the brain, if you’re experiencing pain, it is real 100% of the time. It does NOT mean you are just making it up, or “it’s all in your head” (I mean technically this is true, but it’s a very unhelpful comment to make). People who say “it’s all in your head” tend to be implying that your pain isn’t real and that you just need get on with it, which is the opposite of what you should be doing.

If you’re experiencing pain, it’s because your brain has come to the opinion that it needs to protect you from something. If you get told, “it’s all in your head,” and you must go about your day without having first tried to change your brains opinion on why you need protecting, then it can get stubborn and turn up the pain dial as it hasn’t been convinced that you don’t need protection. Whilst extremely frustrating, this is a very normal and healthy response, but also a response that shouldn’t just get ignored by being told to get on with it.

Keeping up? Give yourself a high five!

Hopefully now you can grasp the idea that we can have pain, without an actual injury. I want to try and explain to you two pain responses to injuries that are more common than you think. I’m going to use a pulled muscle in your back as an example.

You pull a muscle in your back when bending to pick something up. This is extremely painful and so you lie still and don’t move, or move very little, over the next couple of days. A weird thing now happens. Your back heals, just like your skin heals after a paper cut to your finger. However because you haven’t been moving, and your brain hasn’t been receiving any feedback to let it know it’s ok, it will still create a pain response. Crazy right? I like using the analogy of a highway at night. Your brain hasn’t been told it’s daytime, and all the lights are turned up bright in order to protect you so you don’t crash. We need to tell the brain that it’s daytime and that it can turn everything down.

The second scenario is similar. You pull your muscle in your back when bending to pick something up. Again you’re in agony, but this time you move around and begin to feel better. Your back heals, just like the paper cut to your finger. You then go about your normal day, go to pick something up, and you suddenly find yourself in agony again. However what has happened on this occasion is that your brain has come to another incorrect opinion. It’s remembered that the last time you went to pick something up, you hurt yourself, and in order to stop you from hurting yourself again, causes a pain response. You haven’t actually done any damage to your body, it’s just a form of protection carried out subconsciously by your brain.

how do you change the brain's opinion?

So what do you do when this happens? How do you stop yourself experiencing pain when there hasn’t even been any damage? The first thing you should do is seek advice from a professional, and depending on the situation you want to see someone who has detailed knowledge of pain science and rehabilitation. Education and reassurance plays a huge part in the reduction of pain. It’s how you begin to change the brain’s opinion. The next thing is rehabilitation. Depending on the processes behind your pain, your therapist may try a number of different techniques. These may vary from getting you to use the opposite body part to the one that has been injured (if you’ve hurt your right foot then they may ask you to start using your left foot at first) as this can begin to start firing neurological pathways in your injured foot, which can begin to tell the brain it’s ok. They might also suggest imagined movements. This might seem odd but is actually a useful step in the rehabilitation process, particularly those who are suffering from chronic pain. Have you heard of a football or rugby player talk about how they imagine hitting the ball and it going in before they actually hit it? When they do this, in the background their brain and nervous system are prepping the body for all the different movements that are about to take place.

These same techniques can be used to trick the brain when it comes to pain. Another common technique is known as pacing. With pacing the aim is to take things slowly. Whatever you think you’re capable of doing, you do half of that, and then you monitor how you feel the next day, and even the day after. This is because there is something called pain latency. We don’t always experience pain immediately, often because the brain can be preoccupied in getting you through whatever it is you’re doing and then it decides to play catch up. Working out what is likely to cause you discomfort, and trying to organise your days around things that are highly stressful and easier on the body are really useful here. Some people use a traffic light system.

The most important thing to keep in mind is that there is a way to begin turning down your pain and changing your brain’s opinion. It can be a slow task, with highs and lows along the way, but it can be done with support from a medical professional.

If you suffer from chronic pain and would like to learn more about what can be done for you please don’t hesitate to contact us.

0208 088 0533

www.athealth.london

Subscribe to our newsletter for new content