One of the hot topics in the musculoskeletal world at the moment is pain. Traditionally we assume the sensation of pain is as a result of external stimuli or damage to body, this is called nociceptive pain. It is normally acute and will go away when the stimulus is removed and/or the damage heals. An example would be a broken ankle, the pain decreases as the bone heals and eventually, no pain is felt.
When people come into my clinic, it’s mainly with nociceptive pain. The reason we get nociceptive pain is to remove ourselves from stimuli or to prevent us from further damaging a damaged area.
To go back to our ankle example, we have all experienced a twisted ankle. It’s an acute pain that prevents you from putting any weight on the affected foot. A twisted ankle is a sprain caused by parts of the foot going beyond their normal range of motion. The initial sharp pain felt is a protective measure so that you immediately correct the foot’s position, the more dull pain that follows is to due to the damaged tissue and inflammation.
Under normal circumstances, some ice, elevation and rest allow the tissues to repair and regenerate and you can resume normal movement.
Sometimes when you resume movement, there is still pain. Depending on how much time has passed since the initial injury, this pain can be one of three things
- A sign that the injury is more serious than you originally thought
- A pain congruent with the body being cautious about returning to movement
- A cognitive block or “Phantom” pain
It is always important to rule out number one. Depending on what part of your body is injured, a couple of days where you can’t return to normal movement would suggest a more serious injury and a visit to your GP or a scan may be your best course of action.
If we rule that out, then moving on to number two, you must expect some discomfort when returning to normal movement. This should be done cautiously and gradually increased until full normal movement is restored. If you feel the same level of pain, you should seek help from your GP, pharmacist or a manual therapist who will work with you to restore normal movement.
The third choice seems a little silly but is more common than you would guess. If you accept the assertation that the pain sensation is a protective one and part of the body’s autonomic nervous system then a reluctance to perform the movement that led to or caused the initial injury is understandable.
To use an example from my own history, I injured one of my knees quite badly. I rested it, I treated it myself and I regained movement as quick as I was comfortable with. Certain movements gave me pain sensations, such as going up or down stairs or standing on one leg. I knew my knee was not injured. I was confident that the tissue was no longer damaged, so why was I feeling pain? I accepted that it was precautionary in nature, my body was feeling stress or load to the area previously damaged and was using the pain signal as a type of warning, much like park assist on a car.
So I began to treat it as such. Some movement gave me sharper pain and when that happened, I stopped, told myself I was no longer injured and retried the movement with more cognitive focus. What I found was that the second time there was little or even no pain. I’m saying that all pain is in your head but perhaps we can view pain as protective in nature and on a scale. Pain is not a good thing but not all pain is equal.