Your body is 45 miles of nerves travelling through it connecting all body parts. Nerves work like an alarm system. At all times nerves have some electricity flowing through them which is normal and shows you are alive. Lots of different factors (sleep habits, exercise levels, stress, movements, etc.) can cause this electrical activity to go up or down. People with ongoing pain have an extra sensitive alarm system. Think of a house alarm; it should only go off if, for example, if a window breaks. Your house alarm system is so sensitive (i.e. your nerves are so sensitive) that the alarm goes off if a leaf hits the window i.e. there is no damage done but you still experience pain.
But my MRI said..
Pain is far more complex than just tissues (muscles, ligaments, joints, etc). Abnormalities on scans are absolutely normal. Consider the following statistics from MRI scans on people with no pain
Low back – healthy adults with no back pain 64% have one or more disc bulges (bulging discs reabsorb over time)
Shoulders – in people with shoulder tears only 1 in 3 people experience pain or limited activity. 40% of baseball players have full thickness tears with no pain.
Mid back – adults with no mid back pain 53% of them have disc bulges
Key message: don’t panic with what your MRI report says. These findings are a normal part of ageing.
Pain is multidimensional, the over flowing cup
As pain persists it becomes less about tissue damage and more about anything in your life or something in particular that can make you more sensitive. Look at pain as the overflowing of a cup. Many things contribute to what is in that cup. You can have a lot of physical, mechanical, emotional and social stressors and have no pain but at some point, a sudden increase in one of those stressors or a new stressor puts you just over the edge and the water flows out and now you have pain. Pain occurs when we fail to tolerate and adapt to all the stressors in your life. We need to keep that cup from overflowing. You have lots of options for change. Turn down one or two taps or build a bigger cup. You can build a bigger cup in lots of ways.
Here are just some examples:
1. Understanding the contributors to your own pain
2. Getting regular aerobic exercise – 30 minutes 5 days a week
4. Having personal goals
This means that over time you can build resiliency that allows you to adapt and tolerate to all the stressers in your life. Most people can’t run a marathon today but people can slowly build their tolerance to the stresses of running and do it in the future. Pain recovery and coping is the same thing. You can decrease some of the stresses in your life but you can also build resiliency to those stressers.
Beliefs and expectations
How you perceive your condition can influence what you feel. If you’re convinced that your body is fragile and needs protection then you can be more likely to have pain. You’ll have pain as a protective response. You may also increase tension in your body, as a way of guarding this. This is often contributed to by the messages about pain and injury that you are given from health professionals, family, friends and the internet. If you are told your spine is fragile and that you have disc degeneration or two bulging discs it’s not unusual to feel quite negative about your situation. This can lead to us catastrophising. Unfortunately, it’s this misinformation about your pain that leads to these catastrophic thoughts.
Self-efficacy is your belief in your ability to succeed in specific situations. In terms of pain and disability it means that you don’t have to be reliant on someone to fix you. You can work with a therapist but ultimately the goal is for that therapist and you to work together so that you become self-sufficient and enabled to cope with everyday situations and get back doing the things you enjoy.
Just being less healthy can make you more sensitive so perhaps you have some joint degeneration like everyone else does it is possible that having poor health will sensitise you to have the physical contributors to pain. The positive here is that general strategies of just getting healthier can also improve pain and disability. You don’t have to wait for pain to go before getting active again. Getting more active will contribute to pain going.
Anxiety and depression
Just like muscle tears, you can have anxiety and depression and not have pain. You can tolerate these factors but sometimes they contribute and they promote the pain that you have. In the same way that you don’t have to fix a disc or degeneration to eliminate pain you don’t have to eliminate depression or anxiety to get out of pain. There are several strategies you can use to get out of pain and decrease your disability.
Social isolation or a loss of your sense of self
Pain can often make you not feel like yourself. You stop doing the things that are important to you. You stop your hobbies, spending time with friends or doing things with your family. These social variables can contribute to your increased sensitivity.
What’s great about all these factors and this complexity?
You can tolerate each of these factors. You get to work addressing the ones that are important to you but none of them must change for you to get out of pain. Often improving one or two of these is enough to make a huge difference. Further, sometimes just understanding that these factors are important can help in your situation.