The information below is my own summary of some of the work that has been produced by David Butler and Lorimer Mosley. For more detailed information I would highly recommend checking out their book 'Explain Pain'.
Knowledge is Power
Despite what many people still believe, pain is produced by the brain. 100% of the time. With no exceptions. And as I said before in my previous post your brain will produce pain when it believes that your body tissues are in danger regardless of whether this is a real threat or a perceived one. I also stated that this means that the amount of pain you experience does not necessarily correlate with the amount of tissue damage.
But when it comes to chronic pain, sometimes it's difficult for my clients to understand then, why they are in so much pain all of the time. Which is why I spend time with so many of them explaining what the hell is going on. What I have found in spending time doing this is that they get a greater understanding of their own pain, their body, and what they can do to help themselves.
And just knowing this information can be a treatment in itself. As I said above, pain is produced by the brain if there is a threat, even if that threat is only perceived.
So when they gain knowledge about what is going on, the perceived threat reduces and pain will also reduce. This may happen subconsciously but it happens nonetheless.
And so, I wanted to share this information with you. This is a long one so grab a coffee, get comfy. Let's go…
Activating the Sensors
All around your body you have receptors or sensors (think of these as an alarm system). And these sensors become activated by different stimuli such as these (amongst others):
(Note: We do NOT have pain sensors. Remember pain is produced by the brain.)
When the sensors are activated to a certain level, they send a message to the brain saying "Danger".
The brain then constructs as sensible a story as possible (or not so sensible in some cases) based on the information that it has received.
It also takes on board other considerations such as "Have we been in this situation before?" and if we have "Did we get hurt before?". (Check out this video by Lorimer Moseley)
If your brain then concludes that yes, you are in fact in danger (real or perceived), then it will do what is needed to get you out of that said danger.
By producing pain!
Tissue Tolerance Line
Now there is only a certain amount of activity that we can withstand before our body tissues actually become damaged. This is what we will refer to as the Tissue Tolerance Line (Image 1).
Where this line is, is different for everyone. It can change depending on such things as fitness level, age, area of the body, etc.
In some cases we reach this line quickly such as falling, going over on our ankle or being in a car accident and unfortunately, if this does happen, then there is usually not much we can do about it.
Protect By Pain Line
However, the body is super smart and if you were starting to approach this line slowly through training or working hard then a warning is produced before damage actually occurs. This is what we refer to as Protect By Pain Line (Image 2). And it is above THIS line that pain is actually produced (Image 3).
So can we then reach the Tissue Tolerance Line without an injury occurring? Can we reach it slowly? Absolutely. Many of us do this on a daily basis either because we are distracted or because we have chosen to ignore the signals (Protect By Pain line).
Pain Motivates Us
Now it is at the Protect by Pain Line that the danger sensors are activated which alerts the brain. If the brain concludes that yes, you are in fact approaching the Tissue Tolerance Line, then pain will be produced with the intention of motivating you to stop or change what it is that is setting off the signal. (I'm guessing you've already worked out that you can in fact experience pain WITHOUT any tissue damage).
The whole point of this is for you to get your body tissues out of danger. So ignoring this and continuing to do what you are doing, then becomes dangerous. And if you do continue then the Tissue Tolerance Line will be hit resulting in the body tissues becoming damaged.
The Healing Process
Now when you do get injured be it wear and tear, a sprain, cut or break, and no matter whether it happens quickly or slowly, the healing process is still the same.
Firstly there is inflammation and despite the bad press, is a good thing! Then a scar is formed. And then the tissue is remodelled to make as good a match to the original as possible.
How quickly the tissues heal depends on many different factors:
1. Grade of injury - The more sever the injury the longer it will take to heal
2. Site of injury - Depending on where the injury is will determine it's blood supply and therefore healing time (ligaments have a poor blood supply and so take longer to heal than say skin which has a good blood supply)
3. Health of the individual - People with high blood pressure, diabetes or circulatory problems have a longer healing time
4. Nutrition Intake - More nutrients = faster recovery!
5. Stress levels - Stress slows down the healing process
6. Smoking - Nicotine makes blood vessels constrict which reduces blood flow which increase healing time
7. Age - Older people heal slower
8. Remedial Treatment - Massage speeds up recovery but over icing can slow it down (That's definitely for another post!)
9. Alcohol - Also slows the healing process
10. Medication - The use of NSAID's such as Ibuprofen has been linked to injuries taking longer to heal (and another future post!)
Persistent Pain Due To Nervous System
And so when the tissues are healed the pain should diminish. However, this is not always the case. Think of chronic or persistent pain. This means that if you are still having pain after the injury has healed, then this pain is more likely associated with the nervous system than the tissues themselves .
New Tissue Tolerance Line
As a consequence of this a New Tissue Tolerance Line is produced or probably more accurately, the original Tissue Tolerance Line is moved to a lower level (Image 4). This is due to the fact that the tissues may not be as healthy and strong as before the injury. This means that they fatigue quicker and feel weaker. This is why pushing through the pain or dosing up on painkillers (which only mask the pain) is not such a good idea.
New Protect By Pain Line
The Protect By Pain line is also moved to a lower level (Image 5) as the danger sensors become more sensitive. Your body simply does not want to go through this again!
This means that we start to experience pain at a lower level of activity than we did previously in order to protect us from being injured again (and for some people that means feeling pain all of the time!)
Flare Up Line
Now in between the Tissue Tolerance Line and Protect by Pain Line there is a Flare Up line (Image 6).
This, as you can probably guess, is where the site of injury will 'Flare Up' if reached (Think inflammation).
This is again just another way that your body is trying to protect you. It doesn't mean that there is necessarily any damage being done. It just means that the body perceives a threat. It's a warning that you are approaching the Tissue Tolerance Line.
Now can you see why taking constant painkillers is not helping the situation?
Now there are 3 types of people in this world.
1. The No Pain No Gain Guys
The first type of person is the one that has the mantra 'no pain, no gain' even when they are, quite obviously, injured.
For these people they experience pain at their Protect By Pain line. But instead of listening to the warning they choose to ignore it.
They are the perfectionists, the high achievers, the ones who feel that they have to carry on no matter what. Some are even so focused on their goal that they even up the intensity.
As they do, they reach the Flare Up Line. Do they stop here? Do they hell. They strap up and dose up. No pain no gain right? It is only when they hit the Tissue Tolerance Line and end up actually damaging the body tissues do they crash and end up being out of action for weeks or even months.
And ss you already know, when this happens, the Protect By Pain line drops as does the Tissue Tolerance Line and Flare Up Line. As this happens time and time again, the lines continue to drop. The amount of pain that they experience increases and the activity they are able to do, decreases. (Image 7).
2. The Waiters
The second type of person is one that has a huge fear of pain or getting reinjured. For these people they experience pain at their Protect By Pain line. They then rest and wait for the pain to go.
These are the passive copers. They avoid and do nothing all the while worrying about what is happening to them, afraid it may be something terrible that will impact their lives and who they are as a person.
As they experience pain, they do less to avoid it and their activity levels decrease over time (Image 8). This means that their body tissues become weaker and their Tissue Tolerance Line reduces, as does their Protect By Pain and Flare Up Line. This means that their danger sensors become extremely sensitive so even small movements cause pain.
3. The Inbetweeners
And finally there are those people in between the two, who have a respect for and understanding of pain and the body. They are in tune with their own body, respect and listen to it.
They note the difference between the Tissue Tolerance Line and the Protect By Pain line and understand that if they progress slowly then it will be impossible to reinjure the tissues because it will hurt too much to even get close.
Reducing the Threat…Gradually
The inbetweeners have a baseline that they work from (Image 9) one that is below the Flare Up Line. Form here, they then GRADUALLY increase their activity.
As they do, their Flare Up Line starts to lift. Why? Because they are training their brain. They are reducing the perceived threat.
This means that the sensitivity of the alarm system will reduce and so the Protect By Pain Line will slowly lift.
As they have less pain they can do more and their tissues become stronger and fitter. This then means that it will be more difficult for them to reinjure (as they are stronger) and as a result their Tissue Tolerance Line rises too.
Inbetweeners really are smart people. They are patient and persistent. They don’t have a fear of pain, nor do they believe that "No pain no gain" is the way to go.
They know not to cause their body to flare up but they don’t freak out if they do either. They just know that their flare up is their body's way of telling them that they have progressed too quickly.
They don't stress out or give themselves a hard time. They are patient and persistent with their recovery. They understand pain and their body. They don't ignore it or try and find a quick fix.
It's always my aim to help my clients become an Inbetweener by giving them the knowledge of what the hell is going on. After all, I have seen firsthand that just by understanding pain can we reduce the threat value of it and ultimately affect how the brain perceives a situation.
Remember, your brain will only produce pain when it believes that your body tissues are in danger regardless of whether this is real or perceived. So if you have had a past injury and you know it has healed, then the persistent pain that you are feeling is your nervous system still trying to protect you. It does not necessarily mean that there is something sinister occurring. Being smart about your recovery can help you to not only reduce the pain that you feel but also to get you back doing the things you love most.