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COLUMN: Unraveling Pain

Dr. Mike Klobucher | Doctor of Physical Therapy • Oct 6, 2017 at 2:40 AM

Pain and injury are an inevitable part of life, and being held back from the activities we love is very stressful. However, unraveling in simple terms pain and injury (note they are not the same) can make a tough situation easier to handle.

So, what is an injury?

Generally an injury occurs when tissue gets loaded beyond its ability to adapt. This can happen with a major trauma (i.e. ACL tear) or from repetitive stress (i.e. plantar fasciitis). Pain is the alarm alerting us of a threat (i.e. tissue damage). Pain is like a fire alarm. The sound is quite annoying (like pain), but it’s not the root of the problem. The problem is the fire, which would be the actual injured tissue in this analogy.

On a side note, changes can happen in the nervous system when pain has persisted for a long time where we can experience real pain even after the injury has healed. This is like someone pulling the fire alarm as a prank without a fire (i.e. pain without injury). Fortunately, many of the strategies discussed below can help manage this chronic pain too.

If you’re injured or in pain there are likely two scenarios: you move very well, but the loads have just accumulated faster than your body’s ability to adapt, or your movement patterns lack some level of mobility or stability. Thus, some tissue has gotten whacked abnormally or in the same way repeatedly.

Regardless of which of these is the case, there are some simple strategies that can help.

You and no one else can directly “fix” the injured tissue, unfortunately. What you can do, and someone like a physical therapist can help you do, is create the right environment for your miraculous body to heal. So, here’s a recipe:

1. Stop overloading the injured tissue for a while. This is very crucial, but takes extreme self-control. Tissues need a chance to repair without being messed with. It’s amazing how many minor aches feel better after 7-10 days if we simply don’t make them worse. This doesn’t mean not moving, just moving in new ways or training other regions.

2. Address any movement dysfunctions. This means restoring missing mobility and stability prerequisites that are leaving you vulnerable. Without them, your body will probably overcompensate, leaving you open to delayed healing or repeated injuries.

3. Gradually, progressively, and patiently build the tissue back up. The body has an amazing ability to adapt, but it takes time. One strategy here is graded exposure. Think of someone conquering a phobia progressively presented with more threatening situations as they handle the simpler ones before. In recovering from an injury, you slowly expose the tissue to a little stress, and once it tolerates that stress, you gradually give it a little more so it can adapt and become more resilient.

The goal here is to build up the tissue’s capacity to the point where it is greater than the loads it experiences. Essentially, you are trying to “bulletproof” it.

OTHER MEASURES

Sleep. Everything works better when you’re sleeping well.

Work your weaknesses. What better time to address areas of weakness? For example, if your knee is injured, emphasize upper body strength.

Don’t panic or let it define you. Move forward and control what you can.

Ask us for help. We would love the opportunity to help you more specifically with any pain or injury you are struggling with. It’s our mission to help you move better whether you are recovering from an injury or trying to prevent one because we believe that when you move better, you live better.

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