Now in part one of this blog we learnt that pain is a vital part of our survival but sometimes it can persist for longer than we need. So now I’d like to share with you some of the longer term changes that can occur as discovered by pain scientists (Hodges & Tucker, 2011). These adaptations give us a road-map on how to use exercise and movement to free ourselves from pain.
Pain leads to changes in the way we move
Think of a time when you may have hurt yourself and you were in pain. A very common occurrence is twisting your ankle. Sometimes this doesn’t create much tissue damage but it can have a very significant pain response. What you’ll notice is that you’ll limp, maybe just for a little while, as the pain changes the way we move so that we don’t load the affected area too much.
Our muscles around the area will “splint” to stiffen the area up and we’ll subconsciously take load off of the affected side. Now as I stated in part 1 of this blog, this is really useful during the first few months of tissue healing. But long term this can have other consequences. Some common examples are that if we were to injure a joint (let’s stay with the ankle). It can increase the load in joints further up the chain (such as the knee or hip). Alternately, let’s say that we injured our right ankle, if we don’t correct the way we are limping, we’ll place more weight through our left side making it work harder. This could then make the left leg more predisposed to injury.
Now many of these changes in how we move are subconscious. A lot of people don’t realise they are limping long after their initial injury. So sometimes we need to retrain our body to move freely and more evenly again. This is where specific corrective exercise can be useful.
Pain changes the way our muscles fire!
Not only does pain change the way we move, in doing so it also changes the way our muscles fire.
Some muscles will become facilitated
That is, they increase their tone to help protect and splint a particular area. Again while this might be useful for the first few months, these muscles tend to get tight and overworked in the long term.
They also become over-sensitised to pain to the point where even a gentle stretch, well below the threshold that would create tissue damage, creates a pain response. This is where it is important to get these muscles moving freely again, even if it is a little uncomfortable at first. In doing so we are retraining our protective response. Over time our brain no longer deems the use of these muscles as threatening and our pain will gradually decrease.
Some muscles will become inhibited
Now interestingly, while some muscles increase in tone others will “go to sleep”. These are quite often called inhibitions and the long term consequence of these muscles not firing properly can place undue stress on other tissues.
I don’t know whether anyone really knows why this occurs. Perhaps it is part of our short term protective response to prevent us from using a particular area and allow for healing. However we do know that in the brain the areas that fire a particular area become “smudged”. That is when we try to fire a particular muscle we might get a whole group of muscles firing (quite often the protective facilitated ones).
What we find is that we need to “wake up” these inhibited muscles which are quite often muscles that are important for the long term use of our past injured joints. And it is not until these muscles are firing properly again that our pain will subside.
Everyone’s protective pain response is individual
Finally, and most importantly, what we know is that our response to an injury and pain is unique and individual. How we move after an injury depends on what we were doing to cause the injury. How we splint and what muscles tighten up is very individual. And what muscles go to sleep and lose their capacity to fire can be different as well.
Interestingly, all of these people though may have the exact pain in the same location. So it is important that we don’t just focus on the area of pain. In fact, sometimes this can just feed our pain response as it make this area even more sensitive. We need to assess the way you move to see if you are still protecting an area long after it has fully healed. And we also need to identify what muscles are not firing appropriately and what muscles are still stiff and tight trying to protect.
Now this detective work is not always straightforward, particularly if like many of use you’ve accumulated multiple injuries over the years. But unraveling this tangled rope might be one of the best ways to do this and it is probably why good quality movement and exercise is shown to be one of the best ways to free yourself from pain.
Hodges, PW & Tucker, K (2011). Moving differently in pain: A new theory to explain the adaptation to pain. Pain 152 S90-S98
Quite often when we injure or hurt ourselves we tend to go back into our shells and stop our usual activities to prevent pain. This can often mean limiting our movement and exercise, as doing so creates more pain. This is normal and something that shouldn’t be feared.
Pain is a protective response to keep us alive!
Let’s think back to our hunter and gatherer days when our main goals were to eat, sleep and procreate. Back then our survival was dependant on how successful we were in finding our food. This, of course, required a lot of movement. In fact, modern day hunters and gatherers such as the !Kung and Ache tribes average 15-20 km per day. (Cordain et al, 1998). That’s over 20,000 steps a day!
Now obviously if we were to injure ourselves this would severely limit our capacity to hunt and gather. So our in built pain response was designed to allow for tissue healing and conserve energy while our capacity to get food reduces. This protective response in our paleolithic environment was vital to keep us alive. Now pain science can get a bit heavy so I’ve tried to reduce some of the key points for us to understand:
1. Pain tags the brain with the circumstances that lead to creating it.
A toddler only needs to touch a hot stove once to remember that it is not safe to do so again! Back in the hunter and gathering days this might have included the location of dangerous terrain or the time and place of an aggressive animal. Research has shown that the pain response will improve our memory of these specific details.
2. Pain prevents us from moving the affected area for a short period of time.
This is incredibly useful as depending on the tissue that has been injured. It can take around 2 to 12 weeks for the area to heal. Pain can prevent us from loading the particular tissue too much and too soon and allow for recovery.
3. The protective pain response triggers metabolic responses in the body to conserve energy.
Inflammation and cortisol (part of the stress response) both have been shown to increase insulin resistance. This both triggers the body to increase your blood sugar levels for energy and also store your body fat. This is a perfect response for when you didn’t know if or when you would get your next meal. Unfortunately today food is at an abundance and many of us put on weight after an injury. So nowadays we don’t find this too useful!
Pain has short term benefits but can have longer term consequences
As I stated above our protective pain response is really useful for those first few months after the initial injury. However, for many of us pain can go on for much longer than that or we may not have actually had a trauma to create an injury. Long term pain is quite often diagnosed as non-specific pain as doctors can not find any tissue damage or pathology. Sometimes this pain might be the remnants of a past injury that has fully healed. But for some reason our protective pain response remains.
Going into the scientific reasons as to why this occurs is not something we can quickly delve into. However, in part 2 of this blog I’d like to share with you some of the longer term adaptations that occur to us. These adaptations will give us a roadmap as to how to best free ourselves from pain for good.
Cordain, L., Gotshall, R.W., Boyd Eaton, S., & Boyd Eaton III, S. (1998). Physical activity, energy expenditure and fitness: An evolutionary perspective. International Journal of Sports Medicine, 19, 328-335.
I’m not surprised you may not have enough time to exercise, or to look after yourself. It is very clear that our society has it’s reward system back to front; despite the evident negative outcomes such as lack of energy and stiff bodies. I’d like to take this opportunity to boldly share with you our mission at iNform to push back against this tide and urge society to start rewarding differently, more smartly. We will be fighting the status quo for your health!
Invest a small amount in exercise and be rewarded with productivity
The research is very clear that when we invest a small amount of time out of the day for some brisk exercise, we get paid back in stamina and the ability to do more. Yet, our society does not reward this “timeout”. In executive circles, constant pressure to perform, whispers are hard to ignore that time spent at the gym or working-out is a waste of productive time. We have all bought this lie.
So, here’s a simple challenge that will pay you a solid dividend. Find 20 minutes before you leave for work in the morning, or build a half hour break time into your day, treat it as Stephen Covey’s Urgent And Important task, and get in a walk or a run or a cycle or climbing of stairs. Leave a few minutes for a shower if you have one at the office. Start this without telling the world about it. Let them see you start.
And here is what you’ll notice:
People will ask what you are doing and why. This will give you the chance to let them know that you are re-engineering the way our society rewards our behaviours.
You are doing this because everyone around you and the Australian economy, will stand to benefit from a fitter population (and workforce) with sharper thoughts and better stamina.
It all starts by finding any means possible for turning our backs on old habits and putting our backs into smarter efforts that will yield a bigger prize that we’ll all be around longer to enjoy.
Why should we reward ourselves?
Smarter rewards systems are needed in family time too! In the early decades of preparing for and then building a family, where do most of us place our health in the order of tasks and priorities? Nowadays, the ever-growing list of demands means that many women and men who run households and families, put others before themselves at a great and hidden cost.
The cost is all those moments when exhaustion has robbed us of exercise or tight finances have robbed us of health options like exercise physiologists or gym memberships.
There is just not enough time to go around and people with strong parental instincts yield to our inbuilt reward system of giving us an endorphin rush when we sacrifice ourselves for our loved ones. However, that healthy reward system evolved during a time of unavoidable physical labour.
So, we have a battle ahead, but evidence-based approaches to short, structured fitness plans like we provide at iNform Health and Fitness Solutions can give back to your body the strength and capacity it was always destined to have.
Yes, clocks can be turned back, despite all the momentum that tries to pull us away from taking personal time out to invest in our health. So come and join us in fighting the status quo for your health!
I attended an insightful evening at SAHMRI on depression. I don’t want to sound all melancholic at the start of this blog. However, quantitatively speaking, Australia is the unhappiest country in the world (per capita). We also have the highest prescription rate/use of antidepressants in the world (per capita).
Now I am really sounding melancholic.
Why do we have high rates of depression?
I was really saddened that Australia, a wonderful, optimistic, culturally diverse nation is so depressed. Are we trying to put a band-aid on by taking an antidepressant with the notion that quote un-quote “she’ll be right mate”? Are we ill-informed by our health & medical team? Or does one think or feel that a pill is the only way to remission? Or are we literally still stuck in time?
Maybe my past tense reference was justified…
Here’s the problem…
Depression is so much more complex than the first hypothesis from the 50s, which brought us the discovery of the first antidepressant, Fluoxetine (Prozac). The problem is that all that has changed in the last forty years is that we now have ten or more antidepressants rather than just one. The reason I am so passionate about the right co-care and management is because of the side effects of these medicines. For example, the growth factors in antidepressants can contribute to obesity, another morbidity that inundates our health care system.
So what can we do to help treat depression?
Recent advances have shown that our genes can be switched off by our environment, sedentary lifestyles and psychologically stressful events. This includes our BDNF (brain derived neurotrophic factor) genes, which are the fertilisers for our brain. They help protect and grow our neurons. However, positively, we can also switch this gene on by exercising and meditating. Therefore our actions and choices can potentially lead to melancholy or greater health.
I guess this is more of a personal release than an education problem solving blog. Please pardon the lack of clarity/direction. But it many ways I feel this is the current position we are in.
It all starts with the little things:
- Move more…
- Find space, breathe, form boundaries and find silence/solitude…
- Hug more…
- Connect more (interpersonally)…
- Connect with nature…
- Nourish your body… (remember where amino acids are derived from… FOOD. And what do amino acids make? Neurotransmitters!)
The other day while driving through the hills, I saw something that surprised me… A young guy
doing chin ups on the bus shelter, while waiting for the bus! It made me stop and think (well not
literally as I was driving!) but continue to ponder for some time; why should this have made me look
twice? Shouldn’t we live in a society where this behaviour is normal? Here is a young guy utilising
his time while waiting for public transport, instead of sitting down on his phone. I had to commend
Finding time to exercise
All too often I hear people discussing the barriers to exercise, with the most common theme in each
being TIME. I get it, life gets busy! There’s family, work, friends, pets and not to mention the
unexpected events. But what would happen if we took every opportunity we had to exercise a little
Take the guy at the bus stop as the perfect example, he has utilised his time and surroundings to
create an opportunity to move. Now, I know we can’t all do chin ups and we don’t all take public
transport but can you think of any time throughout your day in which you’re waiting around or could
be combining the two? Perhaps walking around the oval while your child is at footy training;
completing push ups on the kitchen sink while waiting for the kettle to boil; walking around while
talking on your mobile; taking the stairs instead of the escalator/lift; or completing sit to stands from
your office chair.
So, my challenge to you is to recognise times where you can be proactive with movement and fill
these waiting moments with ‘chin ups’ or the like! I hope to see more action at bus stops in future!