Practical tips to reduce pain
Now understanding what pain is and how it protects us is useful, but now I would like to use this information to give some practical tips to reduce pain.
In Part 1 of this blog series we learnt that we need pain to survive, to avoid danger and protect us from injury. However in Part 2 we learnt that the protective response from an injury, such as muscle tightness and weakness can persist long after our tissue has healed. This can lead to pain being present for much longer than needed.
So if your pain has persisted for longer than the usual tissue healing time (around 3-6 months), then it might be useful to read below:
Tips to reduce pain:
Find movements that you feel comfortable with and progress slowly.
We know that pain is the result of our brain feeling as though we’ve pushed our tissue tolerance above a certain threshold (Butler & Moseley, 2013). So it’s firstly important to know where that threshold is at and gradually challenge this over time. For example, if your back gets sore after 10 minutes of continuous walking, start with less. Then you gradually build this up minute by minute until you get to an amount you’re happy with.
Now please understand, you will experience flare ups from time to time. However, it’s important not to worry about this. Unless there has been another injury/trauma (you will generally feel this at the time), these flare ups in pain are just a way of your brain telling you that you need to pull it back a bit. Go back to what was previously comfortable and then progress slowly once more.
Train your brain before you train your body
At times movement may be too much. You may know what types of movement give you pain. Quite often these movements are very similar to the movement that may have created your injury in the first place. So why not start with imagining the movement?
Motor skills studies show that just by imagining movements you can improve them. One in particular showed that basketballers who imagined free throws improved just as much as those that physically performed the task (Richardson, 1967).
Now when it comes to pain it’s important to imagine the movement pain free and in a relaxed state. Sometimes just thinking about an aggravating movement can make you feel anxious. It may bring up emotions that you need to recognise to move on. In this case you may need to relax yourself once more before you return to imagining the movement.
Distraction can be a great way to reduce pain
Our levels of pain are amplified in the brain when we focus on them. It makes sense that when we add other stimuli it gives your brain more to process therefore it decreases the pain stimuli (Schreiber et al, 2014).
Distraction is a great way to do this. Some things to consider while you exercise are listening to music, changing your visual input (closing your eyes or using mirrors), performing cognitive tasks (like crosswords/sudoku), adding balance (standing on one leg or moving on an unstable surface), and changing your environment (try outdoors, indoors or in water).
Find an aerobic exercise that suits you and perform it regularly
Now I understand that sometimes when you’re in pain it’s hard to find an aerobic form of exercise that is tolerable. However, research shows that if you can tolerate it (even if it produces a 6/10 pain level), doing it regularly will reduce your pain. This is because aerobic exercise has been shown to reduce your central immune response via the glial cells (Cobianchi, et al, 2017). People with chronic pain can quite often have a hypersensitive central immune system. When this system is always on it creates an inflammatory response, even when it’s not needed. So when you exercise is down regulates this response, leading to less inflammation and in turn reduces pain.
Choose fun, enjoyable activities with people you love!
Finally, one of my favourite pieces of advice is to find activities and movements you love! Not only will this help you reduce pain, we know that people who have hobbies and activities they enjoy typically live longer (and happier) than those who don’t (Fushiki et al, 2012).
In our brainstem we have certain areas that pick up pleasure and displeasure. Interestingly the area of displeasure is closely associated with areas of the brain that detect and produce pain. The pleasure centre does not have this relationship but is closely related to movement and attraction. So let’s use this to our advantage and find activities you actually want to do. It may even help you stay motivated to doing things that aren’t as pleasurable (such as the homework exercises your exercise physiologist gives you), so long as you can relate it to the activity you love (for me this activity is trail running!).
So there you go. Hopefully I’ve given you some practical ideas to reduce your pain and help you get back to doing the things you love doing. Obviously if you need any help with any of the tips above, we are alway here to help you with your journey free of pain.
Butler, D.S., & Moseley, G.L. (2013). Explain Pain (2nd Ed). Adelaide: Noigroup Publications
Cobianchi, S., Arbat-Plana, A., López-Álvarez, V. M., & Navarro, X. (2017). Neuroprotective Effects of Exercise Treatments After Injury: The Dual Role of Neurotrophic Factors. Current Neuropharmacology, 15(4), 495–518. http://doi.org/10.2174/1570159X14666160330105132
Fushiki, Y., Ohnishi, H., Sakauchi, F., Oura, A., & Mori, M. (2012). Relationship of Hobby Activities With Mortality and Frailty Among Community-Dwelling Elderly Adults: Results of a Follow-up Study in Japan. Journal of Epidemiology, 22(4), 340–347. http://doi.org/10.2188/jea.JE20110057
Richardson, A.. (1967) Mental Practice: A Review & Discussion Parts 1 & 2, Research Quarterly. American Association for Health, Physical Education and Recreation. Volume 38, Issue 1.
Schreiber, K.L., Campbell, C., Martel, M.O., Greenbaum, S., Wasan, A.D., Borsook, D., Jamison, R.N., & Edwards, R.R. (2014) Distraction Analgesia in Chronic Pain Patients: The Impact of Catastrophizing. Anesthesiology;121(6):1292-1301. doi: 10.1097/ALN.0000000000000465.
If you’ve followed iNform’s blogs and social media we quite often comment that we are “Made to Move”. However, why do we (I’m talking society as a whole) find it so hard to get out and be active? Why is it so easy to be lazy? Well it seems our drive toward sedentarism is not a new thing. We’ve just happened to get really good at it in recent years!
You see the evolution of us humans has been occurring for hundreds of thousands of years and for around 95% of this time we were hunters and gatherers of our food. During this time we used to walk 15-20 km per day, mainly in search for food (Cordain et al., 1998). We are still physiologically built for this environment, hence we were made to move.
Evolution may drive our desire to be lazy
However, like most animals, we have an in built drive to maximising our energy intake while minimising our expenditure and become as lazy as possible. We needed to be efficient at gathering our food, but in the days of hunting and gathering it was most efficient to stay on the move (Park, 1988). Even the success of a tribe (as expressed by their fertility rates) were greater if they moved more (Surovell, 2000).
Our drive for dopamine kept us on the move
So during this time our physiology worked for us. The increase in protein from hunting, led to increased dopamine production, which led to brain development (Previc, 1999). Now dopamine is a hormone that drives us to explore and increases our desire to move and do things. This drive is what gives us the desire to travel and see the world. However in today’s environment this involves very little physical activity!
Interestingly a lack of dopamine production and sensitivity leads to decreased physical activity in animal studies (Ingram, 2000). Scientists have also found the “lazy gene” in rodents which decreases the amount of dopamine receptors making you less like to enjoy the exploratory movement benefits of dopamine (http://ajpregu.physiology.org/content/early/2013/03/28/ajpregu.00581.2012).
Now if we go back to our hunting and gathering days, exercise would have been in the form of chase hunting. This involved running with a prey until it dropped of exhaustion. Interestingly this type of exercise would have further increased our dopamine levels (Previc, 1999). This positive feedback loop was thought to help us develop into the intelligent species we are today!
So what happened, why did we become so lazy?
Why do so many of us lack the motivation to move? You see dopamine feeds on itself. It increases when you move more but to get it’s feel good exploratory effects you need to start moving! And in today’s environment we no longer need to move to survive!
And where did it all go wrong? As I stated above, most creatures are hardwired to conserve energy, and around 40,000 years ago we learnt that rather than adapting to our environment we could manipulate the environment to suit us. This period was toward the end of the Ice Age and as the Earth warmed cereal crops flourished. By 10,000 years ago we started to get really good at farming and hence the agricultural revolution began (Phelps, 1994).
This meant that we could stay in one place and tend to our crops. We could also store surplus grains for the winter. Where once our hunting and gathering tribes would have mobile camps, humans were now able to establish more permanent housing structures and areas to congregate, and create barriers to keep predators and the pressures of external nature away (Mumford, 1956).
Now over time we’ve gradually become better and better at food production, needing less physical energy to produce. The industrial revolution brought the machines that would end up doing the work for us. Now, the vast majority of us, no longer need to expend energy to get our food and being lazy has become an option.
Fighting our drive to become lazy
All of this came about due to our innate drive to conserve energy in order for us to feel safe and secure. It has now got the the point where high energy food is an abundance and we have to do very little to get it. We can literally sit in the comfort of our homes (even work from home like I’m currently doing!) and order our food to be delivered to us.
Think of how much movement you need to do in the day. Once it was part of life in order to survive but now movement, for most people is a choice. The problem being is that our physiological systems and hence our physical health are built in a stone-age time of when we were “made to move”.
Without thinking, our hardwiring will drive us to be as sedentary as possible and we now have the physical environment to allow us to do this. So this choice to move now needs to be a conscious one. What we do have going in our favour though is the dopaminergic system that feeds on itself. Once we start moving and exercising, we’ll be driven to do more, and as a consequence we’ll improve our brain function and overall health.
So your choice is simple.
Either you sit back and let this innate drive toward laziness and physical environment we’re creating push you toward and enclosed sedentary lifestyle; OR, you get back to your hunting and gathering roots and choose to move more and explore this world we live in!
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.
Ingram, D. K. (2000). Age-related decline in physical activity: Generalization to nonhumans. Medicine and Science in Sports and Exercise, 32(9), 1623-1629.
Mumford, L. (1956). The natural history of urbanization. In W. L. Thomas (Ed.), Man’s role in changing the face of the earth (pp. 382-400). Chicago: University of Chicago Press.
Park, R. J. (1988). How active were early populations? Or squeezing the fossil record. In R. M. Malina & H. M. Eckert (Eds.), Physical activity in early and modern populations: American Academy of Physical Education papers No. 21 (pp. 13-21). Champaign, IL: Human Kinetics.
Phelps, M. T. (1994). How important is the role of intelligence in the rise of civilization? Mankind Quarterly, 34(4), 287-296.
Previc, F. H. (1999). Dopamine and the origins of human intelligence. Brain and Cognition., 41(3), 299-350.
Roberts, M.D., Brown, J.D., Company, J.M., Oberle, L.P., Heese, A.J., Toedebusch, R.G., Wells, K.D., Cruthirds, C.L., Knouse, J.A., Ferreira, J.A.,Childs, T.E., Brown, M., Booth, F.W. (2013). Phenotypic and molecular differences between rats selectively bred to voluntarily run high vs. low nightly distances American Journal of Physiology – Regulatory, Integrative and Comparative Physiology, 304(11) R1024-R1035.
Surovell, T. A. (2000). Early Paleoindian women, children, mobility, and fertility. American Antiquity, 65(3), 493-508.
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.
Let’s draw a line in the sand over stress
This won’t be easy today’s world is full of constant time pressures and worries. We are continually rushing around, meeting deadlines, feeling guilty about not spending enough time with the family, and burning the candle at both ends just to get things done.
Now we’ve known for some time now the benefits of exercise on making us feel better and more productive and in fact I wrote about the neuroscience of it all in a blog back in 2011. However, with summer approaching, and the with the days getting longer, now is the perfect time to take a stand against stress!
Exercise makes us 20% more productive
This isn’t new information, but to put it in a more quantifiable way:-
Twenty minutes of exercise in the morning will pay you back by adding an extra 80 minutes of productivity to your day. That’s a net gain of 60 minutes to your day!
It also makes us less stressed!
A recent study compared 20 minutes of exercise a day to the equivalent time spent performing mindfulness meditation and heart rate biofeedback (a way of controlling your heart rate through breathing and seeing its effect on your heart). Researchers expected mindfulness to be superior, especially in relation to maintaining attention, improving compassion and decreasing worry. They were wrong!
Exercise was just as effective as mindfulness
This surprised the authors of the study, as mindfulness directly focuses on attention, compassion and control over your thinking. Perhaps exercise has an indirect effect on these attributes as increasing your heart rate and breathing rate may challenge your body to become more aware of the “now”.
And we also know exercise is good for more than just stress and productivity
You only need to read the rest of our blogs to know that exercise benefits us in many different ways.
While reduction in blood pressure has also been shown in mindfulness studies, I doubt that they would be able to compete with the metabolic benefits of exercise. If you’re in need of reducing your blood sugars levels, or you want to drop a few centimetres around your waistline 20 minutes of high intensity exercise would suit you better.
At iNform we believe that any exercise as part of a personalised program should be done in a mindful way so that you’re not just “going through the motions.”
If you’re “wired” to move and can’t keep still, or life doesn’t enable you to find the adequate “quiet time” at home, exercise might also be a more palatable way of gaining all these benefits.
So let’s stress less and do more!
No matter whether you prefer to spend 20 minutes a day exercising or in mindful meditation we can all experience these benefits. Now is as good a time to draw a line in the sand and establish this daily habit. Your body, health and relationships will thank you for it!