As an osteopath, I encounter many aches and pains that seems to mysteriously flare up with no real obvious causes. In many cases the people suffering have seen numerous therapists, had numerous opinions, and a variety of treatments in search of a resolution. As a healthcare professional, I thrive on the challenge of trying to unravel the complexities of recurring aches and pains, however in many cases, the healing process starts with the challenging task of unravelling the entrenched beliefs and perceptions held by patients who have gone round and round on a treatment hamster wheel and think that their body is damaged. Understanding a little bit about pain can provide reassurance and confidence to a person who thinks their body is failing them. It can also help somebody who feels helpless, to fully embrace their capacity and responsibility in breaking the chains of their discomfort, and live a life free of the limits that persistent aches and pains can impose.
It can be hard to explain to people that what they believe about their body may not be true, and also try to explain the mystery of aches and pains. It’s completely normal for us to want to know what’s causing our body to hurt, but unfortunately this can often end up in numerous confusing and conflicting opinions, fear of using our body normally, and a perception that our body is not fit for purpose. This is why it is far more important to shift the focus away from chasing the cause, and instead, immerse ourselves in the simple daily habits that create the best physical and psychological state for aches and pains to settle and disappear.
In order to help us truly trust and believe that our bodies are not failing us, it is important to start with a general understanding of how pain works. This can then help us understand all of the weird and wonderful things that contribute to the experience of pain, and also reassure us with the knowledge that we have a significant amount of influence and power to change things.
What is Pain?
In the highly informative book- Explain Pain, Dr David Butler and Professor Lorimer Moseley describe pain as a natural response to what the brain perceives as a threat. Pain can be thought of as a protective response from the brain as a result of threatening information coming from both our physical body and our senses. In most cases pain arises when sensory information from the body alerts the brain to either potential or actual tissue damage, however this is just one aspect of a much bigger picture!The information that the brain uses to gauge the amount of pain we experience also involves previous memories, emotions, reasoning and context.
A minor finger injury may feel a lot worse to a piano player than a football player. This is because an injured finger presents a greater threat to the identity and everyday life of the piano player.
You’re not alone
Joint pain is very common and can also be very distressing. Back and knee pain are amongst the leading cause of disability worldwide, and between 50-80% of adults will experience back pain at some stage in life. Persistent or chronic pain, which is represented by conditions such as osteoarthritis, is estimated to affect between one-third and one-half of the UK population!
Hurt does not mean Harm
When we experience aches and pains in our muscles and joints, it does not necessarily signify that our body is being harmed or damaged. In the case of obvious injury, the pain may well reflect damage done to structures such as muscles, ligaments, tendons and bones. However, in the case of aches and pains that hang around beyond the general time period of 3-6 months, the longer the discomfort persists, the less it relates to any actual harm or damage to any structures of the body.
The actual cause of persistent joint pain can be a mystery, and in most cases, clinical investigations such as MRI and X-ray are unable to accurately identify the actual cause of discomfort. Research suggests that there is very little association between scan results and pain. In addition, treatments that target specific body parts thought to be responsible for the pain are often ineffective.
Many people who have had scans that show things such as bulging discs and spinal degeneration have no pain at all. However, these same scan results in people with pain can entrench negative beliefs, create more fear (hypervigilance), and ultimately result in a greater sensitivity to pain.
Common findings such as dehydrated discs, bulging discs, flattened discs and worn joints become more common as we age, and are considered a result of the normal ageing process.
Pain is weird!
Pain can even be felt in body parts that don’t exist. People with phantom limb pain complain of worse symptoms when they are stressed or when someone comes close to where the body part would have been. Pain after amputation is usually more severe if there was pain before amputation. This suggests that the brain may store some type of PAIN MEMORY.
What can make pain worse
Many parts of the brain are involved in the experience of pain. The activity of these parts vary between people which makes every single experience unique and subjective. Persistent pain engages areas of the brain responsible for producing emotions and can create a state of constant negative emotion and self-beliefs, These in turn, can heighten pain recognition and sensitivity. It is common for people to become less physically active due to the fear of creating more harm. In addition, an increase in vigilance, attention, stress and negative emotions in response to the discomfort can intensify the pain experience, making things hurt even more. Exaggerated negative reactions can contribute to poor physical functioning and heightened pain sensitivity from the most minor and harmless bodily sensations.
Examples of negative pain beliefs:
Pain is a sign of damage
Pain means activity should be avoided
Pain leads to disability
Pain is uncontrollable
Pain is permanent
Common myths about pain
The following myths are important to understand because believing them can make us more sensitive to pain and subsequently experience more discomfort. These are taken from the work of Dr Greg Lehman, a renowned Physiotherapist, Chiropractor and Strength & Conditioning Specialist.
Many of the following ideas have been driven by well-intentioned and often very good therapists but unfortunately have little scientific evidence to support them. Pain is often amplified by faulty beliefs. For example, if you’ve been told your spine is unstable it can set the belief that your back is weak and needs protecting. Remember one way that the brain protects you is by producing pain, so pain might occur more readily when we view our body as weak and unstable. Instead we need to view the body as strong and capable of adapting but often sensitive. It’s this sensitivity, related to the faulty opinion that the body needs protection, that can perpetuate pain.
Your flat feet, knock knees, leg length differences and scoliotic spine are causing the pain.
This one is prevalent. But the research is just not there for most painful conditions. For the scientists out there, there is a very small, probably clinically insignificant, difference in foot flatness for one type of running injury but for the most part our anatomical peculiarities are not related to pain. Why? Because you adapt to them. If you have these differences, and everyone does, you have probably always had it and you have adapted to it. These peculiarities don’t put any greater stress on the body. The only stress is the grief it causes when you view these normal variants as pathologies.
Your joints are stuck, out of alignment and need fixing.
Whole professions are based on this faulty belief. But in the 100 years of studying this no research has ever documented a joint that was stuck or that the body can come out of alignment. No technique has ever been shown to realign joints either. Sometimes the techniques that try are very helpful for pain but this doesn’t mean that you were ever re-aligned. This is important to know because if we believe we are in need of fixing or “realigning” we view the body as fragile and something that “goes out”. Its not. The body is robust. It is strong and capable. Often times it is just very sensitive and uses protective mechanisms that hurt. Believing these falsehoods can create that sense of fragility and the need for over-protection.
You are tight, don’t stretch and therefore have pain.
Big Falsehood. The preponderance of research has not been able to show that stretching helps prevent pain. Nor does it link inflexibility with causing pain. It might work the other way around, in that when you have pain you tend to move more guardedly and you might fear movement and therefore move less. But we don’t get pain because we don’t stretch. However, if you love stretching then you can probably go ahead and do it. It can even help pain sometimes but not because you became more flexible.
Your x-rays show that you have degeneration.
Welcome to the club. If you have wrinkles or if you are losing your hair then this is degeneration. Does your face and head hurt? Of course not. Degeneration is like wrinkles on the inside. It is a normal condition that is poorly related to pain. You don’t expect to have the same face and body that you had at 20 years of age, so why should you expect your bones and joints to look the same. This is a very important falsehood to correct because we know that if you believe the idea that your body is “degenerating” then you will naturally fall into protective behaviours. These protective habits include lack of use, hypervigilance and increased sensitivity. All things that increase pain. The body adapts until it dies. Continuing to stress joints, even those with degeneration, is what protects them and keeps you healthy.
Pain may be inevitable, but suffering is optional
The wisdom of Buddhism sheds light on our capacity to change our experiences of aches and pains with the story of Sallatha Sutta (the dart), which analogizes pain and suffering as being struck by 2 darts. The first dart is described as the feeling of bodily pain such as physical pain or emotional trauma. The second dart is conceptualized as the avoidable psychological suffering that we shoot ourselves with as a reaction to the initial pain. In the context of ongoing joint pain the second arrow relates to the negative emotional content such as fear, anxiety, frustration and stress, that we worsen the experience of pain with.
A good therapist should teach you how to fish
It is very common for people suffering from ongoing aches and pains to have numerous treatments and see many different therapists in the hope of finding something that fixes them once and for all. Unfortunately, this often ends up with a lot of money spent on fleeting pain relief that doesn’t last. Patients can often become dependent on treatments that provide only transient benefit, which in many cases leads people to believe that they have no control over their aches and pains.
Speaking from years of experience as a therapist, our desire to fix people, and provide the very best care possible can result in over-treatment and an over-dependency where patients begin to believe that they need ongoing quick fix treatment to live a normal life! This is a great business model for many manual therapists, but it undermines the patient’s vast innate ability and responsibility in healing themselves. This is reflected in the famous quote:
‘Give a man a fish and you’ll feed him for a day, teach a man to fish and you’ll feed him for a lifetime’
We need to trust our bodies more and treat aches and pains as a call to action. Work with a therapist that focuses on helping you engage in the most effective self-care strategies such as personalised exercise and physical activity, mind body practices, dietary modification and positive psychology techniques.
Unfortunately, we now live in a culture of instant results and shortcuts to success, which is also creating a culture of impatience and greater expectation. Many therapists feel the pressure to perform treatments that please patients rather than helping them adopt the habits and self-care activities that will create better long-term results.
As long as any overly concerning aches and pains have been assessed and given the all clear of any serious conditions, the next step is to ensure that we are doing all we can to allow the body to take care of itself before seeking unnecessary investigations such as scans, blood tests, injections and unnecessary treatments.
So if our aches and pains are under our control, what can we do to get rid of them?
Think of aches and pains as a call to action. Pain is a means of motivating us to take some form of action. The action that we decide to take will significantly influence how well we recover, and how much our aches and pains affect our daily lives.
People who are more active in the management of their aches and pains fair better than those who rely on others to fix them. This is reflected in clinical guidelines for treatment of low back pain which now recommend physical activity as the main component of treatment. Explaining how pain works, can help people get a better understanding of what is happening when things hurt, and also gain reassurance that they are not going to harm themselves by being more active and experimental with self-care activities. An effective daily routine should also include gradual and progressive exposure to activities and movements that may have been avoided because of fear of discomfort. This can be complimented with short daily practices of awareness in the form of mindfulness, which can aid in reducing the negative emotions associated with experiences of pain.
The simple practice of mindfulness helps us develop a non-judgemental awareness of our moment-to-moment physical sensations and experiences. Mindfulness simply requires us to be present with our bodily sensations for as little as 10 minutes per day. Through this practice we begin to notice that physical discomfort is not a constant and that it changes from moment to moment, movement to movement and feeling to feeling. Mindfulness reduces the negative emotions that contribute to ongoing aches and pains and a greater level of mindfulness is associated with less perceived stress, depressive symptoms, better coping and quality of life.
In the great words of the famous psychologist Viktor Frankl:
“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”
Gradually Expose yourself to activities and movement that feel threatening
Joint pain can be influenced by a variety of factors including what’s actually occurring in the joint itself, what we believe about our body, what others tell us, and what we see others doing in similar situations. Even the anticipation of performing certain movements and activities can make things hurt more! This anticipation or hypervigilance can make us more apprehensive about taking part in movement and activities that ultimately help us feel better, more confident and physically capable. It may sound counter intuitive but by gradually exposing ourselves to activities and movements that we would normally perceive as threatening, we can begin to expand our repertoire of movement, build greater confidence in day to day activities, gain reassurance that our body is capable, and begin to dampen down our pain sensitivity.
Dr Greg Lehman describes good treatment as being based around 2 themes:
Desensitizing – any strategy that helps decrease pain
Reloading – applying stress to the person to cause them to adapt
Desensitizing is done a number of ways and involves treating the whole person. Understanding pain, having hope in your recovery, changing lifestyle habits, managing stress/sleep, setting goals, manual therapy and exercise therapy are all great ways to desensitize.
Reloading goes hand in hand with desensitizing. It involves stressing the person a little more than they are used to. This is typically done with rehabilitation exercises but it doesn’t have to be limited to that. Restarting a running program, typing 10 extra minutes a day, spending 3 extra minutes cleaning or performing a slightly painful exercise with vigour are all ways to challenge your body and ecosystem to adapt. They key is determining your sensitivity and your meaningful goals.
Don’t be afraid to ‘Poke the Bear’
The analogy of ‘Poking the Bear’ describes the benefit of confronting and gently pushing into pain in order to decrease sensitivity. If we always avoid even the slightest pain then disability and sensitivity can increase. At times, doing activities that hurt slightly can be beneficial. With the mindset that pain is more about sensitivity than damage, we can understand why doing something that hurts a little is not harming our body. However, we must not completely ignore pain. We acknowledge that increasing discomfort is the brain perceiving a threat so we should not push so much into pain that we contribute to a large flare up of pain the next day.
By carefully ‘poking the bear’ and learning that this does not lead to more pain, we can teach our body and nervous system to desensitize. It learns to tolerate these activities again. in some specific cases, pushing into pain might even be necessary. With many tendinopathies our exercises should be progressed until they are slightly uncomfortable. We also know that with tendon pain we can persist in playing sports or activities while in pain (provided there is minimal next day flare-ups). Poking into pain is a safe and effective way to keep nudging up our threshold and decreasing our sensitivity.
Release your own painkillers
Experimenting with exercise also gives us an opportunity to harness and utilise our own stores of pain reducing chemicals, such as beta endorphin. This will not only help reduce discomfort but also reduce the reliance on pain medications, which can damage the lead to addiction, and a reduced capacity for our body to produce its own natural pain-relieving chemicals.
Attending exercise classes such tai chi, yoga and qigong can also provide us with a support network by getting us out into the community and connecting with people who may also be experiencing similar challenges. Surrounding yourself with positive and upbeat people will help reinforce your motivation, hope, courage and determination. If you have the resources you can also hire an experienced coach to provide you with tailored strength and movement sessions, which also relieve pain, reduce fear of pain and increase strength, confidence and self-esteem.
You can also use social media groups as sources of information, community and motivation. Facebook sites such as Exercise for Injuries, Exercise is Medicine, and Versus Arthritis, provide online communities and resources for advice, feedback and support, aswell as a platform to share your experiences with like-minded people
Try nature’s painkillers
Curcumin (turmeric extract)
Curcumin, an active ingredient of the spice turmeric, has demonstrated a similar reduction in pain and inflammation as various non-steroidal anti-inflammatories (NSAIDS). Questions have been raised over the amount of curcumin that actually enters the circulation (bioavailability) when taken orally. However, taking curcumin with piperine, which is the active ingredient in black pepper, can increase its bioavailability by up to 2000%. Research suggests that it is effective in reducing pain, stiffness and improving function.
Bromelain (pineapple extract)
This enzyme which is found in the stem of the pineapple plant has displayed both anti-inflammatory and pain reducing effects in joint pain. In the case of acute knee pain, doses between 200-400mg of bromelain per day have displayed a significant reduction in pain and stiffness.
Capsaicin is the active compound found in chilli peppers which is responsible for the burning sensation. Capsaicin reduces joint pain by affecting the neurotransmitter that communicates danger or threat messages to the brain. Capsaicin is most often used as a topical cream patch or liquid and may also be found in dietary supplements.
Always remember the ‘Things Just Get Better Anyway’ effect (regression to the mean)
In most cases our aches and pains will ease off with a little time. ‘Regression to the mean’ , describes how episodic flare ups of pain will naturally begin to ease off when they have reached their peak intensity. This is normally when our aches and pains are bothering us enough to go seek treatment, so it is difficult to know whether it is the treatments we have that actually help us feel better or just the natural progression of that particular flare up! Not to mention the placebo effect of treatment, which is another rabbit hole worthy of its own stage.
In summary, there is so much that we can do for our aches and pains, before outsourcing our health to someone who can never understand our body as well as us. That is not to say that a good therapist cannot be of help. On the contrary, they can support and guide us to the water’s edge of the most effective and evidence-based interventions, and habits available, but it is then up to us to drink! So if you want to break the proverbial chains of recurring aches and pains, first ask yourself if you’re doing everything you can to create the environment for recovery and if not, become more of an active participant in your treatment and less of a passive recipient.
For more information, guidance and support with your aches, pains and overall health sign up for my 31 Health Transformation Programme join the Ricky Brown Health Tribe where me and the community will provide you with the support and inspiration to be Happier, Healthier and Pain Free!