Grateful For Pain

I'm a big fan of analogies when it comes to explaining things in the clinic.

Today, my 8am patient expressed disappointment that her thus far linearly progressing improvement had been derailed.  For the first time since commencing therapy following a fracture of her humerus (long arm bone), she experienced an increase in pain and assumed something was wrong.  From the outset, this patient had openly expressed her apprehension and fear of pain.  I had to work to build her trust, and today we had a good discussion about pain.

Pain is a GOOD thing.  Without its perception, staying alive and healthy becomes infinitely more challenging.  Imagine how difficult it would be to keep from harming yourself if you could never feel a hot stove with your hand or a rusty nail in your foot?  For the sake of simplicity, I will avoid bogging you down with the details of the neurophysiology of pain perception.  Rather, I'll use the following analogy.

If your body were a car, imagine pain playing the role of both the steering wheel and the brakes.  If your car were cruising down the road at 65 miles per hour and all of a sudden it began to veer out of your lane, you'd use the steering wheel to adjust and compensate.  If you were driving in the dark and a deer ran out into the road, you'd instinctively hit the brakes to avoid a collision.  Pain can both steer as well as limit or stop your movement.

A common concern that many people have is the fear of "doing more damage" if they continue to perform such-and-such behavior.  I think most folks can tolerate a certain degree of pain, as long as they are assured that nothing "serious" is wrong, and that it is only temporary.  The simplest advice I can offer my patients is to use pain as a guide when it comes to movement.  Don't be afraid to move.  Rather, explore movement in the affected area.  If that's too intolerable, then try moving the surrounding joints in a pain-free manner.  Never barrel ahead with a "no pain, no gain" mentality.  Rather, tease the edge of your pain tolerance with gentle repetitions until you edge that barrier back towards normal functional limits.  This is likely what occurred with my patient this morning.  Her body is diligently healing itself at a normal pace.  Perhaps her progress lead to some over exuberance, and she pushed herself too far.  Not to worry.  We simply dialed it back and used her pain to steer her back into a safe lane.  

If your drifting car didn't have a steering wheel, then you would be liable to end up going off the road.  If your car wasn't equipped with functioning brakes, then you might hit that deer head on.  Disaster in both cases.  Thankfully, functioning cars are equipped with these vital features.  If not, the only safe bet would be to never remove the car from the garage.  The resultant disuse will cause all of its other moving parts to begin a slow, steady decline.  Eventually, your car would never be able to go anywhere.

Don't be like that car sitting idly in the garage.  We were born to move.  Rather than fear pain, embrace it for its protective role and be grateful for it.  Recognize its power to keep you alive and regulate your movement as your body heals itself.  When it's finally gone, get back to moving well.

IMPORTANT FOOTNOTE ON PAIN:

Not all pain is the same.  Should you ever find that pain WAKES you up at night, or that you have pain that is unremitting and unresponsive to positional or activity changes, go seek medical attention.  You must rule out that anything serious and systemic is going on in this case.  In addition, please don't misread the above to suggest that anyone should SEEK pain.  Pain alters motor control (meaning it will cause movement compensations).  We don't want to move for too long with poor movement, because our brains will record these aberrant patterns.  The quicker we can rid our bodies of pain, the faster we can get back to restoring healthy movement.