Thoughts from a PT

A majority of my job deals with pain. People in pain, looking to get out of it. Sometimes they’ve only been in a pain for a short while, from an ankle sprain or muscle strain. Sometimes it’s been pain since 1980 or “since I was 12 yrs old.” I have treated patients as young as 8 yrs old and as old as 95, and have noticed some patterns along the way that may serve you well as you try to grow old well.

For one thing, there is a lot of relatively new research on pain and how it works that I think is pretty life-changing. First of all, pain is created by our brains, and does not come from our body itself. The body only sends data up to the brain, in terms of strain, tension, shear force, temperature etc, that is meant to be useful data for the brain to determine if the body is in danger or not. The brain processes the data and decides whether or not to send out a feeling of pain.

Imagine you are in the final game of your sports career, running the last play, and you sprain your ankle with only yards to go to score that touchdown/homerun/etc/whatever. You likely will not even register that your ankle hurts, because the importance of the moment will override the pain signals and your brain will shut the pain down. Or imagine that you are a mother, and your child is about to get hit by a car in the street. You are barefoot, and running over gravel and broken glass to get to your kid in time; you do not feel the pain in your feet until your kid is out of danger. Your brain has literally blocked the pain signal from your consciousness until it deems you are safe.

On the flip side, have you ever had a bruise that you cannot remember getting? You injured your tissues to the point of a nasty black, blue or green bruise, but have no recollection at all of the event? An injury without any pain? Or what about amputees who have “phantom limb pain?” Those folks have pain in their “foot,” when the physical foot is literally gone.

The brain creates pain (or not) depending on a whole lot of factors. The situation you are in, the mood and mental state you are in (depression and anxiety are strongly linked to higher experiences of pain), your history of pain. If you grew up with parents who freaked out every time you got a boo-boo, you are more likely to think pain is the worst thing ever and to catastrophize any experience of pain, and therefore experience more pain. If your parents were more of a “rub some dirt on it, you’re fine” type, you are less likely as an adult to experience chronic pain.

All that to say that pain is normal. It is very natural part of the human condition and it serves a very good and helpful purpose. Pain is only meant to be information to serve as a warning that our body is in danger. When we have experienced chronic pain, or have depression and/or anxiety, or are under chronic stress (which is pretty much the natural state of being for all of us in the 21st century) or are prone to catastrophizing pain, then our warning systems get jacked way up, and things that are not dangerous at all (like bending over to tie your shoes), get processed as dangerous and therefore elicit a pain response from the brain. It’s like a car alarm that’s overly sensitive and goes off if a leaf lands on the hood.

For folks that have had chronic pain, it is possible to turn down those hyped up warning systems. Meditation and relaxation techniques can help. Deep breathing, as simple as that is, works wonders. Working on “graded exposure” to activity – slowly ramping up time spent doing an activity like walking to keep it under the pain-freak-out-zone – helps to turn down the system. Understanding how pain works alone helps to turn down the system, with realizing that every pain does not mean that your body is broken or that your simple normal movements are not making it worse. Being careful not to overdo it, but to find ways to move that are fun (walking outside, dancing, biking etc) will help.

What I’ve noticed with treating patients over the age spectrum and over a wide variety of physical states, is that the older folks who are still living a good life with a high level of function have some things in common. For one, they have a strong social network. Human beings are not meant to be isolated and alone and there is tons of research to back that up. Having a healthy marriage, or strong community of friends, people to volunteer with etc in old age seems to do wonders for people. I had a patient who still went square dancing in his 80s, as a widow, and had tons of friends that looked forward to seeing him every week. That’s huge.

Another big factor I’ve noticed is being realistic. The old folks I see that are in the best place realize that they are not necessarily going to be painfree most of the time when in their 70s, 80s, 90s. Although that 95 yr old patient I had was in no regular pain and still walked with ramrod-straight posture and only a cane for balance assistance (“just in case”). It is certainly possible to be painfree in your 90s. People who have realistic expectations and don’t put “make me 20 again” on their list of PT Goals, seem happier and more active in life. Pain is normal, and our bodies simply aren’t made to last indefinitely. Some parts are going to get injured, or worn out, and may have some pain on a regular basis. No need to freak out about it. Acceptance of a minimal-to-moderate amount of pain seems to help people succeed in aging well.

Lastly, and I cannot emphasize this enough, but the phrase “use it or lose it” is SO SO true when it comes to aging. The longer you can keep moving, keep working on strength, balance, and endurance, the longer you can keep active. It is really pretty simple. Our bodies are so efficient, so if we stop moving a certain way or using a certain muscle, it gets shut down FAST so as not to waste energy. To avoid getting weak and tired, don’t stop moving. Keep doing that thing you love, or keep trying out new activities. Keep exercising in whatever way you enjoy exercise. Keep moving, and you’ll be able to keep moving. Strength is function-specific, so if you want to be able to keep doing push ups into your 90s, keep doing push ups. Want to keep having an easy time getting off the toilet, keep working on squats or sit-to-stands. You get the picture. Use it. Or lose it.

Everyone likes to think that they are special. Especially people who are injured and have been through a lot. “My doctor said I have the worst knee he’s EVER SEEN.” “My surgeon said I have the spine of an 80 yr old (in my 30s).” “You don’t understand, I have degenerative disc disease / arthritis / bone-on-bone / a disc bulge (BIG WHOOP, who doesn’t??)” Unfortunately, doctors and surgeons have often exaggerated the role that imaging plays in people’s actual experience of pain and function for far too long. People see their MRI, hear that they have bulging discs or severe stenosis or arthritis, and they panic or think that they’re screwed. Their back is broken, their knee is beyond hope, their shoulder is destroyed, the rotator cuff torn up beyond repair. That’s simply not the case. You can google the specific numbers, but there are a lot of people walking around with bulging discs, fully torn rotator cuffs, and bone-on-bone arthritis with NO PAIN. Pain is determined by the brain from a wide variety of factors.

So if you get injured, yes, by all means, go see a PT. Acute injuries need to heal properly. You may have muscle imbalances that need addressing or may be too tight/weak/out of alignment and need some tweaking. And if you are in chronic pain, search for a good PT who helps you get moving again in a safe, comfortable, relatively painless way. If you are in chronic pain, try relaxation techniques, meditation, or therapy if you have a lot of anxiety or have depression. But know that hope is not lost. People have been aging with degenerative changes and injuries for all of life, more and more as we live longer. Our bodies are shockingly resilient, and can rebound from even catastrophic injuries. Don’t underestimate the strength of the human body or the power of the mind. Seek out good friends, fun activities, and enjoy your life!

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A lot of the information on pain in here came from the Explain Pain course I took through NOI. Lorimer Moseley is the one doing a lot of amazing research.

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1 Comment

  1. Also your dad with his shoulder injury and everyone including doctor said to have surgery and instread went to pt and did exercises you to,d him too and he has managed to adjust without the surgery. Good job Dr. Hayward!

    Liked by 1 person

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