We have all at some point in our life suffered an injury or felt the intense sensation of physical pain from something as simple as a cut on our finger, to the intense swelling from a rolled ankle. The feeling is intense and immediate. It is more or less a signal from the brain telling you something is dangerous and needs our attention NOW! Very much like a fire alarm system in your house alerting you of potential fire and danger! The types of pain I described here are what you would call traumatic injuries or acute pain, often caused by an accident or unexpected incident. Chronic pain however is much different and rarely from an accident or one particular incident. It is constant and can last months, even years! Many people suffering from chronic pain are looking for a remedy or a solution to remove the pain and suffering. But the big problem with this is, that removing the pain is rarely addressing the real problem, why the pain was there in the first place. This is the equivalent to removing the batteries from your fire alarm instead of finding where the fire is! Having worked with so many clients over the past 12 years in our rehabilitation program, I see this same story everyday and many of these chronic injuries could have been avoided if the right approach was taken earlier on. This article we are going to look at chronic pain in great detail and challenge your way of thinking in how you address your current problem.
Pain Changes Everything
Our approach to treating pain is that it is a real inconvenience and that there must be some kind of pill, tablet or medical intervention to just get rid of it. Many people treat the car much better than their own body. If a warning light goes off on the dashboard they, they don't just ignore the flashing light, they take it straight to the shop for a thorough examination of where the problem is and have an expert help us to correct the problem. Yet when the warning light goes off in our body we just ignore it, until it becomes a big problem. Now there is a big difference between comparing a human body and car, and a human body is much more complex than a car could ever be, and as a result just replacing a part rarely works. But this is our mentality, we just want to be fixed. On TV almost everyday you will see advertisements for some type of anti inflammation pill, or gels in recent times claiming that this is the solution for your pain so you can get back to doing what you were doing. We are taught that we just need to remove the pain, not address why we have the pain!
Surgery by the way should always be a last resort. After every other option has been exhausted. Yet often you find today, this is almost the first option. There has recently been countless books and articles written by well respected surgeons questioning the benefit of many of the most common surgeries being performed. Dr David Hanscom an orthopedic surgeon in Seattle advises his patients to avoid spinal surgery. He says it best below.
"The success rate of the spinal fusion for back pain was about 24 percent, but we still kept doing it. Then, in 1994, when this paper came out Washington showing that the return-to-work rate one year after a spinal fusion for back pain was 15 percent, I just stopped. Every paper since then has showed pretty much the same dismal results; there's maybe a 20 to 25 percent success rate of spinal fusion for back pain... And the downside of a failed spine surgery is terrible. It's really bad. These people are condemned to live their entire lifetime, 30 to 40 more years, in chronic pain." Despite such findings, spinal fusions are still popular. Each year, some 600,000 spinal fusions are performed in the U.S. with a high percentage of them being performed for non-specific low-back pain, at a cost of more than $600 billion."
You can read more about this and also several other examples in our article "How These People Use Exercise To Beat Chronic Back Pain".
The problem with pain is that it changes so many things. Pain is the fastest way to change how you move! If I was to kick you in the leg you would instantly adopt a limping walking pattern. I would be able to change how you walk instantly. When we change how we move to avoid more pain and create compensatory movements, it causes a chain reaction of a whole set of new problems, and often bigger ones that result in guess what? More pain! We always get many warning signs that are not painful yet to do something but we are so trained to ignore these warnings and go about our day.
Take a look at the pictures below of what can happen from a foot that pronates excessively. The person who does this will develop pain in the knee from a common problem like this. But before the pain often they will feel tightness in either their hips or their feet first. These are the warning signals that a bigger problem is coming if you do not fix the problem. Working on the knee is a waste of time for that is the effect, not the cause. Now it will not always be the knee, this is where other injuries like lower back stiffness and Piriformis syndrome are common with tightness or lack of mobility around the hip, and Plantar Fasciitis or achilles problems are the most common injuries with the feet for the same reason. Pain is rarely in the area that the problem started, but there is a real feeling something is not right. Either it is weak or it is tight. Smart people will seek help in this stage from someone to find out what is going on, and they are the ones that get on top of the problem quickly before it becomes a much bigger injury.
Who Can Help You?
Our instincts and what we have been taught to do when something is wrong is to see a Doctor. But what about if you don't have any pain or are bad enough to see one? Do you just wait until it breaks and then do something? Doctors at medical school and university are taught what to do when something goes wrong, how to fix things rather than keep them from happening in the first place. Basically all medical professionals are educated to do this, that is their profession - to help you deal with a problem you now have.
It is up to us to look after our body and give it the attention it deserves and prevent our problems. But sometimes we just do not know what is happening and need help. The professions that are designed to help you with this prevention method are occupations like Personal Training, Exercise Physiology, Pilates, Yoga, Dietician and Naturopaths. All will have their own methods and philosophies on how to help you. Just getting started on owning your problem is a big step forward. However while many of us do take this step, there are many of us that are ignorant to the benefits of a well rounded approach to health and would prefer to wait until it breaks and get someone to fix me. Their philosophy is, "nothing is wrong, I don't need to worry about anything. If it breaks I will deal with it then." That is the same thing as never maintaining your car. Their body will be giving them some warning signs that something is not right, however most will ignore these signals until it turns into pain! Then they will seek something to remove the pain instead of addressing the cause of the problems. So by all means find someone who you trust and respect to help you.
What you need is a plan that can identify warning signs, find your cause and assist you not only getting rid of your current problem but prevent any further injuries from forming.
What Are The Main Causes Of Chronic Pain So You Prevent Pain & Potential Problems?
It would be impossible to list every potential injury or disease and say exactly what you need to do. We are all very unique and we will all have our own things to work on, but here is some of the main things that if we all adopted this the chance of injury would be significantly reduced. To make sure this article does not go too long I am just going to talk about injury and not disease. But make sure you have your Nutrition, Recovery and Lifestyle factors under control for you these factors can also create pain.
Read our article 16 Ways To Improve Your Health for a full explanation of how to use Holistic Health methods to prevent disease and achieve great fitness results. Doing this is a great start and will solve many small problems on it's own. However chronic pain that has been around for some time is never that easy to get rid of.
Here is my top 3 things you can do to prevent chronic pain. Ironically it is the same 3 things you will need to use to get rid of it, if you are currently suffering with an injury!
- Improve Your Posture & Stability
- Improve Your MOVEMENT skill
- Strength Train 3 Times Per Week
As mentioned before if you injury is not from a car accident or sporting collision as such, and just developed from nothing, 9 times out of 10 it is a postural or movement problem. Meaning if you were working on your posture and movement you would not have developed the injury! Pretty simple stuff. But for many people it is too hard, it takes too long and too much effort on their behalf. They would rather the shortcut of surgery or a pill but as we discussed earlier surgery these things do not address the cause, they are merely treating symptoms. Let's take a quick look at each of these 3 factors.
1: Posture & Stability
This is defined as "The position from which movement begins and ends." If we start in a poor position it is inevitable we will end a bad position. Do it enough times and you break something. We must strive to achieve what is known as ideal posture. This is defined as "a state of muscular and skeletal balance, which protects the supporting structures of the body against injury or progressive deformity, whether you are moving or not. It is during a state of ideal posture that the muscles will function most efficiently". But how does this exactly create your pain you might be thinking? Take a look at the picture below.
This type of posture places huge amount of stress throughout the spine around the neck and the lower back. This type of posture often adopted from sitting too much is what often causes the disc bulges in the lower back and neck. The most concerning issue arising from postural faults and imbalance is not just the area in pain but the risk of further more serious injury in other areas in the body and loss of balance. This is due to the loss of stability and balance. The body will use many protective methods resulting from instability that in turn creates loss of balance and rotation. This is why 90% of back pain sufferers end up with neck pain! The amount of people who lack stability and balance is astounding. I used to think it was just older adults who had this problem but I now see people in their 20's and 30's with severe stability deficits.
What can you do about it?
Well for starters read our article Posture Is Everything as this gives you a much more detailed explanation on posture and several great exercise examples to use straight away.
Secondly watch the video on Stability & Flexibility below. If you were to adopt the strategies I show you in both these videos you will be well on the way to preventing nearly every injury. It will also help significantly if you have a problem for like I said before. The method we use to prevent the problem is the same method we use to treat the problem.
2: Learn To Move Correctly
I cannot state this enough. I see so many people who exercise a lot, eat well and should be very healthy and fit but are constantly injured and in pain. Why? For they are using exercise methods that are destroying their body's ability to move efficiently and effectively. Many exercise programs such as body building methods abuse movement, they sacrifice movement to look good in a mirror. Some abuse the body using the no pain, no gain concept, eg Crossfit. Exercise does not need to be like this and actually it is much easier than you think. When you learn how to move correctly you improve so many things all at once! Strength, coordination, balance, flexibility and even speed and power are all enhanced from learning to move correctly. The brain and the nervous system control everything we do, so by using exercises to upgrade our computer serves to eliminate problems and enhance performance. We can never stop working on this, ever.
Every single person in our rehabilitation programs has a movement problem! EVERY CASE! For some it is with a squat, others it might be a bending or pushing movement pattern. What come first the injury or the movement problem? It is hard to say but once there is a dysfunctional movement pain is not far away! What can you do?
Well firstly you need to assess your movements. There is 7 key patterns that we use as a foundation to create all movement from. If you can improve these foundation movements as close to perfect as possible the chance of injury is almost zero. Once you know what you need to improve you must implement a program to correct your deficiency. This can take some time and is not easy, but well worth it. Below is a video that explains how to do this.
Also you might like to get a copy of our Free Report on Functional Training as i provide many programs you can use to correct each movement pattern.
Do not discount the use of Mobility drills here. Mobility is different to flexibility in that it is not limited to a single joint but a combination of joints. These drills are much more movement based as opposed to holding one particular muscle with increased length for a period of time. This type of training is extremely helpful in removing pain and helping people to feel what it is like to move without restriction. An example would be someone has optimal flexibility at the hip, knee and ankle yet when they squat they lack freedom of movement. This is not a flexibility problem but a mobility and stability problem affecting how they move.
Read our article Mobility and Flexibility Which Comes First and Why for more details and specific examples.
3: Strength Training
The video above is a great examples of taking a movement skill that was difficult to do (bending) and now using strength methods to make it even better than it has ever been. You can see how closely this relates to real movement too. We all must adopt strength training to complete the healing process. The older you are the more important this becomes, as the aging process means we begin to lose muscle year on year if we do nothing to prevent it. Also notice this is step 3 and not the first thing to do. If you are already working on your posture and how you move you will adapt to strength training well, but if you skip those 2 steps and go straight to this you can risk injury! So why we need this, we must respect it and appreciate the fact that stability, posture and movement precede this phase. Along with movement skills, strength training is often missed by most health therapists when treating people in pain as most treatments are trying to release tight muscles or stiff joints. But for every tight muscle, there is also a weak muscle. This is the law of muscle imbalance. And no therapist can strengthen you with a treatment. You can only strengthen your body using strength training exercises. And using body weight and rubber bands may be great in the beginning, but neither apply enough resistance to continually force the body to change and strengthen the weakness.
In knee pain cases we see a chronic tightening of the hip flexors and quadricep muscles that need massage and stretching to release them and restore optimal flexibility and mobility too, but at the same time a real weakness in gluteal muscles and hamstrings that need a strengthening program in order to maintain a balanced knee and hip joint for when we move. The glutes and hamstrings are not in pain, but they are just as big a problem as the area that is tight, stiff and sore. If left unattended nothing will change!
Read our article "Why The Knee Is Rarely The Problem For Knee Pain" and "How To Strengthen The Glutes" for more detail on this.
Before just heading to the gym and stacking some plates on a barbell, get some help in designing a program to correct the muscle imbalance and movement weakness you possess. Whatever you do, avoid machine based training as this will speed up the rate of dysfunction. (read our article Squats vs Leg Press for detail on this) In basic terms you want to strengthen the movement patterns you have been improving on with step 2. If you have pain already this will be challenging and risky if you do not get it right, so I suggest getting a copy of one of our programs below, click the image or go to our Online Shop for more details.
And if you live in Melbourne you can request a Free Consultation from me (see bottom of the page).
What Is Likely To Hurt You Is What You Need To Learn The Most!
A great quote I like to use is "If you can't, you must!
What does this mean? Well most people when they hurt themselves or have difficulty doing a certain movement avoid this particular movement. For example someone who badly hurts their back from bending over will avoid deadlifts for fear of hurting their back again. They will often be told by a Doctor to never do deadlifts in the gym. These are bad for you! This is stupid. For when you avoid the movement you now need to change your entire lifestyle to accommodate this. This means you may need to change jobs, cannot play golf anymore (how are you going to pick up the ball?), gardening is out and a whole stack of other things that are just life activities are now risky. The longer you avoid it, the more compensatory movements you develop and the weaker you get increasing your chances of injuring yourself again significantly.
The same thing happens with a loss of balance or walking problems. Instead of addressing the problems associated with the loss of balance or walking difficulty people begin to avoid activities needing it! All this does is speed up the rate you lose your balance or walking ability until you end up in a wheelchair or needing a walking frame.
You must move towards what is going to hurt you or you fear the most. It is very simple really.
- If bending hurts learn how to bend.
- If you have a balance problem learn how to improve your balance.
- If your knee hurts walking up stairs find a way to make walking up stairs easier.
If you can solve the puzzle of what is holding you back and turn your weakness into a strength, nothing can ever hurt you again. Many health therapists would think this is risky. In a gym environment with an expert by your side helping you and guiding you how to do this, the risk is minimized and absolutely worth taking. For avoiding it guarantees you one thing - you will go backwards. I have seen some amazing things in my 12 years as a trainer, some even I thought were impossible.
To see great examples of this read our testimonials page and the articles below will interest you too.
Why We All Need To Work On Balance
How These People Used Exercise To Beat Chronic Back Pain
Why Sporting Athletes Easily Ruin Their Body
I cannot tell you how many athletes I see create their own injuries by ignoring the warning signals. I have been unfortunate to see many exceptionally gifted athletes retire from their sport early and now walk around like a cripple, after spending years wrecking their body with painkillers to get them back on the field as fast as possible. Some using surgery like the end of season "scrape and clean out" to take shortcuts on dealing with the real problem. You would be a fool to think this doesn't happen anymore which is a real shame to see people with talent unnecessarily wreck their body.
Painkillers are extremely bad for an athlete, not just for the fact they can cause all sorts of stomach ulcers and even addiction problems. They ruin athletes as they disable your internal alarm system in the body warning of poor alignment and stabilization that will cause major damage to joints and tissue in the body. The reflex timing of this system is completely ruined and the athlete continues to play and train unaware of the potential disaster awaiting. This is when you see a season or year later the athlete develop a very serious career threatening injury. Many athletes think they are rehabilitated when the pain is gone, but in most cases the dysfunction and compensation still remains for they still have not addressed the reason the pain was there in the first place. The minute they go back to the sport or even training, disaster awaits! It is just a matter of time. By going through the 3 steps we just discussed, you can get back to playing sports without risk or potential disaster. You may miss some games and become extremely frustrated, but missing 5 or 6 games is better than missing a year and possibly never being able to play to your potential ever again!
Below is some videos of what is regarded as a career ending injury - ACL Rupture or tear. Also you might want to read our article Why Single Leg Squats Are The Best Injury Prevention Exercise where I show you how to use this as an assessment tool to identify weakness.
I would like to say I was one of the smart ones but like most people I ignored the warnings and alarms many times and now at the age of 43 pay the price for it. If you have read this far you are already smarter than I was so you should not make the same mistake. I have been able to make up for some of my problems later on and still can move pretty good for an old bloke. But I wish I had someone tell me this when I was in my 20's.
Can You Have A High Pain Threshold?
This is one of those things that people claim they have a high threshold, when in fact it is the exact opposite. Again many athletes will tell you they have a high pain threshold. They may indeed have had an ability to ignore the alarm system in the early days. But when the pain remains constant for a long time the pain starts to hurt more and more. The best way to look at this is to imagine hitting your thumb lightly with a hammer. At first it doesn't hurt that much, but imagine hitting your thumb 5000 times in a row every day for the next 3 months! Just a feather touching your thumb now will be excruciating. You might not even have to touch it at all, the anticipation alone will be painful! This is what happens with chronic pain sufferers. Because the cause of the pain is not addressed and you keep on hitting it over and over every time you move, eventually the pain develops into much more severe signals. Like the alarm getting louder. Can you see now how the pain threshold is very low. I might hit my thumb with the hammer once and it does nothing to me for I did not have 500,000 hits before it, whereas the person dealing with chronic pain will feel this as if it was a sledgehammer hitting their thumb.
This is also why use of painkillers increases and what worked at first does not work anymore and need a more powerful drug.
Conclusion
I really feel for people who have been suffering with pain for a long time. And I know many people have tried several methods to help get rid of their problem only to end up in either more pain or with very little success. And even those who resorted to surgery to fix them I have seen in more pain than before the surgery only to be told, "sorry there is nothing more we can do, perhaps get a pain counselor to help you deal with the pain". The intention of this article is to hopefully show you that there is more to pain than just trying to get rid of it. Once you have removed the pain, your journey has now just begun and you need to go about finding why did this problem happen in the first place. If we go back to the smoke alarm analogy, where was the fire coming from? If you can find the answer to this, and in ALL cases you will find it traces back to either a POSTURAL problem or a MOVEMENT problem, or both! Our sedentary lifestyle has a lot to do with creating both these problems, but we both know this is not going to go away, so we need to find ways to exercise and move our bodies like we are supposed to do. The older you are the more important this becomes for the aging process is already weakening you and once joints become unstable you will find a new way to stabilize being stiffness. This stiffness is going to change how you move and start to disrupt movement leading eventually to pain.
Always remember pain will change how you move faster than anything. And secondly the movement that hurts you the most is the same thing you must learn how to master!
I hope you have enjoyed this article as much as I have writing it.
Again if you live in Melbourne and would like to organize a Free Consultation click the image below to organize a time.
