Understanding Chronic Pain: What is your body trying to tell you?

Pain is more like a check engine light, but many people think of it as a self-destruct sequence. You know, like in the superhero / spy movies where the hero is up against the clock before the whole thing blows up?

THIS IS NOT YOUR BODY.

Seriously, when did you last see a human body explode, or collapse in on itself?

If you happen to be in possession of a human body, you might be familiar with one of these feelings:

Headache? Might be cancer.

Back hurts after gardening? Probably a slipped disc.

Knees ache after running? Arthritis

But you know what? You're probably wrong. On a rare occasion you’re not, but thanks to “availability bias”, we LOVE to think about the worst case scenarios, because they are so much more “available” to our brain. If your back aches after gardening, it’s not nearly as interesting to mull over the abnormal amount of CGRP due to electrolyte imbalances in the muscular cellular matrix creating local neural hyperactivity 😴 as it is to recall how your cousin with the landscape business eventually had back surgery and was never the same after that.

Nevermind that your cousin was 80 pounds overweight, 15 years older than you, and you’re pretty sure his idea of “ab work” had to do with sitting up in bed to watch more reality television. That image of “something damaged” is much easier to roll around in your head than a temporary state of biochemical dysregulation that is ACTUALLY creating your reality, which we can still admit doesn’t feel great.

Pain DOES NOT mean tissue damage. In fact, many people with severe tissue damage report LESS pain than their counterparts with more persistent, but less severe complaints. Probably because when you’re in real pain (broken arm, dislocated shoulder, etc), you know WHY you’re in pain.

Pinky pointing the wrong way? No mysteries there! Probably should head to the ER!

However, when you don’t understand WHY your body is giving you these signals (because you don’t have an advanced medical or biochemistry degree), we start creating a story in our heads.

“It must be because….”,

“I always felt like my one leg was longer than the other, so now it stands to reason that…..”

“I bet that’s from when I fell on it as a kid”

“I have my mom’s/dad’s/cousin’s/pet chinchilla’s/ grandma’s/ grandpa’s feet/hands/body/posture/legs/hips - it was inevitable that……”

Any of those internal stories sound familiar?

Just acknowledging where the story came from, and that there might be a plausible alternative as to why you’re having pain, discomfort, or difficulty with the activities that get you through the day, can help make it less stressful. The world is confusing and scary enough - why add extra things on to that?

Here’s one of the more salient stories I know of. Heck, some of you reading this might KNOW Scott (he gave us permission to use his story, of course)...

Scott had the fortune of fracturing his spine….TWICE… while he was mountain biking in college. I’m pretty sure that was the end of his mountain biking career. He’s had chronic tension in there since then, and recently he’s been getting progressively more limited in how long he can lift, carry, push, or pull with his arms if he doesn’t want to get that area inflamed due to all the compression.

Then in his early 40s, his knee started giving him trouble - making his job as a construction inspector pretty challenging - hard to inspect things if you can get up and down from the ground. Rehab didn’t help, so on to surgery he went! Taking it easy helped for a bit, but then….uh-oh… symptoms started coming back, and the orthopedist started talking about a knee replacement.

Fortunately, he then had a severe bout of sciatica! Well, not fortunate, but he certainly wasn’t going to head into the surgical table when it felt like someone was taking a blowtorch to his leg. His MRI showed nerve inflammation and a small disc bulge. The Neurologist said “No sweat. We will get the pressure off that nerve, and you’ll feel right as rain.” And after a bit, he did! Except his knee still hurt. And now his back became really stiff from his surgery. He had even less cushioning in his spine thanks to a few old fractures and where the doctor helped remove some of his disc.

Now he’s 49 going on 75. Can’t squat, has to ice the knee every night, he’s got less cushioning in his spine, his wife has to push on his back all the time to get it to “pop” to release the pressure from the “collapsed vertebrae” the doctor told him about.

So, he walks in the door here, because his neighbor(s) told him to. The man helped the last PT he worked with to send his kids to college - what would we do differently here. And he tells me a story like the one above.

We started talking about his knee - can’t do yard work, can’t squat, can’t exercise because it swells after a couple of weeks on a stationary bike, so we just took a few moments to look at his knee. His doctor had done an MRI that said he had no cartilage and gave him an “unloader brace” - which pushes the knee off to the side where there is some cartilage. But it isn’t THAT helpful.

So, we looked at his knee. The missing cartilage part - wasn’t painful at all. I pushed and poked and prodded and stressed it, and it didn’t even make a peep. The area under his kneecap, however, was swollen and painful and irritated - that’s what created his pain. The one that sent him into the surgeon in the first place, that came back not too long after the first surgery.

His answer was “the doctor just talked about my cartilage and meniscus” because that’s what was on the MRI.

We stretched out the thigh a bit, and put some stretchy kinesiology tape on it, and it was 50% better. Like in 10 minutes. He was incredulous. How could some (very colorful and expensive) tape work better than a (sleek and black and custom fit and $2000) brace?

Because the medical tests only confirmed what the surgeon wanted to see - something to do surgery on. And so he did! Now, Scott can ride a bike and he continues to do so 3-5 days a week.

A month or so into our working together on the knee he called me while I was out running (I used to carry the office phone with me!) - he was laying in a hotel room 3 hours away with sciatic pain. He just knew surgery was gonna happen again - “my disc must have ruptured again” were his words to me. He didn’t have any emergency signs, so we got him in the clinic a few days later. He was ready to schedule his MRI that day, but we waited.

He hobbled in, and we assessed the spine - lots of muscular tension, and some signs that indicate some nerve pain and irritation, but no signs of compression (which would indicate something pressing hard on the nerve). So, we did some treatment - got some muscle spasms to calm down with some hands-on work and worked through some gentle exercises to promote circulation.

I discussed how various symptoms can spread down the leg, and how when there is a historic injury (especially with nerves - they’re how we IMPRINT and CARRY the messages of our nervous system, right?) our body can respond like the scenario is the same as the first time. Like PTSD for our physical selves - a “once bitten, twice shy” situation where our bodies over-respond because it was so bad LAST time.

And by the next morning? He was 75% better. That’s when he really understood, for the first time, that pain and tissue damage are NOT the same thing. He realized the sirens were really loud, but hadn’t actually been responding to a real threat. And now when he overdoes it in the yard or at work, the signals down the leg don’t make him anxious (well, not TOO anxious anyway), and he can stretch, move, ice down, and get up the next day feeling great. We almost never have to address his low back anymore.

And his old fractures? Well, there is definitely some arthritis there. But more importantly, there is weakness, inflexibility, avoidance, and poor movement patterns. Because he’s been AVOIDING any stress in that area for decades, why WOULD it feel good to move it? Why WOULD it be capable of handling ANY kind of stress? Well, it didn’t and it wasn’t. So, off we went on a journey to steadily add bits and bits of strength, movement, and endurance - nothing that would set off too many bells, or irritate the less durable tissue from 30-years old compression fractures.

And where are we now? Scott can now knock out six HOURS of yard work (and thank goodness, because his 18 year old son just went off to college!), he’s biking 3-5 days a week (when he’s on his game), and he’s hitting his home weight set up 2-3 days a week. He’s lost 30 pounds, cut back on the beer (a favorite muscle relaxer/ pain reliever here in Asheville), and even decided it was time to explore other career options because he was able to connect the travel / work / stress as a negative externality on his well-being.

But it all started with hope. If the stories you tell yourself are negative and inevitable, are all about your brokenness - either physically, mentally, spiritually, or emotionally - you give up the opportunity to move in the direction of healing. With a bit of detective work and a change in understanding of their own potential, some people can find their way out of chronic pain, just like Scott did.