In part 1 of this series, I talked about how when we have chronic musculoskeletal pain, our world’s can become pretty small and how in those smaller worlds, we don’t move in the ways we used to or move as much as we used to. It hurts, after all.
When we’ve been hurting for a long time, it’s easy to associate certain movements with pain and it’s easy to fall into the notion that moving in certain ways is dangerous and should be avoided. And the more we avoid a certain movement, the more the movement seems dangerous. But it’s not the movement that is dangerous. We need to move, every day in all sorts of ways, in order to function and live.
So, to be clear: movement isn’t dangerous
In fact, movement is one of the most beneficial treatments for people in chronic pain. To go a step further, movement is one of the most beneficial lifestyle behaviors for all people, of all ilks, at all levels of health, of all ages.
But movement can be worrisome when we have pain, and understandably so. After all, if our systems are telling us that we may be in danger, we definitely should pay attention to it, we can’t just ignore it. But paying attention doesn’t mean we need retreat or lose ground or reign in our world to figure out why the alarm is going off.
We are in control here, we hold the keys. We can figure this out and we can get through it.
An overprotective system
A lot of times, the alarm signal of pain is just our systems being overprotective, sensing danger when no danger is present or when danger is pretty unlikely. It’s like a parent not allowing their kid to go down the high slide because they’re afraid the kid will fall. But going down the slide isn’t inherently dangerous, just as moving isn’t inherently dangerous.
Most kids don’t fall off the slide, just as most movements don’t hurt. But if a kid does fall off the slide, their parent will be probably be more likely to think the slide is dangerous, despite all the dozens or hundreds of times the kid went down the slide without falling off of it before. And not even just the slide the kid fell off of, but all slides. Or maybe even the whole play structure that the slide is a part of. The kids world will become very limited because of the erroneous belief that all of this is dangerous and should be avoided.
We can learn to associate pain with movement in the same way. And in the same way, just because a certain movement causes us or has caused us pain, it doesn’t mean we can never perform that movement again, that the movement is dangerous, or that similar movements are dangerous. If a kid falls off a slide, it doesn’t mean they should can never go down a slide again. If it hurts when we move, it doesn’t mean we should never move again.
Revisiting some pain stuff
When pain is present, it’s a result of a whole lotta factors and it resides in the whole of us, not just where we feel the pain. Pain is an emergent experience that results from the rapid interpretation by our brains of a whole lot of information coming into it from our internal and external environments that there may be a credible threat.
So the pain experience is not dependent on just the state of our tissues, on our muscles and bones and joints and skeleton, our pain is not even located where we feel the pain, rather our pain is an interpretation of information from all facets of our lives, including our nervous systems, our thoughts, our beliefs, our feelings, our fears, our relationships, our stress levels, our sleep, our language, our fitness levels, our diet, our hormones, our immune systems…our everything.
To recap, pain isn’t a thing that can be found in our tissues. We don’t have pain sensors or pain receptors or a pain factory. Pain is an experience, dependent on our internal and external contexts, and even when there is tissue damage (an internal context), that’s not where the pain is.
That’s a good thing. It means we don’t have to keep wasting time searching for a pain generator in the tissues. It means that we can change pain through a variety of entry points into the system. It means that there are lots of ways to turn down the sensitivity of the alarm system, the pain signal.
We are bioplastic beings, we’re resilient, we’re adaptable. We’re pretty freakin’ awesome.
And the truth is, most of the time, our tissues are quite alright: they’ve healed or were never damaged in the first place or are well on their way to healing themselves, which they have the amazing capacity to do. And even when our tissues are ‘normal’, there’s going to be some degeneration.
Yes, degeneration is normal, just like wrinkles and gray hairs. We’re not immortal, folks, we’re getting older every day and this is just a part of aging, it happens to all of us, and it doesn’t have to equal pain. There’s plenty of pain-free folks out there with all sorts of degeneration.
So the state of our tissues are only one of the many factors that goes into pain. Our behaviors and thoughts are equally powerful factors, too. An example of this is when someone bends over and experiences back pain and they come to think of bending over as dangerous, despite all the hundreds of times they’d bent over before that one incident with no pain at all. Sometimes there is some tissue damage associated with the pain, but most of the time there isn’t. And even if there is tissue damage, it will heal up to the greatest extent it can relatively quickly, all on it’s own.
The human body is pretty bitchin’
But even knowing all of that, sometimes long after the bending incident that led to pain occurs, and long after any tissue damage that may have occurred heals, those associated thoughts and behaviors related to the painful incident can stick around. And those thoughts and behaviors may lead the person to try and avoid bending because they (or their alarm systems, anyway) think it may be dangerous. They worry that bending over will lead to damage to the tissues or to pain or to disability.
Avoiding movement, shrinking our movement repertoire
When we start to think like this, when we start to associate a particular movement with hurt or pain, it can lead us to avoid that movement and other movements like it. And when we avoid certain movements, when we take them out of our repertoire, we become unable to do them very well and we become more likely to experience pain with them. It’s a vicious cycle! (But one we can change.)
When our muscles and nerves and brains aren’t practicing those movements anymore, those movements we used to be able to do effortlessly and without pain begin to lose their strength and efficiency. We eventually forget how to do them because we’re out of practice. And the more we avoid a movement, or movements like it, the better we get at having pain with those movements when we do them, the more we learn to be in pain with that motion.
On the flipside, the more we keep performing a movement that causes pain, ignoring the pain and pushing through it, the more pain we will have with that movement, too. I’ll talk about that in future posts but the takeaway is that we all benefit from expanding our movement repertoire, moving in a variety of ways rather than moving in the same ways over and over again.
Our bodies and minds thrive on novel stimuli, novel situations, novel movement. That’s how we learn, grow, and develop.
When we avoid movements for a long time, like bending over, it can create a sort of self-fulfilling prophecy. When we do have to bend over for some reason, and day-to-day living usually means we’ll be bending over at some point in time, our back will be much more likely to hurt when we do so because we’re no longer accustomed to it; we’ve stopped practicing it, so we’ve lost some skill, strength, and ability to do it without hurt. But remember, hurt doesn’t equal harm.
Let’s get practical 
It’s really, really hard to avoid day-to-day movements like bending or stepping or squatting or getting up from a chair or going down to the floor or reaching overhead or twisting or lifting something up or carrying something from the car to the house or walking or climbing stairs (who wouldn’t want to climb these stairs – they ascend to the top of the world! Well, to 12,005 feet along the Trail Ridge Road in Rocky Mountain National Park, anyway).
And that’s just stuff we have to do to get by, to function day-to-day, it doesn’t even include all the movements we may want to do like our hobbies or sports or activities.
If we try to keep our back or neck or knee still to ‘protect it’, what happens when it can’t be still? All our joints are involved in pretty much any movement we make, all the live-long day, so we gotta keep them lubed and ready (motion is lotion!), not still and ‘protected’.
When we avoid certain movements, we start to lose our movement variability, our ability to move in lots of different ways and in lots of different contexts. We can’t bend over anymore, or we can’t twist or sit or squat or step off a curb – there are a whole lot of can’ts, a whole lot of danger signals, when there is no real danger present. A whole lot of limitations.
The bottom line is that actively avoiding any or all of these movements is not very good strategy for managing or overcoming pain, just as always moving in the same ways and in the same environments is not a very good strategy for managing or overcoming pain.
So what is a good strategy?
Check in for the upcoming posts. I’m trying to break this up into manageable pieces!
The gist is that we’ll all have our own ranges, our own unique repertoire of what we can do, but if we can do what we can the best that we can do it, we’re golden. And if we continue to find and nudge our limits by introducing new movements and practicing and getting better at those and then introducing yet more, we’re well on our way to a life without limits. We’ll be able to continually expand our movement repertoire, and therefore our world, a bit more.
We’ll get to engage in and interact with the world in ways we enjoy. And this is true whether we’re on two legs or one, or if we’re on two wheels. It is true across the spectrum of movement abilities, from sedentary folks to elite athletes. We all have room for growth, for better.
Coming up…
In the next post, I’ll be talking more about the importance of movement variability for changing pain and in the post after that I’ll write about some of the ways I’ve expanded my own movement repertoire a bit. It’s a balance – it’s about finding our outer reaches and doing the work there while continually nudging that edge a bit farther out. It’s about exploring and expanding our world little by little without going over the edge. (read and watch some of Cory Blickenstaff’s work for more on this kind of idea).
I’ll also be posting about expanding our world a bit through a whole bunch of other means, from creativity and hobbies to travel and micro-adventures to communication and self-expression. (for more on the importance of self-expression, and of therapists listening to patients regardless of their specialty, check out this awesome post by Eric Kruger.)
And if you missed part 1, check it out here.
Who knows, maybe I’m nuts. I’d love to hear what you think.
See! Bigger worlds are better! The more ways we can move, the more we can see and do.
As always, thanks for reading my post, folks! If you have made it this far and if you like what you read or think someone else will like it, please share it! And if you want even more, sign up for the monthly(ish) newsletter that always contains an essay not posted on the blog as well as links to interesting stuff I’ve been reading. Oh, and recipes. I love food. Maybe I’ll do a post on expanding our worlds through food, too :)
Until next time, keep moving!
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