I recently wrote about how my thoughts on movement have changed over the past couple of years (part 1 and 2), but I thought I’d delve a bit more into the evolution of those thoughts and why I posted them, why I think that our emphasis needs to shift a bit from the overly formulaic and prescribed movement to exploring enjoyable movement and embracing intrinsic movement if we are to really get over the fear of movement that often accompanies pain.
We now know that pain can persist long after an injury heals and the tissues have been repaired as much as possible. We also know now that pain can exist in the absence of any sort of underlying tissue damage at all. So pain does not equal tissue damage, the state of the tissues is only one of the many bits of information that are processed by our brains and bodies.
Our stress levels, our physical movement, our relationships, our attitudes, our beliefs, our expectations, our culture, our interactions with the medical professions, our googling our symptoms, our fears and worries and anxieties are other bits of information that are processed by our brains and bodies and can contribute to an experience of pain if, through all of that information processing, our brain and body thinks we are in some sort of danger or potential danger and we need protecting.
Pain is an alarm, an emergent, conscious experience, not a sense
See, pain is protective, it’s trying to help us. It’s an alarm system telling us something is up, one or more of those man bits of information that are coming into the system are causing the system to send out the pain alarm to get us to take notice.
But sometimes the alarm system becomes super sensitive, especially if pain has been around for a while, and it thinks we’re in danger and need protecting when we’re not, when we’re in fact safe and healed and ready to get on with it. Or sometimes it gets the messages mixed up and sets off the alarm for no detectable reason at all. With persistent pain, it’s usually a problem with the alarm system that needs to get set right, not a problem in the tissues.
My alarm system became wonky after an injury, so I did at one time have some tissue damage. I experienced an acute injury to my right hip at work just over five years ago that was eventually surgically repaired. During that time, I started to move differently because of the pain, I started to worry about the pain and what it meant for my future, I started to avoid some movements all together out of fear of making the pain worse, I became more isolated and withdrawn, I was full of doubts and confusion and uncertainty.
All I could think about was the pain, it usurped all of my attention, all of my capacity for doing simple tasks, my ability to make the simplest of decisions, it sapped my energy, my joie de vive.
About 13 months after my initial injury, 13 months of my alarm system becoming more and more sensitive not just because there was a bit of tissue damage but also because of all those other thoughts and feelings that were contributing to my brain and body’s sense that it needed to protect me, I had surgery. A surgery that I’m not so sure I needed now, I wish I would have worked on all those other factors first (but I didn’t know about them back then).
Why? Because although my hip joint was repaired and my surgery was ‘successful’, successful in the sense that the tissues healed, the anatomy looked good, and I had great range of motion and strength in the joint, I still had pain. Lots of it. Long after surgery, long after I was healed.
And I was worried about. Very worried.
Although surgery and rehab had restored the range of motion and function in my hip and the most debilitating pain was resolved (I wonder now if that might have happened without surgery?), I still had pretty significant pain in the area of my sacroiliac joint which would sometimes creep up into my low back or radiate into the groin and down my leg, where I’d experience bouts of troublesome numbness and tingling.
And I still had pain-flare ups that could drop me, that still drop me, though less frequently now than before (and now I don’t freak out!).
And I was scared.
Fear of Movement
I used to be terrified of this pain, because I thought that it meant I was damaging my hip again. I thought that pain meant injury. So I thought if I moved and felt pain, I was injuring myself.
I began to fear I wasn’t moving properly, or sitting properly, or sleeping properly. It didn’t so much stem from a fear of the pain itself, I can deal with the pain, it was the stress and worry about what the pain meant that did me in. I was terrified of not moving in a biomechanically sound way. I was always so obsessed with my hip position, my spine position, how my joints were stacked that I was always always always thinking about it.
How am I sitting? How am I standing? How am I walking? What can I do to make it better?
When we are told that our postures are causing us pain and that our movement patterns are dysfunctional, it messes with our heads and can make us focus too much on trying to create perfect movement rather than just focus on creating natural movement.
I really thought I was doing everything right. I was diligent in my therapy, I thought I was avoiding protective and guarding responses through a hyper-awareness of my body position. But I’ve since learned that when we’re in pain, our propioception and interoception (our sense of where our body is in space, how it’s positioned, how it’s moving, etc. and our sense of our inner-workings, the stuff going on inside our bodies, respectively) gets skewed when the pain doesn’t go away.
So the body signals we’re interpreting aren’t always accurate. So rather than changing my postures and movement based on good information, I was actually trying to change my movement based on the misinterpretations, as well as misinformation that there is a universally ideal way to move.
There is no perfect movement or perfect posture. By nature, we are variable beings who have variable bodies that are really good at adapting to the demands of the environment around us and the activities we wish to engage in.
I used to obsess over my posture and every move I made, for fear that any thing I did “wrong” was going to exacerbate my pain and prolong my recovery. But it was the fear of moving wrong that exacerbated my pain, it was the fear of movement that prolonged my recovery.
Pain doesn’t mean damage for most chronic non-specific pains
Once I understood that that I wasn’t doing damage to my body, even though it hurt, it was life-changing.
Once I understood that one little “wrong” movement wasn’t going to undo the months (years!) of physical therapy, it was life-changing.
Once I understood that we are all asymmetrical beings with all kinds of different movement patterns, and that that is not only normal, it’s beneficial, it was life-changing.
Once I understood that pain does not equal damage, it freed my mind from the constant stress and worry, allowing me to actually start managing the pain and moving on with life.
Once I got over my fear, I was able to let go of the need to always control my posture and “protect” my hip by not moving it. In letting go of that need to control and protect, I started moving again without thinking about it all the damn time. And I started moving in all kinds of ways.
Easing into movement, getting over fear
Now I’m not saying go full bore and start cranking on the hurt body part, pushing through pain doesn’t help us overcome pain any better than avoiding movement to avoid pain. It’s important to ease into movement, to focus on natural movements, and to just do things that you enjoy, to move in ways that your body wants to move.
We often don’t listen to our bodies when we’re in pain, understandably so. Our pain shuts down our ability to do that, oftentimes, all we feel is pain and we no longer think of our body as a whole, we only think about the part that hurts. It makes us fearful of moving for fear that it will hurt. It distorts our mental map of our body, it distorts our propioception and interoception and feeds our processing systems with bad information, which feeds into our pain cycle and makes it worse.
Take some time to figure out what works for you
So we have to take the time to sit with our bodies and figure them out a bit. The whole thing, not just where it hurts. We have to figure out what movements we’re good at, which movements we tend to do over and over again, and what movements we’re not so good at, what movements we avoid. We have to find that edge of pain and hang out there for a minute to explore it, to feel comfortable there, and then to nudge it a little bit.
I had a great fear of hopping or jumping on my right leg. So for a long time, I just stood on that leg and thought about hopping. It took a long time for me to make the leap, which was giant in my mind but was in actuality a couple centimeters. But the victory wasn’t in the height of the hop, it was in the clearing the mental hurdle that had prevented me from hopping for so long.
Moving from avoidance to engagement
We all avoid some movement when we’re in pain, it’s natural. We avoid bending with back pain, avoid turning our head with neck pain, avoid stairs with knee pain. But bending, turning, climbing, these things aren’t causing our pain, we just associate them with pain.
And we cannot avoid these things, anyway, they’re a part of everyday life. So it behooves us to stop trying to avoid them (unless were in the midst of an acute injury that needs some time to heal), which we’ll never be able to do anyway, and to get better at doing them. To ease back into doing them and practice them. To get our bodies, ourselves, moving again in all sorts of ways, in all sorts of contexts, with confidence and capability.
And movement doesn’t have to be a physical therapy or gym session, it doesn’t have to be ‘exercise’. Movement can and should be enjoyable, something we look forward to, something we want to do. It needs to be something we do A LOT, so we might as well move in the ways we want to. There can be structure and planning, but there should be play, too.
Movement is walking, playing catch, practicing yoga, training in the martial arts, dancing, golfing, swimming, boarding, snowshoeing, hiking, boxing, skiing, climbing, taking pictures, geocaching, hopping, skipping, jumping, running, having sex, playing sports, crawling around on the ground, cooking, painting, lifting, carrying stuff, stretching, doing pilates, biking, going from sitting to standing and back again, twisting, twirling, turning, bending, kicking, throwing, kayaking, paddling, peddling, exploring, wandering, playing.
Movement includes doing stuff that we just plain enjoy, that feels good, that makes us feel warm and flushed, invigorated and energized, active and happy. Remember that feeling?
Motion is lotion..
It’s just moving. Getting better at what were not so good at, at the things we want to do. Getting out of our old habits that once served to protect us but that are no longer serving us, getting over our fears.
What is important is that we pay attention to the whole body, not just the painful part, that we move the whole body through full ranges of natural and necessary motions. When we’re in pain, the body part that is in pain tends to steal all of our attention and become our sole focus. We forget that’s it a part of a whole, complex system that all works together to get us from A to B, to complete our chores or work tasks, to sing, to dance, to play, to eat, drink and be merry.
To get all the parts moving again and to regain confidence in moving in the areas that are of the most concern to us, the part that hurts, is a life changer. It removes limitations and allows us to engage in the world again. It allows us to live life now, without waiting for the pain to be gone. It allows us to pursue what matters to us, even if we have pain.
This doesn’t mean push through pain, but we can nudge it
I’m also not saying just push through the pain. Pain is a signal, not of damage, more of a “whoa – this isn’t good for me right now, let’s do something different”.
But I am saying we can nudge the pain a little bit.
One of the greatest contributors to my chronic pain was a fear of moving “wrong“. But it was not moving “wrong” that caused or prolonged my pain; it was the not moving that took place as a result of it that did. The guarded movement that took place as tried to “protect” my hip by keeping it locked into a “safe position” so as not to do damage.
But that’s not how our bodies work, our bodies are meant to move in all kinds of ways and in all kinds of situations. Our bodies love to move.
Preventing my hip from moving exacerbated and prolonged my pain. It wasn’t until I understood that I didn’t need to fear movement, that one little “wrong” move wasn’t going to cause me damage or set me back, that I was able to begin to overcome my pain. That I was able to move, to explore movement, to try out different movements, to really start paying attention to my body, not just my hip, when I was moving.
The only correct posture is moving through lots of postures!
To move through a variety of postures all day long without worrying about if they were ‘correct’ or right. There is no correct or right, any sustained posture, no matter how perfect, is going to cause some discomfort or pain, even when we don’t have a pain condition.
When I finally realized this I was finally able to walk, sit, and move without fear and without overthinking everything. I was able to move without worrying about it so damn much. It allowed me to accept that pain was still here but that it didn’t mean I was damaged, that I could still move and be active and engage in life, that my movement may not be the same now as it was before my injury, but so what? I also have a few more gray hairs and wrinkles, some of these changes are just a part of agin.
These realizations also meant that my pain levels improved dramatically. And my engagement with life and play and activity improved dramatically.
My health and happiness improved dramatically.
Just keep moving
I am trying to flip the script for everyone in pain from one of viewing movement with fear and trepidation to one of recognizing the positive role that movement plays in our rehabilitation, our health, and our happiness.
Our bodies are designed to move. All of our parts are designed to move, even the ones we’re worried about, the ones that cause us pain.
It will take some careful nudging and easing into movement in those areas we have been trying to protect.
It will take work.
It will take time.
It will take exploration and creativity and discovery.
But our stories can change, we are the narrator after all.
We can take comfort in knowing that we are not weak, fragile, and breakable; that we are not damaged goods. We empower ourselves, our stories, by recognizing that our bodies are resilient, adaptable, and capable and that they thrive when they move. That our brains and organs and systems and muscles and joints thrive when we move. That our attitudes, mindsets, thoughts, moods, emotions, awareness, and outlook improves when we move.
That our lives thrive when we move, when we overcome fear and despair, when we embrace our current self, pain and all.
It will take time, persistence, consistency. It takes some self-reflection, some mindfulness, some increased awareness. It takes the acceptance that the best solutions lie within us, not in a pill or a surgery or a particular type of therapy or doctor. It takes commitment to doing the things we find that help us with our pain and reducing the things that flare up our pain.
It takes work, hard work, but it’s worth it. And we’re going to get there, folks. One step at a time.
As always, thank you for taking the time to read my post. I’m trying to be more brief but I find I have so much to say that conciseness fails me. I’m sure I’ll get better as I write more. It doesn’t help that I’m also in the midst of writing my book (yay!) so my mind is crammed with every thought I’ve ever had in order to try and get it down in some cohesive format that people will actually be able to (and want to!) read.
And I’d love to hear from you; feel free to send me an email via the contact form or add a comment below. Or if you prefer social media, connect with me on Facebook or Instagram (I’m on Twitter, too, but I’m not so good with the tweeting thing). I
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The kayaking picture of me, my mom, my brother, and his girlfriend by the marvelous Ms. Michele Klaver in Interlochen, MI, my homestate.
The bottom pic is my own, taken in my home away from home a week ago, Fraser/Winter Park, Colorado.