Understanding Pain
Pain as a message and how bodywork can help
In a way, having pain is a good thing. Pain is not fun to experience, but you need to understand that pain is a signal/message indicating that something needs help in your body. It tells you that your body needs some assistance to reach normal equilibrium again. When equilibrium is reached, the pain normally leaves your body naturally. So pain is actually a good thing because it tells you that something is wrong, and that you need to take action to fix it.
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Most causes of pain in the human body come from soft-tissue dysfunction. Soft-tissue dysfunctions include:
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Damaged or torn tissue
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Tissue that is stuck together (i.e. adhesions, knots, restrictions, or pattern)
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Tissue that is contracted and cannot lengthen normally
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Inflamed tissue
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Ischemic tissue (i.e. lacking proper nutrition and blood flow)
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Atrophied tissue (i.e. tissue that has wasted away or shrunk)
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Tissue with trigger points or tender points
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Tissue that is compressed by other structures
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Nerve compression/entrapment
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and of course Posture and Alignment issues
In all of these cases, if you can correct what is wrong, the pain will go away.
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Current medical philosophy seems to prescribe pain-killers as the main form of relief from pain. Taking pain-killers are good for blocking out the pain signals. Unfortunately, pain-killers usually do nothing to eliminate the source of the issue... that which is causing the pain signals to be sent in the first place. Unless you eliminate the source of pain, pain will continue and further damage may occur.
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The other option usually presented by doctors is surgery. In the case of a torn tendon or ligament, surgery is usually the correct answer... but for cases where tissue is stuck, inflamed, or contracted, surgery is different than the best option. All surgery creates scar tissue, and scar tissue usually shrinks as it matures, pulling on all the structures around it. This can potentially cause a re-occurrence of the original problem, or possibly a new problem. If there is an alternative to surgery, or a non-invasive way to treat your soft-tissue problem, then it is usually the better solution. Thankfully soft tissue responds very well to manual manipulation as provided in a session.
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Pain also has interesting phenomena that occur if it goes unchecked. These phenomena are explained by Pfluger's (5) Laws - which basically state... As a sensory nerve is stimulated in an irritating manner, then irritation and pain will start at the area of stimulation. Given enough time with the irritating stimulation, more of the nervous system becomes involved, which can spread irritation/pain not only to the other side of the body, but can lead to irritation/pain all over the body. In other words... If a nerve has been irritated for long enough, then the pain could start to spread throughout the whole body.
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Treatment massage/Structural Integration works because the focus is on locating and eliminating the source of pain while treating your body as a system. This is accomplished by:
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Restoring proper circulation to and from the tissue
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Removing restrictions from the soft-tissue
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Lengthening and expanding tissue that is contracted
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Reducing/eliminating trigger points and tender points
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Reducing compression by other structures
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Freeing up the structures that cause nerve compression/entrapment
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Restoring balance to the physical body
The Pain Cycle
The body's pain cycle is an interesting one, but is also fundamental to understanding what is occurring in our own bodies.
When tissue gets damaged, inflammation typically occurs and the fascia also responds. When inflammation occurs, the increase of blood flow to the damaged area brings in the various cells and materials for repair. In addition, the swelling caused by the inflammation could creates more pressure in the area, which can stimulate the pressure sensitive nerves sending signals to the brain. The signals are usually interpreted as pain. This is all very normal, and in many cases the situation stops there since the area gets repaired and the inflammation goes away.
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The fascia responds in some interesting ways. Fascia is a protective barrier, and typically creates "pattern" (i.e. restrictions) which are held connections/compression of the tissue in cases of physical trauma. Fascia also helps to create our structure, which alters with each physical trauma.
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Fascia has an interesting protective mechanism. In some cases, the pain sensation is so strong that the surrounding tissue acts to protect the damaged area from any further damage. The surrounding tissue protects the damaged area by clamping down and creating a wall preventing movement in the area of the damaged tissue.
In the short term, this "muscle splinting" is a helpful action. In a longer term scenario, splinting becomes a problem since the area that is clamped down to protect ends up getting irritated and possibly inflamed by being protective for so long. So the protecting area starts the pain cycle anew, and the irritated and injured area continues to grow. This is called a positive feedback loop, where the process continues to grow. As the injured area and the associated pain continues, more of the nervous system becomes involved and the pain can spread further out in the body. Usually pain will spread from the local tissue into neighboring tissue, then further along the limb or trunk. Eventually it spreads to the opposite side of the body, and then further up and down the body. In some of the most severe cases, the pain has spread through the whole body and limits the person's daily activities.
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The way to prevent the pain cycle from growing or continuing is to provide outside stimulus aimed at reducing the originally injured and restricted tissue: which reduces the restriction, the inflammation and also pain.
Moving or Migrating Pain
One of the topics that generally becomes part of the conversation I have with my clients relates to the way that pain moves or migrates from one area to another, and sometimes back again after it has gone away for a while. Why does this happen and what is going on? To understand that, we need to understand some fundamentals about pain.
There are many different things which ultimately cause pain, but a few of the most common are pressure, congestion/inflammation, and restriction. These main three all act in similar ways in regard to how we perceive the pain caused by them, since pain is an interpretation in the brain of signals coming from the affected areas in the body. The key thing to note here is that the brain acts like a computer to process the signals coming in. If the signal never reaches the brain for interpretation, then you don't experience pain. This is the mechanism for most pain-relief drugs.
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While the brain interprets the signals, it uses a few basic rules to determine what our experience is. These rules are loosely translated into the following:
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If the signal strength (from the affected area) is greater than threshold amount "x", the signal provides an indicator (physical sensation) that something is wrong.
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If the signal strength increases above threshold amount "y", modify the indicator sensation into pain. (The threshold level of "y" indicates the threshold for the creation of pain.)
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If multiple signals come in at the same time, you become more aware of the strongest signal (and the other signals tend to be experienced less).
As a generalized experience, people first notice problems in the body manifesting as a twinge, a little stiffness, or a bit of temporary soreness, etc. This is the first rule in action. There is a problem, but it is a low level problem at this point, and so your body is making you aware of the issue. Most of us notice the indicating symptom, but quickly ignore it. "Oh, it's just a little sore... it will go away on its own." Sometimes it does, and sometimes it does not.
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As the problem persists and progresses, the signal strength increases. Once the signal strength increases over a magical threshold, we experience real pain (rule two in action). It can be annoying low level constant pain, sharp pain, or anything in between. The threshold level is the key to what we experience. If the signal strength is over the specified level, there is pain. If it is lower, there is no pain. This explains why some pain "magically" goes away (since the signal strength has decreased under the threshold level).
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This is a very simplistic, but a reasonably accurate explanation of our experience regarding pains that come and go over a period of time (whether it is hours, days, or even years). Just because a pain "goes away," doesn't mean that the problem is gone... it can still exist, but at a level that is below that threshold which causes you pain. The signaling is like a light switch... on or off depending on if the specific threshold level is met.
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If you have multiple areas of pain, then usually you will notice only the worst one. You can think of this as the squeaky wheel scenario. The worst pain is noticed until its level decreases so that it is now less than the level of the second worst pain. When that happens, the previous worst pain becomes the second worst pain and the previous second worst is now (in our awareness as) the current worst pain. Since we typically notice or feel the worst pain area, when they "change ranks" we also perceive a shift in the location of pain. "My neck stopped hurting, but now my shoulder hurts." These forces are in constant flux and can easily change back. "My neck started hurting again, but my shoulder isn't so bad any more."
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As a massage therapist and structural integrator, I know this can be confusing to understand. I'm sure if you think back to your history of dealing with pain, these loose interpretations of the body's rules will make sense. If you interpret things differently, I'd love to hear about it. This information comes out of my practice working over many years with many different clients.
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In addition to me rattling on, and hopefully providing you with useful information on what you experience, I want to leave you with one important message: If you get an indicator sensation that something is wrong, take action to avoid it developing into a real pain situation. It is far easier to eliminate small issues, than it is to eliminate issues that have entrenched themselves into your body. Recognize the little sensations of your body informing you something is starting to become an issue. Take action by getting professional help.
Aging and Pain
Some parts of the process of aging are greatly misunderstood (in my opinion). Some of the common questions I get from clients are:
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Isn't pain just a part of growing old?
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Can lean muscle tissue be built as we get older?
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Doesn't everyone get less flexible as they age?
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Why have I shrunk in height?
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On and on similar questions go... but these typify the current mindset. Let us develop a new frame of reference, a new option, and possibly new hope.
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As we get older certain things do happen which create a significant change in our body's ability to cope with stress, change, and physical trauma. By and large, the biggest factor is our attitude and mental outlook. If our outlook and feelings are less positive, we are likely to have a unpleasant time and our body will follow suit. If we have a more positive outlook, we are more likely to have better posture and take healthy actions, thoughts and feelings. If we feel this way, being positive, we can take corrective action to stretch out our bodies for more comfort.
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The second largest factor is that our body's remodeling, recycling, and repairing mechanisms all slow down (or work less efficiently). They stay functioning, just slower. So healing from a broken bone (i.e. a fracture) takes longer, six months instead of two months. Building lean muscle happens, but takes more consistent effort over a longer period of time to achieve the same result in our sixties/seventies as it would in our twenties.
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Restrictions (areas where tissue is stuck down, thick, non-stretchy, or just doesn't move properly) are the cause of many problems in our (young or old) bodies. Restrictions are the result of trauma/injury, poor posture, over-use, or even non-use of our bodies. It is also very rare for someone to be free of all restrictions. Restrictions are the result of living in these physical bodies, and they tend to slowly accumulate. Many of them get worked out naturally by how we move and use our bodies... but some of them settle in for the long haul.
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The restrictions that want to stay in the body for long periods of time are typically the ones that give us trouble as we get older. Since restrictions tend to accumulate, the areas of thickness grow in size and our ability to move decreases or takes more effort. These changes happen over long periods of time and cause pain, stiffness, and poor posture. But you can choose not to accept this fate for yourself. You can choose to move and be pain free as you grow older.
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How you may ask? By effort and determination. The best thing to prevent restrictions from building up is to move your body through its available range of motion. The more you move in a particular direction, the easier that direction will become over time. Do that movement enough and your body remodels to make that movement even easier. If you constantly explore the available motion in your body, you will keep all that motion. If you explore the edges of your restrictions, you will slowly increase the space before the boundary occurs and you will gain more available motion. This works at any age, but the changes are far easier when you are young.
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So whatever age you happen to be, demand more motion from your body and over time you will be rewarded by easier movement, less pain, and greater mobility. Be consistent and diligent in your efforts, and your effort will pay off.