Pain? "Don't be sad, be a detective!"

An old teacher of mine, Andrew Pacho, said that to me and a friend years ago and I will always remember it…

There's Pain. What do you do?

Last week, I posted on facebook that I was sourcing information on how people navigate pain. I was curious if amongst a variety of responders, there might be any common protocols people took. I got responses from professional and recreational circus artists, runners, somatic practitioners, and a theme did in fact emerge: the more people had invested time into understanding basic body mechanics and combined that with honing their somatic listening skills, the more effectively they could strategize how to navigate pain.  

Since being embodied enough to decipher the body's signals is a skill, and a mental one at that, not many people develop it without practice. I found it interesting that my facebook friends who responded referencing experiences of overcoming multiple injuries, had the most refined approach to pain navigation. They had learned through experience what kinds of protocols might be necessary for what kinds of sensations.

In contrast, for the majority of people with whom I've spoken who don't test their body's thresholds often, who have less experience recovering from pain, have a much more general and less successful protocol. For them: a part of the body hurts. They will likely hope that if they take some ibuprofen and see a professional bodyworker (massage therapist, acupuncturist, etc), that the professional will fix them and the pain will be over and they can go on with their lives as they did before. While this may have temporary benefit, it is an incomplete strategy.

Why? Why are people who have overcome more injuries arguably "better" at recovering?

Essentially training is teaching the nervous system to be more sensitive to feedback and sensation so that the body can do more complex and challenging movements. This also results in a deeper sensitivity to when movement is NOT working. People who challenge their bodies, feel dysfunction, treat it and improve it, are not only healing their tissue in that process. They are retraining how they move by retraining how they think about and feel for proper movement.

Being a "detective" as Pacho would say takes time and practice. Here a few distinct steps that I think are helpful for successful detecting:

1) Get a baseline of knowledge : Take some time to gain a basic practical understanding of physiology. What does healthy movement look like? Do you look like that? Can you understand why you do or you don't? What are the names for parts of the body that you use the most? What injuries are associated with the activities you like to do? How do those happen? Learning these things on an intellectual level will give you a reference point if and when you need bodywork or physical therapy. You will have the vocabulary with which to speak to doctors or therapists about your symptoms and findings.

2) Follow the clues: Example, I am aerialist with a pretty good understanding of anatomy and physiology. I have some neck stiffness and wrist pain right now from overuse on rope recently. Even though my neck is where there is a lot of tightness and the wrist is sensitive, I also can see and feel that my right arm isn't rotating properly in the socket overhead. I know intellectually that the rotator cuff stabilizes the ball of the humerus in the shoulder socket in different ranges of shoulder positioning. Knowing this, I tested rotating my arm in various positions of flexion (working towards overhead position). I discovered my arm barely rotated! When I successfully could manage to externally rotate my arm slightly- with a lot of focus - the wrist pain subsided. Now I know it isn't only a neck problem or a wrist problem. This will be useful information when I see my PT, and when I approach rehab. 

3) Get help from the outside: Fortunately, there are professionals who can put us on the right track. A skilled manual therapist can provide an intervention to a spasming muscle. That is an important part of the recovery process. Having an outside eye asses our movement and offer rehab suggestions is also essential. Unfortunately there isn't much consistency in the PT world in terms of treatment approaches. Finding a physio who understands your needs can take some trial and error. But more informed you are, the more you will know how to discern if the physio's approach is right for you. 

4) Don't stop there: The most important step in rehab is learning what to tell your body to do instead of whatever you were telling it that caused injury or inflammation. This is that training your nervous system piece. Learning how to coordinate your thinking with your movement is a never-ending process. There are two sides to this: the first is simply recognizing how mindful you are when you move. Do you think about how you tell yourself to do a push-up or do you just kinda do it? The more specific your mind is, the more specific your movement will be. The second step is recognizing what kinds of thinking bring out the most effective movement patterns in your body. *Hint* thinking in terms of individual muscles isn't all that helpful. Thinking in terms of actions and tasks is often helpful. Example for isolating hip extension: Instead of "lay on your belly squeeze your butt and your hamstrings off the floor"  try "laying on the belly without arching the back, keep both hip bones on the floor. Then draw the knees towards the midline. Imagine you have a glass of wine on your thigh bone while you lift the entire thigh to the ceiling, and don't spill the wine." See which one teaches helps you find a deeper, more specific body position and muscle engagement in hip extension.

5) Tune in more:  Christine Wright, a legend amongst New York City dancers, talks about the importance of transitioning from being in our (perhaps default) verbal, hyper-intellectual states to being a more physically-driven "animal state" of feeling when we go to train. The more tuned in we are to force on our bodies and sensation within them, the more likely we are to properly interpret those signals to change our movement habits into healthier ones. Make sure you take a a few moments to pause, breathe, listen to the sounds around you, feel the floor beneath you etc at the beginning of your rehab sessions so that your mind can adjust its focus. It's a little meditation - or mind training session- that will help you get so much more out of the work. I work on this vigorously with my students and clients. Training our bodies is also training how we think in our bodies.

Moral of the Story:

Approaching pain, discomfort or injury is a subjective experience, and an outside person alone can't help you for good. Real physiological adaptation takes committed work by you over time. The good news, is that the process IS learnable. Get as much help as you need. Get hands on intervention. Get coaching to learn new approaches to movement.

Remember it is an ongoing process, and enjoy it.

 

Special thanks to Emily Rubin SPT once again for edits! Thanks also to Andrew Pacho for that wise detective insight, Christine Wright for inspiring information in the Fundamentals workshops, and all the folks on facebook who offered insights for this post!

Next week: Making the most of your Training Time