About pain. Information from Steven Clarke Physiotherapy
Pain can be the result of many different causes. In my field of health expertise most people are either referred (by doctors and other health professionals) to a physio like me, or their pain will drive them to seek treatment themselves. For most of these individuals the cause of their pain will be the result of:
Trauma (eg a fall, accident or sporting incident). Obviously this is not age dependent, but the older we are the more likely we are to suffer a fall, for example, and sustain greater injury as a result (thanks to loss of bone density and muscle padding and our increasing likelihood of physical disorders associated with living longer). In the elderly, not all falls have a resulting physical injury, but 100% will have a psychological impact. That affects confidence, which can lead to loss of fitness; due to anxiety, older people will avoid activity.
Surgery This could be non-elective, where you’ve, say, fallen and broken a hip, which has needed surgery, or sports injury (football, skiing etc). Or it could be pain from surgery you’ve chosen to have (aka elective surgery), eg lumbar spine decompression or total knee replacement.
Disuse/loss of fitness Lack of movement can lead to:
Weakened muscles, stiff joints
Poor balance
Less endurance in walking activities
These in turn can reduce your confidence and cause you to worry about further falls and injury. That can result in avoidance of activity and loss of fitness. And so the cycle goes on. Elderly people are particularly vulnerable to this set of circumstances because, as we get older, we naturally become less active. As children we seem to have limitless energy, and play with friends and do sports at school. After school years we start work, and do less sports & play. We learn to drive and so do less walking, cycling, etc. Then we may have families, work longer hours and give more of our own time to family commitments. Giving less time to our own fitness, we become progressively more sedentary.
Keep moving to keep moving…
The reason children seem to have unlimited energy is partly because they are very active. The less we do the less energy reserves we have, and the less we can do and want to do. Lack of physical activity is a huge contributor to premature ageing and illness.
…and to avoid injury
Apart from falls, if muscles or joints are not as strong as they should be to allow certain activities (due to disuse / loss of fitness), then those structures may be strained as a result of unaccustomed activity. For example, if you went to the airport with a 30kg suitcase for your once yearly vacation, and never lifted 30kgs weight on any other occasion, then you may be more prone to injury as a result. If, however, you went to the gym regularly and lifted this or heavier weights then you are less likely to sustain injury on the way to the airport. Again, because most people do less with ageing then we are more prone to these kind of problems.
Pain explained
The brain always considers pain to be a sign of damage to our bodies. We are programmed to try and avoid causing ourselves pain. This fact is particularly helpful right after a trauma; it enables us to understand our injured tissues need to rest and repair. That’s why we avoid movement of affected joints after injury (eg not moving the neck after a whiplash injury). However, if we don’t start to move these joints at the appropriate time, then all the disuse problems described above (joint stiffness, muscle weakness, etc) start to become a problem. Healing is a painful process, as is moving stiff joints and activating weak muscles. Unfortunately the brain doesn’t know the difference between tissue damage pain and healing pain. Therefore, people are understandably reluctant to move. Then, long after healing of the damaged tissues has finished, they still suffer pain due to disuse & sub-optimal tissue repair, and think it is still due to the original trauma. (Pain that does not resolve in the expected time frames is called ‘chronic pain’.) Movement is key to good healing after trauma (and surgery) as it guides the healing process and formation of scar tissue to give the optimum healing affect. It’s one of the physiotherapist’s jobs to guide the patient through this process.
Pain is a perception
You cannot measure pain objectively. The analogy I use is ‘a sense of humour’ which is also a perception. It is not possible to state objectively that Bob Hope was 8/10 on the humour scale but Robin Williams was 6/10. Pain will be perceived differently in different situations, as is humour. For example, if I tell you a joke and your cat had just died, you might be offended. However, you may consider the same joke to be hilarious if I told you after you just found out you won the lottery. Pain is the same: if we are in a low mood or feel stressed then we will perceive our pain to be greater. If we are in high spirits the pain perception will be less.
Good news for chronic pain sufferers
If you suffer from chronic pain, cardio-vascular exercise (fitness activities) will reduce stress and improve your mood. It will also boost strength and your belief that you can achieve your goals. All of which reduces your pain perception.
My physiotherapy uses various strategies to treat chronic pain sufferers and those patients who are unwilling to be active early after trauma (because they fear their healing pain is tissue damage).
My strategies include:
Pacing and postural correction
Postural exercises
Education
Reassurance
Contact Steven Clarke about reducing pain with physiotherapy in your home