Persistent Pain Recovery Part One — Movement and Trust
My second walk/run on April 28th 2024, Gibsons Beach coastal trail with both dogs and Olly. Our whole pack! I was sooooo joyful! So joyful I enthusiastically abandoned all plans of Graded Exposure and paid for it the next day with a stonker of a flare up. Lesson learnt!
I’m 10 days in to my recovery journey from persistent pain. Writing is part of it, so here I go, even though I had planned to clean the bathroom! April was a breakthrough month for me. Who knows what came ever me — maybe it was fighting off a pack of nine wolves with my bare hands back in February (but that’s another story!) — but there’s been a change in me, so when I saw Greg Lehman, Clinical Educator and Physiotherapist was doing online coaching I immediately went for it! Wahooo! I’ve been following his work for years so very timely.
I developed persistent (chronic) neck pain and the accompanying deep fear of movement in Whistler 10 years ago, following a running accident shortly after my beloved Dad Pops T had died. Maybe the recent 10 year milestone also triggered in me taking a good, hard luck at my situation and how to start recovery. A truly daunting prospect after living with pain that has frequently been debilitating on some days. It’s not that I’ve ever given up. Far from it. Although some of my friends maybe think so. My conversation with Greg revealed that on the contrary, the relentless quest for answers has been a huge contributor to my system’s vigilance and over-protection. Hell, I even changed my line of work so my life revolves around improving things!
You see, persistent pain is all about protection. “Pain, first and foremost and without exception, exists to protect and preserve you.” (from The Explain Pain Handbook Protectometer p. 11). Persistent (chronic) pain is defined as pain that continues for more than three months. Unlike acute pain, persistent pain serves no biological function and continues long after the tissue has healed from injury. Importantly, persistent and acute pain are entirely different clinical entities. Acute pain is provoked by a specific injury or disease; it serves a useful biological purpose (protection) and often disappears before an injury is healed, whereas persistent pain is currently considered a disease state. It is pain that outlasts the normal time of healing. Essentially, the brain ‘learns’ pain, it becomes habit, causing unimaginable suffering for a fifth of Earth’s population. It’s like a car alarm going off for no reason; there’s no danger but the system is stuck on. It is an invisible condition that is widely misunderstood, and greatly stigmatized. It is neuroplasticity (or bioplasticity as Noigroup would say) gone awry. Many things affect our experience of pain
Example 1: Noigroup’s Lorimer Moseley is a clinical scientist that investigates pain. He tells a story of a man being admitted to ER with a nail through his boot, in excruciating pain. The removal of his boot revealed that the nail had missed his foot but gone between his toes! The excruciating pain vanished. Proof that what we see and hear provide information relevant to threat and subsequently have a strong power to affect pain.
Example 2: An identical finger injury will cause more pain in a violinist than in a dancer because finger damage poses more of a threat to a violinist (Explain Pain p. 18). What we believe and where we are affect pain.
Example 3: If a cold metal rod is placed on your hand, seeing a red light at the same time will make it hurt more than seeing a blue light at the same time. What’s more seeing the red light will make the rod feel hot (Explain Pain p. 18.). What we think affects pain, as do our emotions and things we smell, taste and touch.
Essentially, our movements, sensations, thoughts, emotions and memories all have an effect on pain. My pain levels are rising now just because I’m sat typing at my computer. My system thinks it’s dangerous to sit as I had so much fear around sitting, especially at the computer, starting in 2015. My nervous system is watching out for me, keeping me safe. Pain is the unfortunate output.
So. Pain is complex, and I will write more about it’s mechanisms in further posts, but for now, believe me when I say that living with persistent pain sucks the life out of you. It’s real and it’s exhausting. It’s invisible. Look how healthy I look in the photo! No wonder no-one gets it. We look completely OK so why aren’t we? “Have you tried…?” is such a common refrain we hear, but here’s the thing: we don’t need fixing. “Do you believe you need fixing? There’s nothing to fix,” Greg said. This can be subconscious. I knew I didn’t need fixing from all I’d learnt and had read (books, courses, workshops…) but did I believe that at a bone deep level?
On to our Zoom meeting. I’m calling it Recovery Day One. Just having someone to finally work with was such a relief, after all this time. Someone to listen to my pain story, and get it. Someone knowledgeable yet humble, non-judgmental, down-to-Earth and fun. I trust Greg.Turns out I lost trust in my body — in myself — a decade ago. Now it’s time to start slowly building that trust back. “You’ll get better when you trust yourself as much as I do,” Greg said. Greg KNOWS I can recover. He’s seen it happen many times!
Greg was able to confirm I have nociceptive and nociplastic pain, although I don’t fit lots of the criteria for nociplastic pain. Google them if you’re curious. I found this helpful to know, as that’s what I’d suspected. Essentially, part of my homework is that there are no off- limit movements for me. I have permission to move and can do whatever I want!! Liberating. It feels strange typing this, and shame is creeping in. I’m a movement teacher that’s afraid of movement? It’s true! More on that in another post too, but crucially we discussed that in my case, too much interception is getting in the way of my recovery. I’m a teacher of Hanna Somatic Education, in which we sense ourselves moving as we move. I’m still getting my head around it, but it makes sense. Could it really be a contributor to my system to be on high-alert, causing an already vigilant system to be even more vigilant with such close internal scrutiny? Stress, worry and fear are all enormous contributors to my pain. My beliefs too. There’s a lot to discover!
The day after our meeting, I woke up, and in bed lay there and flexed my neck right back a few times, trusting, not sensing it (a terrifying movement for me). I got up and felt fine!! Then, with Jhana, I went for my first run/walk in 10 years!! I realised I hadn’t run since I fell training for the Sun Run in February 2014. Wow. As planned, I went out for about 20 minutes, and every two minutes, burst into a 10 second run. It was fun!! And no flare up. Three days later (in the photo) I got into a HUGE flare up, not that day but the next, interestingly. It was, of course, horrendous. The accompanying anxiety too. Extremely awful, but not the end of the world. It’s all part of the process. Yesterday I stuck to the walk/run plan, and felt great. I’m already hiking with less pain too. Because I’m starting to trust myself again and trust that I WILL recover. I feel empowered and less afraid. My system will learn by doing. Moving without hard rigid rules, for me, will ultimately convince that deep part of myself that has no faith that I am in fact robust and safe!
By the way, Greg’s a big fan of any exploratory movement without rules. Somatics included. More on that later. No movement is off the table! I’m free! :) That’s worth celebrating. And Greg has offered to do a guest post on this blog, worth celebrating too! There’s light at the end of the tunnel! There’s HOPE :) I can learn to trust in my amazing, adaptable and strong system.
The many different ways our protective systems can look after us when we’re facing trouble. From the Explain Pain Protectometer p. 25.