If you’ve played sports, worked out, or participated in recreational activities long enough…then at some point you’re bound to experience some type of pain or injury. It’s inevitable, and represents the double edged sword of exercise…while the benefits of regular exercise are undeniable as far as long term health, performance, and staving off disease…the reality is that the more you use your body, the more likely it is to run into snags as time progresses. So what should we do about that nagging ache, pain, or chronic injury that keeps getting in the way of our progress?!
While there is certainly no generic article I could write here to give you the reasons why you’re experiencing pain, what I can do, it clarify WHAT PAIN ACTUALLY MEANS, and how to navigate finding a solution.
Like I stated previously, if you train hard enough, for long enough you’re bound to experience injury or pain. It’s really not a matter of IF but really WHEN. So the first thing we have to discuss is the difference between chronic and acute injury.
First off is the obvious…you’re working out, playing your sport, and you just experienced the dreaded pop, snap, or immediate sensation of intense pain and burning with an associated loss of function…you have just suffered an ACUTE INJURY.
ACUTE means that the mechanism of the injury is known because it just happened and you are likely dealing with some type of structural damage to a tendon, bone, ligament, or other connective tissue of the body. The sensation of pain associated with Acute Injuries is often what we in the rehab industry deem, BOTTOM UP pain. Bottom up pain means that your brain is receiving signals from the tissues of your body correlating with the area that has been compromised. Notice I said THREAT and not DAMAGE…more on this as we discuss chronic pain… We refer to this as bottom up because the signal from the tissue to the brain travels up…and your brain quickly interprets these signals and sends the sensation your experiencing back to the tissues…Acute injuries are no fun at all, but the saving grace of acute injuries is that generally speaking, our medical system is actually quite good dealing with this type of problem.
The first step is generally seeing a physician and getting 1 or a series of diagnostic tests like x-ray and MRI to determine where, what, and the extent of the damage you’ve sustained. This process can take a few days up to a few weeks, and generally you will be recommended to ICE, REST, and IMMOBILIZE the area in question. ( I actually disagree with this in almost all cases except for a bone fracture, but the reason for this we will save a for a dedicated article) This is mainly done to protect you from hurting yourself more. In many cases, if you’ve torn a ligament, tendon or cartilage, it MAY require surgery…it really just depends. A good idea would be to seek out a good PHYSICAL THERAPIST or ATHLETIC TRAINER for help rehabilitating this type of injury and getting some guidance on how to progress back to an active lifestyle.
But what about if the pain you’re experiencing from an injury doesn’t go away? Or maybe instead an acute injury, the pain you’re experiencing is more chronic? Chronic pain means that generally the onset of symptoms was more gradual and built up over time. Maybe early on it was just a twinge that didn’t give you any pause to stop, but now it has grown into something giving you reason for concern…what does that mean?
Chronic pain is where we run into quite a bit more trouble in a diagnostic sense. The reality is Pain is more of a threat meter than a damage meter in these types of cases. What this means, is you may experience pain WITH OR WITHOUT any structural damage to tissues. We refer to this type of pain sensation as more TOP DOWN, meaning that is comes less from tissue messaging and more from the brain down to the tissues… Why? Well in the absence of tissue damage, the brain is still setting off the alarm. Its like the smoke alarm going off when there is no fire…The alarm is real, the experience is real, but maybe disproportionate or not accurately representative of the actual threat to the area. An example similar to this is someone who experiences panic attacks. A panic attack represents an extreme neurophysiological response to a very small trigger in correlation. The experience is absolutely terrifying and awful, but the stimulus that triggers it generally isn’t something that would warrant that extreme of a response under normal circumstances. Chronic pain works in a similar way…Big threat response to a disproportional threat.
The other difficult part of this conversation is that pain severity is not directly correlated with amount of tissue damage. For example, a paper cut hurts like hell, but it isn’t a lot of tissue damage! It is in this way that the chronic pain scenarios are a lot trickier to deal with… there are just so many more pieces to the puzzle. Think of acute pain like a 50 piece jigsaw puzzle (pretty easy) versus a 1000 piece jigsaw puzzle. Chronic stuff takes more focus, specificity, patience, and the process is slower and take consistency over time, and maybe a team of providers to nail down.
In most cases, if we’re talking about orthopedic issues that cause chronic pain, where you think the problem is, or where you may be experiencing your pain, is often NOT where the actual issue is. Now, I am taking about ortho here, as it is well documented things like mental/emotional trauma, systemic disease, cancers, and other ailments can manifest as physical pain elsewhere in the body. So for this conversation lets keep it around orthopedic issues. The troubling issue with chronic injuries, is the very same healthcare system that is quite proficient in dealing with acute trauma is equally as HORRIBLE at dealing with chronic pain. Why? Well, mainly because they use the SAME diagnostic strategies as they do for acute injury. The over reliance on MRI for chronic pain issues ends up leading people to the operating table, and ultimately not solving the underlying biomechanics reason for the chronic injury to begin with. It is, in my opinion, the bane of the current orthopedic system. Lets break this down using a case study example.
Athlete A is a distance runner, and has been experiencing knee pain around the inside portion of the knee. Over time, it get worse and worse until finally the athlete decides its time to go to the doctor. Doctor orders and MRI and it reveals a meniscus tear and some cartilage loss around the knee and he recommends an injection/rest, therapy, and possible surgery. Therapy would often consist of knee strengthening exercise, but lets consider that the pain doesn’t go away, and this athlete ends up having surgery to repair the damaged meniscus. We have answered perhaps WHAT is wrong, but why did the meniscus just tear? Was it slowly happening over time? If so then how? Was the tear already there and just asymptomatic until now? Difficult questions to answer for sure, and none of these questions can be answered with a scan…
Well, the first issue is the MRI. What does an MRI show? It is a 2D static picture, or 3D dynamic structures of the knee, so right off the bat, the MRI is telling us that the knee IS THAT WAY, but not WHY IT IS THAT WAY. It is critical that we answer the WHY question because ultimately, that is where the solution will be found. So the doctor is offering a KNEE SOLUTION to the KNEE PROBLEM. However, the body is one unit, and not easily separated into different parts.
Consider that the knee is operating between the adjacent joints of the hip and the foot/ankle. What if the athlete has a hip mobility problem that contributes to excessive stress at the knee? This would represent the WHY behind their knee problem. This can be quite a bit more complicated process and this is why seeking a competent physical therapist or athletic trainer who has a background in MOVEMENT ASSESSMENT really comes into play. The bottom line is this, when it comes to chronic pain, we can’t play by the acute rules, and unfortunately many physicians think they are the end all be all when it comes to intervening but the reality is that in the cases of chronic injury…MOVEMENT is the key factor, not structure. It is for this reason that PAIN IS A TERRIBLE BIOMARKER for what’s wrong.
So what should you do??? How can you ensure that no matter what type of injury or pain you have that you’re taking care of the root issue? The answer is you need a TEAM! No single provider has all the keys to this puzzle. Finding a quality orthopedic physician/surgeon, a quality Physical Therapist/Athletic Trainer, and a quality strength coach/personal trainer all have their role in keeping an athlete healthy, and performing at the top of their game! Like all things, it takes a village.
This is why here at The Movement Underground we have built an entire network of specialists that WE TRUST. Providers of a like mind who offer quality services and are at the top of their game so that you can be at the top of yours! If you’re in the NY area, give us a call and schedule an assessment and lets see if we can get you feeling better, moving better, and moving more! If we can’t help you, we likely know the person who can help us 😉!
