Exercise, It's A Sore Subject
Exercise Right Week from 21-27 May celebrates how exercise improves the lives of Australian’s and ultimately changes their futures.
We all know that exercise is an essential part of good health, however pain is often a limiting factor for many in their movement.
We talk to Aaron Hull, Physiotherapist at Peak Sports & Spine Centre, to find out how we can minimise and manage our pain in order to move and exercise right.
PAIN: MORE THAN AN UNPLEASANT SENSATION
WE KNOW MORE NOW
Pain is a phenomenon that is largely misunderstood. Knowledge regarding the processes involved in pain has significantly improved over the last 10 years due to the emergence of sophisticated medical imaging techniques and psychology research.
What this means is that the days of being told to rest up, take time off work, be fearful of movement and be over reliant on pain medications are well and truly gone!
A BIOPSYCHOSOCIAL APPROACH
Traditionally we have looked at pain through a biological lens. Focusing on tissue damage and repair. However, we have shifted our focus to looking at pain in terms of a biopsychosocial framework.
It is considering a dynamic, reciprocal and complex interaction of biological, psychological and social factors that influence pain. A classic example is someone noticing their ankle pain (biological), being worse when they are stressed at work (psychological) and are going through a tough family time (social).
Let’s explore this further.
PAIN AS AN OUTPUT
The purpose of pain is to alert, protect and stimulate a change in bodily behaviour to protect from further damage and facilitate good healing conditions.
If there is one thing that you take away from this article, it is that pain is an OUTPUT and not an INPUT. There is no such thing as a ‘pain receptor’. Because there are no pain receptors, the body cannot send pain signals to the brain. Stay with me.
There are ‘receptors’ on the body that allow us to sense things such as the pressure of a fall and the heat of a flame. They are ‘receptors’ that then send danger signals to the brain. Once in the brain, it makes a decision as to whether the information coming up (in addition to past experiences & social factors) is dangerous or not. Consequently, the output can be one of pain or no pain.
Below we will discuss this using an example.
Think of a time at work, late in the afternoon, where things were extremely busy. You get home at night and sit down to have some dinner and notice a big bruise on your knee. You hit your knee on a table and didn’t even notice it at the time.
The evidence of biological tissue damage is there, however, the brain weighed up the information at the time of hitting your knee and concluded that the ‘threat’ to the body was low, and therefore pain production was unnecessary.
Something else to consider is stepping on a nail in your house, versus stepping on a nail whilst running away from a Lion. When running away from the Lion, the threat is the Lion and not the nail in your foot, and as such, you won’t notice the pain of nail like you would at home.
YOUR PAIN
Pain is personal!
What you view to be 4 out of 10 pain, another views as 9 out of 10. Significant damage does not always cause significant pain. Equally, significant pain does not mean that there is significant biological tissue damage.
The amount of pain you experience is a reflection of the amount of threat your brain believes you are under and not the amount of tissue damage.
WHAT THIS MEANS FOR MANAGING YOUR PAIN
Of course, there are certain times where rest and immobilisation are required, and pain is the result of real threat (i.e. motor vehicle accident injuries). The following management is directed towards everyday types of pain. If you are unsure of your pain, talk to your doctor.
The cornerstone for managing pain is limiting maladaptive behaviours (i.e. not moving, negative thoughts, fear of movement) and reducing threat through advice and education in conjunction with graded exercise exposure.
Have you ever noticed that your low back pain gets worse when you sit on the couch or in the car for long periods of time and feels better by getting up and walking around?
1. Advice & Education: In most cases, your back or other areas are not ‘damaged’, they are just ‘angry.’ It is only natural for all of us to experience things like spinal degeneration as we age. People can have degenerated spines and be perfectly functional with no pain.
Again, pain is an output of the brain and not an indicator of tissue damage. Thinking positively and getting moving under the guidance of your physiotherapist is a highly effective way to managing your pain!
2. Graded Exercise: Strength is protective of injury and therefore pain. Gentle ‘motion is lotion.’ By completing regular graded exercise, your brain will begin to see movement as a normal thing, therefore decreasing the threat associated with certain movements.
For example, do you have a goal of playing golf, yet are limited by your back pain? When we break it down, golf is movement and the spine loves movement. You just need to gradually reduce the threat and build up your exercise capacity.
"Motion is lotion"
PAIN PLAN
Pain is now considered in a biopsychosocial framework. It is an output of the brain and is not an indicator of the extent of tissue damage. Advice and education, in conjunction with graded exercise is paramount to managing many painful conditions.
Talk to your doctor about how they work closely with physiotherapists in developing active self-management plans for patients today.
*Always consult your doctor for pain that is severe and/or unfamiliar.
AARON HULL – PHYSIOTHERAPIST
Bachelor of Exercise & Sport Sciences
Bachelor of Physiotherapy (Honours Class 1)
Level 2 Coach: Australian Strength & Conditioning Association (ASCA)
Aaron is a physiotherapist at Peak Sports and Spine Centre who is uniquely qualified in both exercise & sport sciences, and physiotherapy. He has experience working with elite and junior elite AFL footballers, in addition to various adult and paediatric populations. He utilises his experience across multiple populations to educate and empower people of all abilities to self-manage their pain and achieve things that they never thought possible.
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