Recently I have received some great comments from readers which illustrate a very important point: pain education can help reduce threat, pain and disability. This is particularly true when it serves to alleviate threats created by well meaning health care providers who ascribe too much importance to some alleged structural pathology as the cause of the pain. I wrote about this a little in my recent post on muscle knots, and received this amazing comment from a reader relating her own experience:
Just a few thoughts on muscle “knots” and the effects of language. I’ve had leg and back pain for years now, the original trigger being a knee injury. One of the worst symptoms was severe soreness/tenderness in the IT band area of both thighs. If I poked this area with a finger, the sensation was so horrible I would feel nauseous.
A massage therapist told me that I had extensive muscle knots and scar tissue in my IT bands, and this idea was really persistent, and negative for me – I thought I had caused some major structural damage to my legs. It really made me lose confidence in my body, and my body’s ability to heal.
A few months ago, after reading some material on your website, I decided to completely stop doing stretching exercises, as an experiment. Within a few weeks, the pain and tenderness had gone, which I found quite amazing.
I think these things that some therapists may say, quite flippantly, can become obsessional for the client, and these obsessions and anxieties then stand in the way of awareness and healing.
Wow! This reader is absolutely right that well meaning therapists can cause clients a lot of anxiety by telling them about alleged defects in their body. Many of my clients have been told that their back is "out", that they have the "neck of a seventy year old", or that their knee is "bone on bone." These statements can increase threat, cause disability and pain, and lead to treatments that are unnecessary or even harmful.
On that note, here's a video that has been circulating recently showing physical therapist Peter O'Sullivan (who is of course Australian), talking with a former client, Jack, about his dramatic recovery from debilitating back pain. The successful therapy involved dealing with Jack's fears that forward bending was unsafe, which stemmed in part from hearing previous therapists tell him that he had the "back of a seventy year old", that his back was "in pieces" and that "he couldn't do nothing." But O'Sullivan showed him otherwise, and the results were amazing to say the least. This guy went from not being able to ride in a car to digging ditches pain free in short order:
Of course pain education will only rarely lead to such dramatic results, but this is an inspiring example of what is possible.
Here's another comment from a reader I received just few days ago in response to my post on the comfort hypothesis. She mentions that after doing some reading on this site and Paul Ingraham's site, her pain improved, partly from just learning that pain does not imply damage.
Thanks for everything you do here, between you and Paul Ingraham my low back pain is about 5% of what it was a week ago. With regards to the comfort issue, I work as an offshore fisherman, and for the last ten years or so I’ve been aboard an old beast of a scow, built in the 60′s when the design was all function and little regard for comfort. ... I experienced the usual pains of hard work – you don’t throw around 80,000lbs. of shrimp in 3 days without muscle fatigue – but never once did I experience the kind of back pain I’ve been dealing with since I spent six weeks aboard a newly remodeled, supposedly ‘comfortable’ boat this fall. ... I’ll take the hard life over the soft life any day!
I asked Carolyn whether her results were the result of education or some specific interventions and she responded:
The most powerful impact came simply from education. This was my first time dealing with this kind of pain and I had all the usual fears (‘will I ever be able to fish again?’ being a major one), and my pain was reduced before I tried a single practical suggestion, just by reading around a bit.
I’ve been playing around with a bunch of different strategies – Paul’s sweet spots were a big one to get the pain back down to the minor twitch it was before I foolishly decided to try and exercise it out – and with the pain under control I’ve been focussing more on your side of things: exploring movement options, paying attention to what I’m up to, and just slowing down in general. The hardest thing to wrap my head around was the ‘pain breeds pain’ thing; once I realized what I was doing to myself with all the poking and prodding and twisting and stretching, I went out and bought a back brace as a kind of placebo… I didn’t expect any miracles of pain relief just from the brace itself, but I used it as a way to remind me how to move (and how not to) for a few days, and to bring a sense of stillness and protection to the suffering area. After wearing it for less than 24 hours, I thoughtlessly leapt up off the couch in my old way without an ounce of pain – a movement I haven’t been able to make smoothly and unthinkingly for weeks! I’m not cured by any stretch, being out and about in the cold is still a bit of an ordeal, but that moment was the turning point, when my brain finally started to believe that maybe there wasn’t so much wrong with me after all. Thanks again and Merry Christmas!
Thanks for sharing Carolyn I really appreciate it. It's very rewarding to hear that this blog has helped someone. I used to have chronic pain myself, and getting over it was what started me on my whole journey of learning how to move better and feel better. I have a lot of empathy and respect for others who are working through pain issues. It takes bravery, perseverance and creativity. I am very pleased whenever I can help!
Happy Holidays everyone.