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My Relationship with Pain

Remember that saying “No pain, no gain?” that was touted in the heyday of the fitness gym where it was suggested if your workouts didn’t result in pain, you weren’t trying hard enough and wouldn’t benefit as much as you could? There were similar thoughts in the massage and Rolfing worlds, where it was believed deep tissue work that hurt was the only thing that would result in lasting change. Luckily things have taken a turn in both worlds (although there are certainly holdouts amongst both practitioners and clients who still believe in inflicting/tolerating as much pain as possible), as treatments that are gentle and effective are taking hold in the industries of exercise science and treatment protocols.

It seems weird to me that we would seek pain in circumstances where we think it will help us (eventually) but do everything humanely possible to staunch pain in circumstances where it is expected, such as birthing, illness and injuries. Our relationship to pain is effed up.

NOTE: This post is about pain in circumstances where it would be expected and not chronic pain, which is another animal altogether. I do my best to read and study the current pain science articles, books and research, but it is beyond my scope to write about it. If you are a chronic pain sufferer I will link to some resources below.

Horse people are known to be a bit stupidly brave about pain. One of my clients recently told a story where she broke her nose for the third time (riding) and knew from previous experience she’d have a few minutes before the shock wore off and the pain would come flooding in, so she took the opportunity to school her horse over a few more jumps.

Maybe some day a university will get funding to research horsey people and pain tolerance, but in fact, I don’t think it is due my horse gene that my pain tolerance is high. Because it’s not really. I feel pain like the next person, when something is painful. I gave birth twice without an epidural. I’ve had a root canal that I would classify as “torture” – it went beyond the level of intolerable pain to “I’ll do anything if you stop now.”

But the three times I’ve broken bones resulted in almost no pain (other than soft tissue bruising kind). I do think I’ve been lucky in my breaks (lucky breaks!) as my bones broke cleanly and without shattering or twisting. (Another friend had a tibial fracture where the bottom broken bones were twisted relative to the rest of the lower leg, and the pain stopped when the bones were aligned again, even before the leg was immobilized.)

But here’s the weird thing: in all three cases when I’ve suffered broken bones (fifth metatarsal, radius and tibia/fibula), the medical staff expected me to feel pain. ER staff, nurses, doctors, surgeons, interns, radiologists, MRI techs, all could not believe I wasn’t in pain. In all three cases, I was told it probably wasn’t broken because it doesn’t hurt (on palpation). I’ve had doctors ask me more than once, upon seeing X-rays “Are you sure it doesn’t hurt?” Last time, after the doctor saw my X-rays she asked me “Now do you want painkillers?” (and when I declined, she just shook her head unbelievingly).

When I broke my arm, the MRI tech apologized for having to put me in such a weird contorted position to get the view he needed, and I was like “um it’s no problem!” and he looked me in the eye, furrowed his brow, and asked quite seriously “Why doesn’t it hurt?” (to which I had no answer). My guess is that medical staff are still practiced in the nocebic language of pain. I was told in Emergency that I would be going right in because “this is bad and will probably need surgery tonight.” Their method of dealing with pain is primarily medication. It is probably easier to work with people when they are calm, sedated and feeling no pain.

So am I some kind of freak that doesn’t feel pain? Was I just lucky that my breaks were clean and didn’t affect nerves or damage surrounding tissues? Am I just stoic? A combination? I have a theory and my theory involves my relationship with pain and how pain is perceived in our culture (bad, to be avoided, indication of damage, something to control).

Another thing that seemed to surprise people was how calm I was, both right after the injury and in hospital. I’ve heard accounts of people “losing it” when the diagnosis came back and surgery was eminent. I almost seemed to have an “out of body” ability to push aside the fear and chaotic thoughts (such as “how am I going to work?” “how will I get to RES week now?” and other thoughts that would have made me cry if I’d entertained them then). My thoughts were all about logistics. “How do I get back up the hill? How do I get to the hospital?” and dealing with things one step at a time. One thing I’m totally not thrilled about is IVs and I had three in one week! Each time I just thought of my cats (pleasant thoughts) and focussed on getting through the next few minutes. One step, one thing at a time. Don’t get ahead of yourself, that’s how you lose control. Push aside the worry. I’m pretty sure anxiety and worry and fear don’t help a pain response.

I’ve worked a good deal on breath and breathing. I seem to be able to process trauma quickly and efficiently. In many cases I can recall (car accidents, and the recent injuries included) I experienced tremors for a few minutes, which I calmly allowed. (There’s a protocol called TRE® which emphasizes releasing trauma through tremors.) In the case of my broken ankle, I was on a gurney attached to heart rate monitors and IV during the tremors and was repeatedly told to “calm down” by attending staff. I had to tell them I was calm, I was just processing shock! (Again, is this not recognized by them? Is it a cultural thing to avoid shock processing? Is it embarrassing and strange?)

I’ve read a lot about pain, where it comes from, what it means. I hope I never have to deal with crushing pain from an injury or chronic pain. But the day-to-day kinds of pain, or pain from a sudden unavoidable accident is something we will in all probability experience at one time or another. How you deal with it might just be determined by how much you know about the pain process (and how much of a mover you already are). Women giving birth know the contraction pains are severe but temporary and can be coached to get through them with coping mechanisms including breathing, meditation, calming practices such as music, baths, rolling on a ball, walking and moving (and failing that; medication). Below are some resources for pain education that might help those in chronic and acute pain situations.

Thanks for reading.
Carol

Resources:

Retrain Pain Foundation

Why Things Hurt, by Lorimer Moseley (a funny video on pain!)

What is this thing called pain? by Clifford J. Woolf

The Lived Experience of Pain: A Painful Journey for Medicine, by Milton Cohen & John Quintner

Reconsidering the International Association for the Study of Pain definition of pain
Milton Cohen, John Quintner, Simon van Rysewyk

Free Pain Guidebook Download by Greg Lehman – be sure to read Greg’s Blog on this site as well.

Explain Pain, by David S. Butler (or get it from your local library!)

DNM – Dermo Neuro Modulating, by Diane Jacobs and a video demonstration by Jason Erickson
Diane Jacobs’ blog (so good!)