Pain, movement and exercise

 “The Pilates method teaches you to be in control of your body and not at its mercy” Joseph Pilates

First and foremost it is important to recognise pain as normal.  It is a protective measure, a way of letting us know we are in danger of being injured or that we are injured.  Pain is also an important part of healing.

Pain is defined as an unpleasant conscious experience and is controlled by the central nervous system in the body. The central nervous system is a network of nerves that connect the brain to the rest of the body to allow the input of information. When you feel pain, it means that your brain thinks the body is under threat, and that something has to be done about it.

When a body part is damaged, nerve endings are triggered and send warning signals to the brain. This triggers protective behaviour, to minimize further damage and allow time for healing. This leads to immobilization of the area, results in protective muscle spasm and causes us to avoid movement. Once the body part has healed, the nerves endings in the area should calm down and stop sending warning signals to the brain, the pain should end allowing us to get back to normal movement and function.

Pain doesn’t always equal damage. Sometimes, the central nervous system becomes sensitized, especially if the pain has been around for a while, and it thinks we still need to protect the area, even though it has already healed and there is no more injury or tissue damage. This is the case in chronic pain, where pain continues for long periods of time without any real source of continuing harm. In this case, there is a problem with the pain processing system, not the body. When an area becomes sensitized we can expect the pain to be felt sooner and more strongly, even a minor, non-painful stimulus can trigger the pain response.

It has also been shown that emotional states such as anger, depression, stress and anxiety will reduce tolerance to pain. Although it is hard to believe, research provides strong evidence that a significant portion of chronic back pain is caused more by emotional and social factors than actual physical damage to tissues.

Chronic pain states cause us to adapt the way we move and we may even avoid movement altogether, due to fear of flaring up our injury or causing damage. This is known as fear avoidance and is the main contributor to the continuation of chronic pain. A lack of movement feeds the pain cycle and actually makes the pain worse and prolongs recovery.

Moreover, when we are told that our postures are causing pain or our movement patterns are dysfunctional we begin to obsess about trying to adopt a perfect posture and create perfect movement, rather than just focusing on creating natural movement. There is no perfect movement or perfect posture, we are individual beings and our bodies are very good at adapting to the demands of our environment and the activities we engage in.

What you believe about pain can have a very big impact on your recovery. If you have helpful beliefs (for example some pain is part of recovery and does not mean more damage, it is safe to move), then you are less likely to experience ongoing pain. If you have unhelpful beliefs (for example hurt equals harm, I am doing more damage), then your recovery is likely to be slower and you are more susceptible to developing persistent or chronic pain.

Research has shown that movement and exercise are very helpful to reduce pain and improve function for people with low back pain and is a key component in recovery.

One of the primary ways that movement can reduce pain is through the phenomenon of sensory gating or pain gating. This means that while your nervous system is processing signals resulting from active movement or touch, it has less ability to perceive and process the pain signals. A good example of sensory or pain gating is when you stub your toe and instinctively rub the area. In the same way, coordinated controlled and mindful movement will reduce the perception of a painful stimulus and relieve pain.