Pain is the number ONE issue that causes people to think about going to see a physical therapist. We, as physical therapists, have continued to precipitate this emphasis by asking about pain, and performing techniques that are focused on pain relief, BUT we as therapists want to do so much more for our patients, and if we can understand that Pain is a Liar, we can.
There are a large number of sayings that we as PT’s use in relation to pain that can shed some light on one of the most misunderstood parts of life. Sayings like “pain is an output”, “pain is weakness leaving your body”, “pain is temporary” and of course “pain is a liar”.
Let’s use some of these sayings to shed some light on pain and how concentrating on pain can limit progress and continue the feeling of pain.
“Pain is an Output”
Pain is actually your brain’s interpretation of a signal from an area of dysfunction, injury, or nocioception.
In a recent study, they looked at two people who have a genetic disorder that does not allow them to experience pain. These are those people that can put their hand on a hot stove and report that their hand will feel warmer, but it’s not painful. They had each of these people receive a ‘pinprick’ stimulus, which would make most of us say “ow” or want to strike back at the tester. During the stimulus they performed a Functional MRI (An fMRI measures brain blood flow to display brain activity changes.) to evaluate was going on during the stimulus and did the same stimulus with a few age-matched normal people as comparison. What they found was that the key areas for the “pain matrix” would ‘light-up’ on fMRI for both groups in the similarly. The difference was that the “normal” people complained of pain, but the two people with the genetic disorder did not complain. So, when the researchers gave a pain stimulus, there are key areas of the brain that were activated in both of the groups. The “pain” input activating the ‘pain matrix’ does not mean it is pain. Pain occurs only when it becomes the output and the person feels the pain. The stimulus is not the pain. Pain is about the output, not the input.
When we understand the characteristic or pain as an output, it frees us (both as therapists and patients) to concentrate on the cause of the pain. It allows us to correct the movement disorder, muscle imbalance or poor muscle performance that has caused that output. If you had a splinter in your finger that REALLY hurt your finger, you would pull the splinter out of your finger. If we take care of the input (cause of the pain), the output goes.
"Pain is Weakness Leaving your Body"
A lot of people have heard this one, but not many people know where it came from or have even thought about its MANY meanings and uses.
First, this one started as propaganda by the US Marines Recruiting offices to get more people to join the Marines (and it was very effective at that).
Technically, it is not true. As we just said pain is your brain’s response to a stimulus to tell your body that something is wrong. It is telling you to stop what you’re doing and protect yourself from that input.
Figuratively, it is true. If you punched a tree every day for a year, your hand would not be broken (unless you punched it too hard), but it would hurt to do it, but in the long run, your hand would come out callused and stronger than when you started.
If you started running 15 miles a day every day, all your muscles would have aches and pains (especially in the first few weeks), but after a while your muscles will be stronger, your endurance will be better and you will ultimately be in better shape than you are when you started.
Finally, if you experience some emotional pain—say you fall and break your leg and have never had this kind of an injury before and have to miss a month of work and miss your softball team’s championship game that you work so hard to get to for the last year, you would be extremely upset, frustrated and even angry, but after all the rehab and torture that you put yourself through for missing those important parts of your life, you will have dealt with that emotional pain and now know that you can get through it and come out emotionally stronger.
So, “pain is weakness leaving your body”, but only in the figurative, short term kind of way. We all deal with multiple kinds of pain on a daily basis, and hopefully all come out stronger, but sometimes we need some help getting there.
“Pain is Temporary”
This one is a favorite of coaches—“Pain is temporary; championships are forever”. It can be an awesome motivator for kids to dig deep and push for one more lap, one more play, or one more point, but is it true?
If you want to get all philosophical, yeah—everything is temporary. The house we live in, our life on this planet, even this planet as a whole are all temporary. The pain you are having will end…when you take that splinter out, stop running 10 miles a day, or just stop all together.
But do you really want to guess how long that temporary will be? There are chronic pains, but most of what we experience on a daily, weekly or occasional basis are temporary and just need some help. They need some sort of help to make that temporary pain even more temporary, like some therapy, some exercise, some medications (notice that that is the third option), or possibly (but hopefully not) a surgery.
Pain is temporary—as long as you don’t quit (then it is permanent).
“Pain is a Liar”
There is a joke I like to use--”A man goes to see his doctor and tells his doctor about pain all over his body. He says to the doctor ‘It hurts when I touch my shoulder. It hurts when I touch my hip. It hurts when I touch my head. It even hurts when I touch the very tip of my nose’ (All the while the man shows the doctor what he means by touching these body part. The wise old physician looks at the man and says ‘Ah ha, I know exactly what is wrong…you, sir, have a broken finger’”
Pain just tells you that something is wrong, but there is a highly connected network of nerves getting the information back to the brain, and as the signal travels further along that network it loses some of its specificity of where it’s been. (Have you ever gone on a long trip, and about three quarters of the way there realize that you don’t remember if you turned right or left onto the highway?)
There are pains called referred pain (a dysfunction that sends pain to a completely different area), radicular pain (a nerve issue that sends pain down the arm or leg that starts in the neck or back at the origin of that nerve), phantom pains (pain in an amputated limb that makes it feel like the limb is there and extremely painful), and visceral pain (pain from an organ that feels like musculoskeletal pain usually in the back, neck or head) just to name a few.
So, Pain is a Liar. Pain needs to be traced back to the source. When talking about Somatic pain (musculoskeletal pain), that source can be a tight tissue somewhere else, weakness in that area or even another, a core instability, a joint that doesn’t move enough (or too much), or even the way you sit. No matter what that source is, it will cause a movement disorder that causes that pain to lie to you.
The more we learn about pain, the more we realize that we still need to learn and explore. The old platitudes about pain are founded in some truth and have value to our lives, but not always in the straight forward way we want them to.
The pain you feel is only a portion of what is going in your body, and I encourage you to never stop looking for that source, so you can make that WEAK LYING OUTPUT TEMPORARY, and get back to what you love.