It’s Not About The Pain

Being a good osteopath involves being good at communication.

Being good at communication involves being good at listening.

Being good at listening involves understanding, not only what was said, but what wasn’t said.

This is because:

People don’t seek your help because of their pain, they seek your help because of the pain their pain causes.

When We Start, We Don’t Know Where We Will End Up

When I was a teenager, I was lucky enough that my dad, for whatever reason, bought a copy of a book called Smart Sport, which is essentially a book of sports science for lay people.

I read that book multiple times, developing an interest in exercise physiology and sports performance.

Indirectly, that has lead me into my current profession, but that is not what this post is about.

Because of my interest in exercise physiology, I became interested in cycling, and if you were interested in cycling at the turn of the century, you were interested in Lance Armstrong. Say what you want about him, but the man made cycling exciting!

Part of his appeal was his back story, which he detailed in a book titled It’s Not About The Bike.

The book outlines Lance’s struggles in life, and with cancer, as well as his comeback from the brink of death. It peaks when Lance is on the recovery trail and is climbing a hill in Colorado, when he realises his life is meant to be a struggle.

Which brings me to pain.

Pain Is Good, And Bad

None of us is entitled to be pain free, all the time.

[Note: This actually wouldn’t be a good thing either, as people with congenital analgesia (genetically can’t feel pain) tend to have shorter lifespans than average.]

Most of us are lucky in that we only experience pain in a positive way. That is, short term pain that is protecting us from something obvious (or not so obvious); a broken bone, a strained muscle, too much exertion in too little time.

However, some people experience constant, chronic pain, which we could say is not positive at all, but rather negative.

This pain is still protective (all pain is), however it is also pathological.

It occurs when the nervous system has changed, both in structure and function and become hyper protective. This type of pain is negative, because in the vast majority of cases it doesn’t correlate well with any tissue damage needing protection, and becomes a big hurdle to living a full life.

What we (as a population) have to understand is, some pain cannot be resolved.

We just don’t know enough yet. And even if we did, perhaps some pain is not meant to be resolved?

So if you are suffering from chronic pain, you have to ask yourself:

If this pain never went away, can I still live a good life?

And to me, as an osteopath, the answer is always yes. Mind you, many people will actually experience their pain decreases as they learn how to manage it better, but more on that later.

If you have have chronic pain, and you cannot fathom a way to live a good life, then you need help.

You need a team of health professionals who understand pain, who can work with you on reshaping your expectations, improving your management and helping you get as much out of life as possible.

#TheStruggleIsReal

Back to Lance. This is what I think he was talking about: life is all about the struggle.

We all struggle.

Our struggles vary, but to the person struggling, as the internet says “the struggle is real”.

But this struggle defines us.

It is because we struggle that we become stronger people.

It is because we struggle that we rely on others, building relationships that add to the richness of life.

It is because we struggle that we can help others who share the same struggle.

Perhaps, if we can learn to find meaning in the struggle, the struggle isn’t so much of a struggle, but a journey. And like every journey, some have it harder than others. Some don’t even make it. It’s not fair, but it is life.

Knowledge Is Power

I have talked about pain over the last few years, using tens of thousands of words to try and help people understand what pain is, how it works and how to move, think and live in order to overcome pain and achieve optimal health.

But overcoming pain doesn’t always mean getting rid of pain.

It means overcoming the adversity that pain brings.

It means understanding the key points of pain science education, as my friend and colleague Alison Sim outlines:

  • Pain does not equal tissue damage
  • Focus on function, not pain
  • Use physiology to underpin management (i.e. manipulate physiology with exercise and pyschological techniques to reduce stress and anxiety)

Mostly, it means understanding that it’s not about the pain, it’s about living as well as possible given the circumstances.

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 



 

 

How Your Mindset Impacts Your Pain

Mind

Most people think pain is a physical problem, because we feel it in our body.

Whilst this is not wrong, it is not completely right either.

This is because all pain has 3 components:

  1. “Bio” (biological – aka what is going on in the body)
  2. “Psycho” (psychological – what’s going on in the mind)
  3. “Social” (what’s going on in our environment)

You might be thinking, that doesn’t apply to me, “I strained my back shifting the couch, there’s nothing going on in my head or around me”.

That might be so, but, even if we strain out back moving furniture (an obvious physical cause to pain), by the time we experience pain, our brains have done a magnificent job of filtering the sensory information from our body via all our existing biases and preconceptions (“psycho” and “social”).

This simply means, if you’ve heard your grandfather complain about how getting old sucks because his back hurts, and if you’ve heard people talk about “wear and tear” or anything else about back pain, you brain, cool as it is, will consider this when deciding whether to produce pain that you feel “in your back”.

The fancy name to describe this, is a neurotag.

I like to think of it as a filing system in our brains.

When you see, hear, or read something about low back pain for instance, it goes in your “file” titled “low back pain”.

It doesn’t stop there. Neurotags, I mean, the filing cabinet in our brain, also cross reference.

So when your grandfather complains about being old and having low back pain, your brain files “low back pain” into the “old” file, and “old” into the “low back pain file”.

So, when you strain your back, causing the sensory nerves to start firing rapidly and bombard the spinal cord with messages of danger, your brain is pulling up all these files:

  • Danger is coming from the body
  • The danger seems to be around the low back
  • Low back pain
  • Old
  • Wear and tear
  • Can’t move
  • Never be the same

Or whatever else is stored in there. As you can imagine, over time, this could get pretty full.

All this means that even a “simple” low back strain is not so simple.

Some people are at a high risk of developing chronic pain, even from a relatively benign back strain. All because of the psycho-social factors involved. This is why it is important to always address all factors involved in your pain. After all, all chronic pain was acute at some stage. 

When it comes to treating pain, your mindset matters.

In general, there are two types mindsets that we can possess.  One can lead to a better recovery, while the other can actually impair your recovery.

The Two Types of Mindset

When it comes to our mindset, we either have a fixed mindset, or a growth mindset.

This concept was first described by a psychologist, Carol Dweck, who once had a teacher who arranged the seating order of the class by IQ. Whilst Dweck was actually in the number one position, she felt enormous pressure to maintain that position, whilst those lower in the order became resigned to their fate.

This teacher inspired Carol to conduct her own research, which lead her to conclude:

People with fixed mindsets believe that they were born with all the intelligence and talent they will ever have, and that this cannot change.

People with growth mindsets, as you might guess, believe that their abilities can expand and improve over time.

The vast majority of people who have had success in life, especially those who have had to overcome adversity, display characteristics of a growth mindset.

How Your Mindset Affects Pain

If you search for articles on “fixed vs growth mindset”, most of the results will be about personal development and business, but this concept can also apply to pain.

The easiest way to demonstrate this is with an example.

Let’s imagine two completely fictitious people, Danny and Danielle.

Danny

Danny, 30, is a rising star in the corporate world. He works his ass off every day to improve at his job – networking, learning persuasion and sales techniques, studying his field so he is on top of his game. He goes to the gym 5 times per week and ensures he eats well most of the time so he looks and feels good. On top of this, Danny has a daily ritual of visualising his success.

One day Danny starts to experience neck and shoulder pain. The onset wasn’t caused by anything in particular, but he did recall training extra hard that month.

Not wanting the pain to interrupt his life more than necessary, Danny seeks the help of an osteopath named Nick.

His osteopath formulates a treatment plan designed to get him back to full training in 4 weeks. In the mean time, Danny reads some articles Nick sent him and does some extra research on the topic from some trusted health sites he frequents.

At 4 weeks, Danny is not only pain free, but he has learnt about injury management and knows how to improve his gym workouts so that the issue doesn’t recur. In essence, he has come back stronger than ever.

Danielle

Now, let’s have a look at Danielle, 35, who is a public servant. Danielle enjoys her life – she works from Monday to Friday and enjoys exploring galleries and cafes on the weekends with her partner. At work she does what she has to do, but no more, thinking “if I’m not paid to do it, it’s not my responsibility”. Danielle feels like her life is pretty good, but she has one eye on retirement.

One day at work, Danielle starts experiencing neck and shoulder pain, and she recalls her mother having something similar due to her work as a seamstress and thinks to herself that it “must be genetic”. After talking to a colleague whose partner, Danny, had a similar problem and was able to resolve it after consulting an osteopath, she books an appointment with the same osteopath.

When she arrives for her consult, they discuss a treatment plan and get started. After a few days, there has been no change and Danielle loses motivation to do her home based exercises. She continues treatment for a few more weeks, as she enjoys the way manual therapy feels, but she is disengaged. After 6 weeks there is no change, and she is convinced her original thoughts were correct, and that her pain is “genetic” and “there is nothing she can do”.

Your Mindset Affects Your Behaviour

It should be obvious who has the growth mindset, and who has the fixed mindset, and as you can see, your mindset permeates every aspect of your life, including pain.

Having a growth mindset meant that Danny saw his pain as something that could be changed, if he changed what he was doing and improved (his knowledge, his body etc).

Having a fixed mindset limited Danielle’s recovery, as she saw her pain as her destiny (genetic), and thus was not inclined to try and change or help herself.

While pain is never simple, there are so many unseen factors, we can control much of our reaction to pain and what we do in the future. If you have the belief that you can grow and improve throughout your life, that it is likely this will extend to your beliefs around pain.

Can You Change Your Mindset?

This is the trickiest question to answer. People with a growth mindset will believe so, but people with a fixed mindset may not.

The science is unequivocal – our brains are plastic and can continue to change as long as we are alive.

As we change our thoughts and behaviours, our brain structure changes too.

If you want to change your mindset (wanting to change is key), then the best way is via actions.

You see, our brains are funny.

When we sit idle and think, especially about the future, our brains can get very creative. This can be a positive if you start thinking about where you want to be in 5 years and what you have to do to get there, but not so much if all this thinking does is keep you idling in place for another 1/2/5/oh-shit-where-did-my-life-go years.

It’s even worse if you start getting into negative thought spirals.

However, if we take action, any action, then our brains can’t get carried away. And, if we are smart, and start small, then we achieve a little success, we build confidence and momentum. Repeat this process long enough and you become a different person.

This, in essence, is mindfulness, but let’s call it something else – let’s call it momentum. Create momentum by starting small and before you know it, you have changed.

Really, My Back Hurts, How Does This Help Me?

In essence, it all boils down to this: are you resigned to having pain or looking for someone else to solve your problem (fixed mindset), or, are you willing to adapt, change and do what it takes to help yourself?

Some conditions are very easy to recover from, others very hard. What doesn’t change though, is that if you have no doubt in your mind you will improve, no matter what it takes, then you probably will*.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

 

 

References

(1) Wikipedia – Carol Dweck: https://en.wikipedia.org/wiki/Carol_Dweck

(2) Stanford News Service – Fixed versus growth intelligencehttp://news.stanford.edu/pr/2007/pr-dweck-020707.html

(3) NY Times – If You’re Open To Growth, You Tend To Grow: http://www.nytimes.com/2008/07/06/business/06unbox.html

(4) Brain Plasticity and Behaviour – https://www.psychologicalscience.org/journals/cd/12_1/Kolb.cfm

 

*Please don’t take this the wrong way if you suffer from chronic pain. This isn’t meant to belittle your pain or say you are not trying. The recovery rate for chronic pain is quite low, but many people learn to live fulfilling lives and manage their pain quite well. In part this comes from re-shaping their thoughts, emotions and behaviours around pain. Cognitive Behavioural Therapy (CBT) is quite helpful in this regard.