How Our Chronic Pain Peeps Can Return to The Activities They Love. Pain-Free.

Somewhere along the lines of getting older and accruing multiple injuries, phrases like, "Oh I can't squat in the gym anymore, that hurts my back." or "I used to be able to kneel in my garden, but now I avoid it because of pain" start to play on repeat like a broken record. It's almost like a right of passage, or a given presumption, that once we hit a certain point in our lives, the activities we love slowly (or quickly) die off.

The presumption is fair, to an extent. No matter how well we maintain our bodies or recover from injuries, Father time will always win -If you're 90 years old with bilateral knee replacements, skiing down a double black diamond and hollering at your grandson to meet you at the bottom is probably not a great idea. Situations like this are not what we are talking about.

The people we want to help "see the light" are those who have misguided beliefs about why they cannot do a specific activity or movement anymore.

For some clarity about what we mean, here are some examples we see daily:

A. "My shoulder hurts every time I do a push-up, therefore I can't do push-ups anymore. I'm only 40, I should be able to do push-ups (even though I haven't done push-ups in years). There must be something seriously wrong with my shoulder, and I probably need surgery to fix this." - Yes, this happens more than you think. People significantly overestimate what they should be able to do and then internalize unfounded beliefs as to why they can't.

B. The person who always blames the activity but not the amount, intensity, or novelty of the activity. It's running hurts my knees, but never the amount of running hurts my knees. Or it couldn't be my brand new, for the first time in my life, gym routine, with an unqualified trainer that's making my back hurt - it's always "the gym" or "insert activity" that hurts my back.

C. When a medical professional comes along early in someone's life and spreads unfounded beliefs like -  "squatting is bad for your hips." "If you keep running, you'll develop knee problems." " You have degenerative disc disease, and your spine is wearing down." The list goes on and on. Medical professionals can be quick to give out diagnoses and then let the patient figure out the meaning.

D.  The typical pain argument - that if something is excruciating, there must be a lot of damage going on. Remember, pain is a subjective experience.

In the medical community, these misguided relationships are considered thought viruses, which are defined as:

"A limiting or harmful belief one comes to hold about themselves or some aspect of their life that can infect the mind, thus leading to the spread and strengthening of manipulative beliefs. Thought viruses are often generalizations or distortions of reality drawn from a single bad experience, inaccurate sources, biased perceptions, false assumptions, untruthful societal beliefs, and appeal to untrustworthy authorities among other common sources of information."

Whew. In other words, we need to be careful about the thoughts we choose to believe and who we get our information from. The problem becomes, that once personal beliefs are established, these beliefs can become self-perpetuating.

We're only human after all - it's much safer to confirm our own biases, rather than question our truths.

Again, we are not knocking those who have a lot of pain or who experience pain during an activity. Pain sucks and is an entirely valid reason not to do something, however, where we tend to miss the mark is the "why." More times than not, it has nothing to do with the activity.

The truth often resides in a swimming pool full of other reasons such as:

1. Aging

2. Loss of strength and power

3. Decreased muscle mass

4. Injury history

5. Decreased bone density

6. Poor movement strategies (our bread and butter)

7. Tissue health

8. Deconditioning

9. Overtraining

10. Too much too soon

11. Novel and new activity we weren't ready for

12. Our beliefs about ourselves and our actions

13. How we choose to associate pain with certain activities

It's always the activity (running), movement (bending over) or specific thing (diagnosis/surgery) that we blame, it's never the other confounding variables.

The great news is that many of these variables can be improved upon, which means you can get back to the activities you love. On a basic level, we all understand this, but it's something few put into practice.

To help explain further, the concepts of the SAID principle and Graded Exposure will now be discussed.

What is SAID and Graded Exposure?

SAID stands for specific adaptations to imposed demands, and it brings to light that humans are adaptable. For example, when we work out, if the stress imposed by lifting weights is appropriate, we get stronger. The stronger we get, the easier it becomes to lift a certain amount of weight. Therefore we've improved our resilience to a given amount of weight. This is how the SAID principle works - given the right environment and context, the body will adapt to the demands placed on it. However, if the stress from lifting weights greatly exceeds our body's current ability, then the risk of injury or pain increases significantly.

The trick is to find the sweet spot - enough stress to stimulate adaptation but not enough stress to cause injury or delay healing. What makes finding the sweet spot so hard is that stress is multi-factorial, meaning a lack of sleep, decreased water intake, a difficult presentation at work, a big test in school or a failing relationship can all affect how our body handles or tolerates specific activities.

Here is a video from the University of Missouri discussing how collegiate football players are two times more likely to have an injury during periods of high stress, such as midterms or finals testing.

and here is a quote from Bryan Mann the Assistant Director of Strength and Conditioning explaining the effects of cumulative stress in collegiate football players:

“Everything players deal with daily creates stress. They don’t have separate accounts to withdraw from for practice, school, and relationships. Whenever there’s stress, something’s got to give. Otherwise, it’s similar to when unexpected expenses arise at the same time, and you’re likely to overdraw your checking account. It’s the same idea but on a physiological basis rather than a monetary one.”

The concept applies to all humans. For those of us who are healthy or have continued to develop our resilience to stress (physical, mental, emotional), we can take hits, recover appropriately, and grow from it. However, for those of us who continue to dip into our reserve tanks and never bounce back, things get dicey. Everyone's got a breaking point.

We believe the musculoskeletal system (muscles, bones, joints, cartilage, etc) to be like any other system of the body, i.e., the cardiovascular system, the nervous system, and the integumentary system. For one, they are all connected. You can't have properly functioning muscles and healthy joints without blood being pumped to them. And two, you have to take care of them. If you don't eat right, you increase the risk of heart disease, and if you don't perform physical activity, you increase the risk of osteoporosis.

Now just like your brother who smoked 15 packs a day and never got lung cancer, there is a considerable amount of genetic variability that decreases or increases one's inherent risk to certain types of diseases. In terms of aging, pain, and our ability to tolerate activities - some people are the exception and can get away with moving poorly, never working out, and laying on the couch for 15 hours a day, without any issues. For most of us, however, we must continuously stress our musculoskeletal system to maintain an appreciable amount of resilience. Exercise is to our bones, muscles, and joints as what eating healthy is to our triglycerides, HDL, and LDL levels. And no, our baseline daily activity levels are not enough.

The stress of the activity/movement/situation becomes greater than our ability to effectively handle it. Therefore, it's not the activity/movement/situation that causes pain/injury, it's our body's ability to tolerate the specific activity/movement/situation. Are we ready for it or not?

This is good news! We can effectively modify activities to make sure the stress is appropriate, create a guided plan that promotes adaption, and return you to the activities you love without pain. All while avoiding surgery or your spine going in and out of place ;).

Now on to Graded Exposure.

Graded Exposure

Sometimes pain has nothing to do with tissue damage. The gist is that the nervous system can be on red alert, always, like an overprotective mother. To get the proverbial mom to calm down and let us be, we need to show her things are going to be alright. We don't go about this by diving into the deep end head first and hoping she will just get over it. We dip our toes in, providing constant reassurance to her (nervous system) that things are going to be just fine. After she's comfortable with our toes being a little wet, we can then wade around the shallow end for a bit. Once she's cool with that, we can slowly make our way over to the deep end and then the diving board and so on. That's graded exposure in a nutshell.

We have to show the body and nervous system that things are going to be just fine. The more positive encouragement we send the body, without entering the danger zone, the quicker we can return to our normal scheduled activities. Eventually by doing this long enough and continually progressing, what used to be very threatening to the body, becomes a walk in the park.

This can take a while, especially for those who have been in pain for a long time. However, to get out of pain and back to what we love, it's completely worth it.

Where do I go from here?

Without shamelessly tooting our own horn, we can help! We are experts in getting people out of pain and back to the activities they love. The first thing you need to do is get assessed by one of our professionals. Everyone's different, and before we can create a game plan, we need to understand you.  

Do I need to talk to my doctor before coming to PT?

In short, no. In the state of Missouri, no laws restrict you from directly seeing a physical therapist for a musculoskeletal condition.  

What are we?

We are the Vital Six, offering the best recovery, performance, and physical rehabilitation services in the Kansas City Metro.  

We help our patients get out of pain and get back to doing what they love 2-3x faster than the industry average.

Next Steps

Call us at 913 303 0032 now to get back to the life you deserve.

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