There are many misconceptions perpetuated by the medical community these days.

One of the most impactful misconceptions that we experience on a regular basis in our physical therapy practice is the misconception about pain.

after reading this article you will have a new understanding of pain.

If a medical professional has ever told you that because you have a bulging disc, or rotator cuff tear, or osteoarthritis, or any other diagnosis, that you will have pain for the rest of your life, this article is for you.

The standard way that pain is taught is that Pain = Tissue Damage and that Tissue Damage = Pain. This idea has been disproven time and time again by research but somehow this misconception lives on.

Ever find a bruise on your body and wonder how it got there? That bruise is a clear sign of tissue damage but somehow it didn’t hurt. How does that happen?

Did you know that there are a number of studies (referenced below) that show a high rate of “abnormalities” (that include disc bulges, herniations, labral tears, rotator cuff tears) in ASYMPTOMATIC (meaning they don’t have pain) individuals?

Did you know that there are likely a high number of people walking around with full blown rotator cuff tears that have no pain or limitation?

How does that happen?

Let me expand on this:

Did you know that there are no nerves in your body specifically designed to sense pain? There are nerves that sense touch, pressure, temperature, and chemicals to name a few. But it is entirely up to your brain on how to interpret those sensations.

Take this example:

Your eyes sense light, it’s your brain that interprets the light based on your experiences and the context of events and then produces an image that we call vision.

Another example is your ears:

The nerves in your ears sense vibration. It is once again your brain that interprets these vibrations based on experience and context and produces what we call sound.

So how does pain really work?

You experience pain when your body perceives a threat.

Let’s say your walking barefoot and you step on a piece of glass. The nerves in your foot sense something sharp and send a signal to your brain. Your brain then interprets that signal and sets off an alarm. That alarm is pain. The brain has decided that the piece of glass is a threat and it makes you experience pain so that you will stop and remove the piece of glass in your foot.

This makes sense right?

Now, lets make this example a little more complicated:

Let’s say you’re awakened in the middle of the night to a ragging fire in your room. What do you do? You run out of the room. But as your running you step on that same piece of glass. What happens now, do you think you feel pain? Definitely not! You stepping on a piece of glass is much less of a threat than the ragging fire in your room. So you run out of the house with the piece of glass in your foot and only until you have safely removed yourself from the threat of fire, do you start to notice that your foot hurts. This is because the bigger threat has been removed and your body can now worry about the smaller one.

So what does this have to do with physical therapy?

In the example above, the brain activates an alarm based on the brains perception of threat. That alarm makes you sense pain. The alarm can be turned on or off depending on the circumstance, seen in the second example.

Once the threat is removed (i.e. once you remove the piece of glass) the alarm starts to turn off and in few minutes the pain is relatively minor. In a few days the pain is gone.

However, what happens when the alarm stays on?

This can happen in about 25% of people that experience pain.

Remember pain is triggered by the body’s perception of threat. The real key here is that THREAT is multifactorial.

Let’s compare the following two examples:

Example 1: Lets say you’re a quarterback for a professional football team and you have injured your throwing shoulder. You’re midway through the season in the last year of your contract, the season hasn’t been going well and your worried that if you don’t perform this could be the end of your career. You’re married with two children who fully rely on the income that you make. You love playing football, you have worked incredibly hard to make it to the professional level and it’s the only thing that you have ever wanted to do in your life.

Example 2: Lets say you were convinced by a friend to play a game of pick up football and you sustain the same exact injury to your throwing arm. You don’t really love playing football, you barely ever play and you have a secure job that doesn’t require more out of your arm than typing on the computer.

Of these two examples who is threatened more by the same injury? Clearly it’s the professional quarterback. Because the repercussions of the injury have more of a potential impact on all aspects of the quarterback’s life. For this hypothetical quarterback this injury could mean that he gets replaced. If he gets replaced then maybe his contract won’t get picked up again. He could loose his job, his source of income, his identity, and even his opportunity to do the one thing that he loves to do, play football. Think his alarm is going off? Absolutely, there are a number of underlying factors that are making his alarm go off like crazy.

Because of these extra factors it is possible that the quarterback’s alarm will keep going off even as the tissues heal.

The quarterback wouldn’t be alone in this. Remember this happens in 25% of people who experience pain and most people don’t even know it’s happening because all they have ever been told is that pain = tissue injury.

Tissues heal, but sometimes the alarm stays on.

Part of a good physical therapy approach is to identify if someone’s alarm is still on.

Treating the sensitive alarm so that it calms down is just as important as treating the tissues.

If you have gone through failed treatment after failed treatment it’s almost a certainty that your alarm is way too sensitive.

There are plenty of ways to turn down the intensity of that alarm. The first and most important is through knowledge. Studies show that just by understanding how pain really works you can start to turn down that sensitive alarm.

Call/Text today To Book an Appointment.

we can help you turn off the alarm!

References:

  1. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73. doi: 10.1056/NEJM199407143310201. PMID: 8208267.

  2. Bastian SA, Rahmi H, Crues J, Bhanu S, Blout C, Rangarajan R, Lee B, Itamura J. Variations of magnetic resonance imaging findings in asymptomatic elbows. J Shoulder Elbow Surg. 2019 Jun;28(6S):S154-S160. doi: 10.1016/j.jse.2019.05.006. PMID: 31196510.

  3. Gutierrez NM, Granville C, Kaplan L, Baraga M, Jose J. Elbow MRI Findings Do Not Correlate With Future Placement on the Disabled List in Asymptomatic Professional Baseball Pitchers. Sports Health. 2017 May/Jun;9(3):222-229. doi: 10.1177/1941738117701769. Epub 2017 Apr 10. PMID: 28394713; PMCID: PMC5435154.

  4. Gill TK, Shanahan EM, Allison D, Alcorn D, Hill CL. Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. Int J Rheum Dis. 2014 Nov;17(8):863-71. doi: 10.1111/1756-185X.12476. Epub 2014 Oct 8. PMID: 25294682.

  5. Hacken B, Onks C, Flemming D, Mosher T, Silvis M, Black K, Stuck D, Dhawan A. Prevalence of MRI Shoulder Abnormalities in Asymptomatic Professional and Collegiate Ice Hockey Athletes. Orthop J Sports Med. 2019 Oct 10;7(10):2325967119876865. doi: 10.1177/2325967119876865. PMID: 31637270; PMCID: PMC6787880.

  6. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract. 2016 Jul;32(5):332-55. doi: 10.1080/09593985.2016.1194646. Epub 2016 Jun 28. PMID: 27351541.