Take a moment; how are you right now? Look around you, what can you see, hear, feel, smell; what do you notice? How are you feeling?
A recurrent theme in a lot of the professional reading I am coming across is our mental and emotional state and how it affects our experiences and perception. Tom Goom of The Running Physio explored a recent study looking at the effects of catastrophising (worrying about the worst possible outcomes) and how mindfulness may help with managing knee pain in runners: https://www.running-physio.com/mindful-knee/. Research into pain has noticed that we can train our brain: if we focus on and worry about the pain our perception of it becomes magnified as the brain is on high alert; if we can divert our attention onto other things or engage calmly with the sensation (for instance by understanding what is happening and so dampening anxiety) the brain tones down the pain message. Pain is a sensation; it can be a response to our emotional situation as well as to physical injury - the brain does not distinguish between the two - and how we respond to pain influences our sensation.
How we communicate with people experiencing pain is important. People may worry that if their pain sensation is reduced then their other symptoms will not be taken seriously; this may cause them to focus on and nurture their pain. The fact that pain is controlled by the brain may cause people to worry that they will be told 'that it's all in their head' and not be taken seriously. Pain is our brain warning us about something; once the warning signal has been acknowledged we can ask it to turn down the signal whilst we explore what caused the alarm. However whilst pain can be triggered by physical damage, it does not always mean that there is injury; sometimes pain sensation is triggered by the brain recognising a scenario that it associates with danger and injury.
Our past history can have a major effect (see my previous blog post linking to Lorimer Moseley's research, http://hedgerowremedies.blogspot.com/2021/01/retraining-brain-around-persistent-pain.html). Back in 2018 I began to experience debilitating, increasingly intense sciatic pain; it became so intense that I began to experience panic sensations. I didn't understand what was happening and the pain episodes became more frequent. I eventually realised that the cause was the effect my knee injury was having on my back; once I understood that I felt the return of some control and the pain became less intense and eventually after treatment went altogether. Recently some of the early signs began to reoccur and I noticed that my nervous system was going on high alert; I was experiencing fear in anticipation of the pain returning. What could I do? First, I acknowledged it; this calms the amygdala down in favour of the cerebral cortex. Next I put it into context; because I experienced pain in the past does not automatically mean that I will again and this time I understand it better. I then encouraged my body to relax - it had tensed in fear - whilst reminding myself that relaxing will encourage better movement and help my back and knee. I then initiated helpful exercises and self-treatment and looked for improvement in how I was feeling rather than focusing on negatives. The feeling of panic retreated and two weeks on the underlying issue is still there but I am feeling ok. I am mindful that fear can cause me to avoid certain movements and that this is not always necessary or helpful; it is beneficial for me to explore movement in a context where I feel safe so that I can expand my boundaries rather than be increasingly constricted.
So, why ask how you are feeling right now? I began with a link to Tom Goom's post on a mindfulness trial that sought to address the tendency when injured to dwell on the injury and worst case scenarios and to be overly protective. Mindfulness aims to take us away from worrying about the past or the future - what has happened, what may happen - and instead notice our immediate surroundings and how we are right now. It places us in the present and allows us to relax as we take in what we can see, feel, hear, taste and smell. From there we can check in on how and what we are feeling and see if we can influence this. Mindfulness encourages us to reflect on some positives; think of three positive things that have happened today. They don't have to be major things; it is restorative to take pleasure in small things. Examples could be a bird or plant you noticed, or enjoying a cup of tea or a book, or looking at the clouds in the sky, wearing a favourite item of clothing or someone saying thank you or smiling at you. Katie Sheen in her course on mindfulness (free at present) describes how she played a game with herself of creating stories around what she could see on her windowsill from her hospital bed to help her cope with her cancer treatment https://www.soulnutrition.org/mindfulness-for-anxiety-udemy-course/. We can retrain the brain to look for positives rather than negatives and this can help us with our pain perception.
Another way of managing pain is to take time to allow the brain to process what is happening. Often when we feel pain we very naturally flinch away and avoid repeating the movement or action we associate with triggering it - this is very helpful in learning to avoid burning ourselves, for instance. However sometimes, if we take a moment, the brain can process more information and maybe realise that in certain situations we don't always need such a strong pain response, or any at all. An example would be when we stumble; if this happened whilst we were recovering from an injury and there was inflammation this would initiate a pain response as part of protecting the injury. This may continue to happen even after the inflammation has gone - the brain has learnt to give a pain warning whenever it senses a stumble; pain can be initiated by the brain's perception of threat rather than actual damage. By taking a moment to process the situation and be curious about how we are feeling the brain can learn that it no longer needs to give the protective pain signal when we stumble. In some cases a conditioned pain response may be having a profound impact on how we move and hold ourselves; taking time to explore this in a safe environment can be transformative as the brain is reassured and lets go of perceived threats.
Pain is real, it should be acknowledged; we can also engage with and understand it. Recovering from injury is not just a physical process, we need to check in with the mental and emotional side too.