Episode 15 | How to Recover from Pain
I'm in pain. Now what? We all know what it's like to experience an injury or a flare up. There's a moment of shock, a moment of fear, and then the inevitable question: "What do I do now? How do I move forward?" Hey everyone. Welcome back to Mind Your Body. I'm Dr. Zev Nevo, your source for pain and trauma-informed psychoeducation and the exploration of Mind Body Rehabilitation.
This episode is about moving from a reactive response to a proactive strategic plan for healing and recovery.
One of the questions I explored in depth over the past few years was determining what factors are most impactful to help people who experienced pain [00:02:00] recover? What is recovery? Recovery is a bit of a buzzword to be honest. It can have vast implications and meanings, depending on who is the human being experiencing pain.
The meat of the question is: is removing pain alone sufficient to recover? The answer may be surprising to some and extremely obvious to many: No.
Pain reduction is only an initial step towards lasting recovery.
In truth, there's a bit of a mess to clean up. In efforts to keep us safe, and depending on how long we have been in pain and how sensitized we have become to our pain, we have so much more than pain alone to still overcome. This is why pain interventions in isolation, be it medications, [00:03:00] injections, massage therapy, alternative and complimentary medicine modalities, or even surgery, do not often provide lasting pain relief or necessarily help us get back fully to the life and the lifestyles that we were seemingly stripped of as a result of our pain experience.
Recovering from pain is about moving from an event to a process, and it all begins with understanding the protective habits our bodies form, both physically and nonphysically.
When we experience a painful event, a sprained ankle, a strained back, or a repetitive injury such as tennis elbow, our bodies are brilliant. They immediately engage in what I call protective habits. These are physical changes you might not even realize you're doing. The altered posture, [00:04:00] the subtle limp, the guarding of a body part, or a constant muscle spasm.
Muscle guarding, in particular, is a fascinating phenomenon. Where our nervous system instinctively contracts our muscles around an injured area to create a protective halo and splint, which helps to offload areas of our body that need space to heal. On the surface, these habits are a really good thing.
They are our body's best attempt to keep us out of pain.
They're like a temporary cast or a protective brace automatically positioning us in ways that offload a sensitized or injured area. They are an initial brilliant survival response. Many patients after shoulder injuries begin to carry their arms slightly higher in a shrugged position .
[00:05:00] Their head may come a little more forward. Their shoulders protract a little more towards the front of their body. Their bodies are trying to protect the injured tissues from further stress, and it works, but it only works for a while. Here's the problem. These temporary solutions are not meant to be permanent. Over time, they become long-term problems in of themselves. These physical protective habits often have significant drawbacks. Let's get into it. First, they require more physical energy to maintain, which often leads to earlier fatigue when we engage our bodies. Think about trying to hold your breath for a few seconds. Now, imagine holding it all day long. That's what these habits feel like to your nervous system. Second, [00:06:00] they become a constant physical reminder that something isn't okay. The limp that you see in the mirror or the posture you feel can keep pain in the forefront of your awareness, reinforcing the brain's alarm system. I recall a patient who for months after a knee injury would still limp, even though the interventions and physical therapy had restored all of his strength and range of motion. The limp had become a habit, a constant cue and reminder to his brain and his body that his knee was still vulnerable to injury.
Finally, these compensatory movements can often create secondary pain syndromes. This is what happens when the fix becomes a new problem. We see this with diagnoses like myofascial pain or greater trochanteric pain syndrome, where unconscious [00:07:00] modifications of how we position our bodies when we lie down, sit, stand, or walk, create new, confusing layers of pain.
These are often addressed with manual therapies and modalities such as acupuncture, dry needling, cupping, scraping, rolfing, massage, et cetera. usually with only temporary and unsustained relief.
I often tell my patients that these therapies address the smoke and not the fire. They're intended to remove pain, but not fix the abnormal loading forces that led to the development of pain or the impaired patterns of movement that are compensatory to pain.
True lasting recovery requires a more comprehensive strategic approach. What does this plan look like? It's a phased approach that moves you from being reactive [00:08:00] to being proactive.
These are the seven intentional steps that reforge new, healthier neural pathways and restore function. Number one, acknowledging our pain. The very first step is to honor the pain we have. This is the stage where you simply rest, protect the area, and allow your body to do its initial passive healing.
Number two is aiming to achieve painless range of motion. We begin to slowly restore mobility in the injured part of the body. We work within a safe, comfortable range, getting your body slowly reacquainted with movement without triggering the danger signals of pain. Let's call this testing the water.
You don't jump into the deep end. You just dip a toe in to see if it's [00:09:00] safe.
Once we start to experience safe sensations in the region that previously sent messages of pain, we start to trust our bodies to move into these positions again . Number three is progressive strengthening. Once we establish healthy, painless range of motion, we begin to lean into it and strengthen, but in a progressive manner.
Not all strengthening is equal. We start with what we call closed chain movements where our hands or our feet are fixed against a surface, and isometric contractions, which is tensing our muscles without movement of the joint. These are inherently safer because they provide stability and stimulate muscle activation with less stress to the joints. They feel safer to our nervous systems. We progress strategically towards more [00:10:00] stress. Number four is multiplanar movements.
We start to add complexity. Our body doesn't just move forward and back. It twists, it rotates, it moves in all directions. So we start to move beyond simple movements to incorporate balance, coordination, and proprioception, which is our body's ability to know where it is in space.
We are retraining our brain and our bodies to work together in more complex, real world ways. Number five is repetition. This is where the magic of neuroplasticity really comes in. We repeat these new, healthier movements with intention. This repetition helps to prune away old, unhelpful movement habits and patterns and forges new pathways.
Let's call them new muscle memories. Number six is return to play or return to work. [00:11:00] This is a crucial phase of reentry. We transition from general exercises to highly specific and targeted movements required for your sport, your job, or your hobbies. We test the new muscle memories in a safe, controlled way, preparing you for the full demands of your life. And finally, number seven, which is maintenance. The final phase is about making this new way of moving and thinking a permanent part of your life. We use a combination of interval training, biofeedback, and a conscious queuing to maintain strength, build endurance, and proper form so that we can best and most confidently prevent future flareups of pain in the future. This plan moves you from a state of injury all the way back to a state of resilience and readiness. However, these are all generally [00:12:00] physical strategies we use in rehabilitation to help us recover.
Let's pivot now to the non-physical side of this equation which is often not talked about or discussed. A nd in many ways this section here is the why behind our continued physical dysfunction, and why so many people continue to have pain chronically, and continue to suffer with pain despite their initial injuries having healed or the expectation of it having healed. Our recovery from injury is profoundly influenced by how we feel about our pain.
Here are seven consequences of a negative emotional state on our physical recovery. Number one, how we feel about pain, our fear, our frustration, our need to fix it, and our focus ends up driving the suffering of the pain experience [00:13:00] itself. This suffering is not the sensation of pain itself. But it's the emotional layer and the meaning that we attach to it.
As Dr. John Sarno, a pioneer in mind-body medicine once said, pain is a perception. It's not necessarily a fact. Our beliefs about pain and our fear of it can be more debilitating than the physical sensation itself.
Number two: This emotional state sets off a chain reaction that increases the chronicity of the pain and augments the unpleasant sensations. It's quite a feedback loop. The more you fear your pain, the more you focus on it and the more it consumes you.
Number three, the brain and its protective drive seems to keep moving the needle and limiting our mobility, in many cases, even more than what caused us pain in the first [00:14:00] place, with no differentiation of physical and non-physical triggers.
The brain cannot differentiate between emotional and physical stress, and when pain is experienced chronically, the patterns of protection and guidance towards safety, the involuntary guarding tendencies that we have, and the regions of the body that tend to tense up when we experience stress remain engaged, so long as our physical and non-physical triggers remain in place.
Number four: the predictive brain anticipates pain even when there is none. Which can paralyze us and become a major barrier to participation in our physical therapy and home exercise programs. This concept is explored in books such as The Way Out by Alan Gordon. The brain predicts a threat and creates a pain response [00:15:00] in order to keep us safe.
Number five: our decreased activity can lead us to deconditioning and limited activity tolerance, especially for vulnerable populations.
When we stop moving because we feel or fear pain, we lose strength and endurance, which makes us even more vulnerable to injury. This becomes a real danger in of itself, especially for older adults who can develop acute deconditioning within days of inactivity. Number six: the non-physical spiral drains us completely. Physically, mentally, emotionally, and cognitively. It often leads to severe irritability, a general hypersensitivity to almost all sensations and stimuli, a state of anxiety , panic, and even brain fog, making you feel [00:16:00] like you haven't slept in days.
Number seven: Ultimately, this can lead to learned helplessness where we become so exhausted by the fight that we stop trying. This makes us apprehensive to try new treatments, and we begin to doubt that anything will ever work. This becomes a very strong chain that binds us to pain and is called the nocebo effect, where our negative expectations actually make an intervention, regardless of the intervention, to be less likely to be effective.
So how do we break this cycle and find a new way forward? Well, here are seven tips for addressing these pain habits. Number one: understand how and why these habits were formed to begin with. At one point, they were necessary to keep us out of pain. Number [00:17:00] two: acknowledge this brilliant survival mechanism, but consciously decide that in this moment they're no longer serving you.
Number three. Honor and respect their legacy, but gently begin to transition away from them. Number four: paint a post pain picture. Ask yourself the following, what does my life look like without pain? What would you do tomorrow if you woke up with less pain and weren't afraid of it coming back? This isn't about being naive, it's about shifting your state of mind to one that is conducive to healing.
A simple trick is to lean into moments when we experience less or no pain during the day, and take a mental snapshot. Tell yourself, look, my body has the capacity to feel less pain here. Number five: pilot your body like a [00:18:00] plane. Imagine your post pain picture to be a destination.
You are now tasked with learning how to fly your own plane towards recovery. You don't immediately get into the plane and start flying. You begin with reading the manuals. Y ou practice navigating in simulation mode.
We call this somatic tracking, where we start to imagine the movements, the positions, and all of the triggers that tend to aggravate our pain without actually moving into those positions, and we start to notice what changes we experience in our thoughts and in our bodies.
The next step to becoming a pilot is progressing towards flying exercises on very safe runways. Think of bright skies, long runways, no traffic. This is comparable to what we do in rehabilitation when working on [00:19:00] restoring painless range of motion gently with support using closed chain kinetics.
We understand that with every flight there are always clouds to get through when taking off and landing, and those clouds are comparable to our periods of warming up and cooling down. There are times where we tend to feel more discomfort, and these can be turbulent or annoying, but guess what? They're absolutely necessary in order to get to our destination.
Number six: recognize that rehabilitation from pain is inherently confusing and seemingly contradictory. Because it often requires us to expose ourselves to some level of discomfort and pain in order to get rid of pain in the future. Having reassurance and clarity about the severity of our diagnosis and our injury [00:20:00] is paramount.
Having trust in a provider who has adequately and thoroughly listened to our pain experience and that we feel viscerally understands what we are going through and what our goals are, and how we have been impacted by our pain and understanding what our care plan is moving forward. Not feeling pressured to proceed with one or another type of intervention,
and someone who has helped instill in us a sense of restored hope and optimism that we can actually have a life back without pain.
Not merely offering an intervention and saying, come back if it hurts, and we'll do it again, but giving us a path forward, helping us see what our destination is, understanding there's gonna be turbulence along the way, but giving us a general sense that somebody is there with us, reassuring us in [00:21:00] the movements that still cause us pain, but are safe and helping us troubleshoot when pain becomes a barrier for us to move forward.
Number seven: trust the process. Recovery from pain is an investment. We often don't see an immediate return. It requires so many things from us such as hope and optimism, trust and knowledge, qualities that are often in very short supply when we're stressed and in survival mode. By learning to internally and viscerally trust the process of recovery, you can move from a state of reactive defense to a state of proactive conscious healing, because our bodies need the right context in order to heal. If you have an acorn and you put it on your bookshelf, it will not grow into a tree. You must nurture it in the right soil with the right [00:22:00] food and water and microenvironment to be conducive to healing. So too, when we experience pain, we need to nurture all parts of ourselves in order to create an environment that is conducive to heal.
We need to acknowledge our pain. We need to work towards diminishing our pain. We need to trust the fact that recovery often includes experiencing more pain along the way, but trusting that our bodies will continue to progress towards healing and recovery.
So, here's your take home challenge for the week. Number one: identify one physical and non-physical protective habit that you've formed when you have experienced pain. Number two: take a mental snapshot of a moment where you experience less pain during the day, no matter how brief. N umber three: begin to paint your post pain picture. What is one small thing you would do tomorrow [00:23:00] if you woke up with less or no pain? Finally, ask yourself: what does recovering from pain actually mean to you? Before we conclude, I wanna leave you with a quote that I believe beautifully encapsulates the entire message of today's episode. " Our fears are always more numerous than our dangers." This profound quote from the stoic philosopher, Seneca the Younger, reminds us that while our pain is a very real sensation, our mind's interpretation of it often creates a fear that is far greater than the actual physical danger. By understanding the mind-body connection and consciously choosing to reframe our thoughts and habits, we can finally begin to create a path towards healing and wellbeing, disarming our fear, and truly taking back our lives.
Thank you so much for listening, and I'll see you next [00:24:00] time.
