Pain is one of the most intricate sensations that a human being can feel because at times it can be primarily dictated by biology and neurology, while at other times can be heavily influenced by psychology.
Whether or not an individual has a “high pain tolerance” or they’ve “had pain for so long they don’t know life without it”, pain cannot and should not be ignored. It is a signal from your body that something is not functioning properly within your body and needs correction. Sometimes this correction is as simple as a change in position (sitting to standing) and in other cases, pain can be an indication of something significantly more severe occurring.
Is all pain created equal?
As stated above, pain can vary from an acute episode lasting a few seconds (touching a hot piece of food) to an unrelenting, disability pain (kidney stones), and everywhere in between. There are instances where joint, muscle and nerve pain can be abolished rapidly by using a simple directional exercise, adjustment or manual therapy technique.
These forms of pain are predominantly driven by neurology and a signal that a specific intervention or movement is necessary to “reset” the pain signal. When an area of the body does not move well, the body will put “caution tape” around that area in the form of muscle tonicity and pain in order to protect the area and prevent further damage.
If pain has so many causes and mechanisms, how do we address it?
Pain has so many sources and each individual responds differently to pain, which means that attempting to diagnose every condition and attach a pain number to that diagnosis will not cut it. Disc herniations affect every individual differently, some feel no symptoms, others feel excruciating pain even if the MRI looks similar. On the other hand, if one patient can have disabling. 7/10 back pain with no MRI or orthopedic findings while another individual can have 7/10 pain and continue to “train through the pain”.
Pain itself must be assessed and addressed on a case by case basis, starting with proper classification or sub-grouping.
Classification of musculoskeletal conditions is the critical first step in finding an appropriate solution for pain. In our clinic, we use both the Mckenzie method of classification as well as the Pain Mechanism Classification system. With these two systems, we are able to determine if a condition is primarily inflammatory, a mechanical joint issue, a nerve condition or a central nervous system disorder presenting. We are going to summarize the “behaviors” of each of these painful conditions below.
If you are currently experiencing pain or have had pain before, you likely will be able to place yourself into one of these four categories. Once we are able to properly categorize which group your specific pain belongs in, we then have a great starting point for how to approach treatment and individualize your care.
What are the characteristics of inflammatory pain, how do we treat it?
When pain is driven primarily by inflammation, we are generally going to see discoloration of the tissue and/or swelling. This particular type of pain is common after an acute injury such as an ankle sprain. When an individual sprains their ankle, for example, the first step to treatment is taking bodyweight off of that area and reduce the swelling with ice and anti-inflammatory medication.
After a few days of ice and compression, the area may be ready to start gentle movements and therapy can commence. Often times a mechanical condition is underlying to an inflammatory condition so we will first focus to control the inflammation and take a mechanical approach afterward if warranted.
If a patient has inflammatory or chemical pain that is chronic in nature, there may be an underlying health condition that causes a consistent chemical reaction in the body that needs to be assessed using advanced testing and resolved with a functional medicine approach rather than a physical medicine approach.
What are the characteristics of mechanical pain, how do we treat it?
Mechanical pain is the most common type of pain condition that we see in our office. These types of conditions can be acute or chronic but symptoms are very movement and position-specific.
For example, lower back pain that is made worse with sitting and bending over, but feels better with walking. When we have clear condition behaviors such as this we are generally able to resolve these conditions quickly using chiropractic adjustments, manual therapy, and specific exercise prescribed for that condition.
Chronic mechanical conditions can be related to poor tissue healing and chronic injury resulting in fibrosis and scar tissue being laid down in an area. This type of condition will present with repeated pain in one or a few movements that are no variable in nature.
For these types of conditions we will use active release technique, instrument assisted soft tissue therapy and repeated movements to remodel the tissue. This process of remodeling biology, however, is not as rapid as mechanical pain driven by neurology.
What are the characteristics of nerve pain, how do we treat it?
Nerves are some of the most resilient and complicated tissues in our body. All of our sensation and muscle function is transmitted through our nerves. They are the road between our central nervous system (brain and spinal cord) and the outside world. Nerve pain can be the most frustrating and debilitating but also able to be treated rapidly if the appropriate intervention is applied.
Nerve pain is unique in that it may present with burning, tingling, shooting pain, numbness, tingling, and weakness which can be felt locally or can peripheralize (ex. sciatica). In our clinic, this form of pain is generally treated with gentle soft tissue therapy to desensitize, specific chiropractic adjustments to relieve nerve pressure and specific stretches to restore a tight to nerve to resting length and tension.
What are the characteristics of central pain, how do we treat it?
Central pain is pain that may or may not be related to any orthopedic or neurological findings. Generally, pain that is central in nature is chronic and may be related to a traumatic event. If an individual decides to “live with the pain” and does not seek treatment at the appropriate time, they may still experience pain in an area of the body long after that area has healed.
Additionally, if an area has repeated experienced trauma, your central nervous system may send constant and unrelenting pain signals to the area. This specific type of pain is normally treated with patient education and graded exposure to activities. When the body is slowly re-introduced to activity couple with appropriate pain education, even chronic and central pain can be resolved completely over time.
If an activity is painful, should I stop?
What happens when we ignore pain?
When pain is ignored or an individual becomes content living with pain, this is what will ultimately lead to disability. Pain in itself can be debilitating but when not assessed and treated, the long term disability is the only outcome. When individuals first experience pain in an area, they will modify one or two activities at first to avoid the pain, but eventually, any activities using that area of the body become painful. When you ignore pain over time, it becomes chronic, disabling and engrained in your neurology.
All pain should be address because no one deserves to live with pain. Though the pain may not always resolve rapidly or entirely, there are always opportunities to find relief and continue doing the activities you love.
If you are currently dealing with pain and ready to get back to what you love. Please reach out to us, we’re here to help!