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From Powerlifter to Physio and back again – What is pain and how can I deal with it

In this article series, I am going to talk about some key points I have learned on my journey from powerlifter to Physio and hopefully give some good info along the way. I am hoping this article is an easy read into some complex rehabilitative topics and am aiming it at people with some exercise knowledge but little rehabilitative knowledge. 

This is my first online article for Cast Iron strength so I am going to try to keep it interesting and make it easy to read.

Reasons Why People are in pain (pain mechanisms) 

I tore this, I snapped that, my arm fell off…. blah blah blah. Yes everybody knows that if soft tissue damage or injury occurs it will be sore until it heals.  More to the point a specific pain mechanism called nociception occurs, which in essence means pain that is associated with soft tissue damage which will go away when the tissue heals.  Or you can get transient pain which is pain not associated with tissue damage aka I pinch your pain goes away as soon as i stop pinching you. 

Most people’s understanding of pain stops here but there are multiple pain mechanisms in reality which I swear I will only bore you with these for a few sentences. For example there is Peripheral Neuropathic Pain aka nerve pain in the limbs or Centralised pain aka pain stemming from the central nervous system. 

So let me get to the interesting part that shocked me. If we break down centralised pain a little more. So the definition of centralised pain – “Central pain is pain initiated or caused by a primary lesion or dysfunction in the central nervous system (CNS).” (CNS = Brain and spinal cord) 

So yeah if I went full aliens vs predator on you and ripped your spine out you would probably get a pretty big centralised pain response.  And I would have another trophy to add to my collection. 

Everyone understands physical damage to the CNS will cause pain however as research has advanced it is now said centralized pain describes any pain that happens when the central nervous system doesn’t process pain signals properly. 

Centralised pain can sensitise – you feel more pain than you should or feel pain when you should not. Because the central nervous system (CNS) is changeable, nerves that send pain responses get better at it over time. Then small messages of pain start to respond as if they are big ones. This can happen in the CNS itself at a cellular level. Many patients who have this sort of pain response do so after having an injury and subsequently develop conditions such as depression, fear-avoidance behaviours, anxiety, loss of sleep and other stressors. The stress of these responses can, in turn, further exacerbate the nervous system, leading to central sensitization. 

This is to say- factors such as over worrying due to a lack of education/ knowledge of pain/ injury can stop people from recovering post-injury even after tissue damage has healed- a lot of the time this is what is going on with people who have chronic pain. I feel most lifters and athletes understand this to a degree as many struggle after an injury to get their head back into the game and begin to push up their performance for a while, and what I discussed above is basically this but to an extreme. 

Before becoming a physio I did not realize how much knowledge and mindset can play in recovery post-injury.  Which is why a good clinician will educate you and reassure you about everything that is going on. There are many patients who I have seen who frankly I could not help not because of their physical problem, I knew exactly how to improve that, but because I could not change a poor belief system, a mindset or other mental factor. I have likewise helped people get out of pain because I was seen as a professional in a professional setting, and I simply told a patient they were going to be ok and this was enough to reassure the patient to stop worrying about things so much. However, most of the time the advice and education with reassurance of a person/athlete’s presentation with a rehabilitation plan is the best way forward. Most athletes know mindset is super important for performance, well it’s just as important for recovery post-injury.

Most people see pain and injury as a purely physical thing and you know what, particularly I find with athletes- it is. However make no mistake that the mind, your thoughts, and beliefs also play a huge role in rehabilitation/ recovery too. 

So if you have pain or an injury and you are confused about your presentation- go see a professional specialized in sports rehabilitation- particularly one who builds your knowledge and gives you the map to getting out of pain by building your self-efficacy and confidence. Most good and properly educated clinicians should do this, unfortunately, there are a few who prey upon people with this sort of pain response and add to the patient’s poor belief system with the goal of taking away the patient’s self-efficacy usually replacing it with an over reliance on the clinician. 

But that is a topic for another day but remember kids if you have seen your rehab professional every week for 5 years they probably aren’t doing a very good job, the less you see them the better they are, and the better you will get.

Ali

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