In the first few days after my recent back spasm, I instinctively minimized my movements, but after the acute pain had subsided, movement became my therapy. The initial role of pain in this case was to cause me to restrict motion, to protect the area, and to remind me to use caution. Once that pain diminished and the aggravated tissue healed, I was left with something more like a nagging ache, a feeling akin to that sore, tired back feeling many people have at the end of the day, only for me it began upon rising. Emily insisted no lifting whatsoever until the pain was gone, but she encouraged walking and gentle yoga. The first day I was feeling well enough to be back in the gym, she told me that the purpose of my lifts that day was strictly to reassure my brain that my body could still move safely. This was important, she explained, because often our brains hold on to a memory of pain and experience it as though it is real for a longer time than the pain serves the purpose of protecting the body. The point of my lifts that day was not to work up to a certain weight on the bar, but rather movement for the specific purpose of retraining my brain after an experience with acute pain; in other words, medicinal lifting.
From my own past experience, this made complete sense. I had twisted my knee up badly in a skiing injury in my 20s. Sometimes it still bothers me, but these days I can fully bend it. That was not always the case. I remember yoga classes in my 30s where everyone else was sitting on their heels “ohmm-ing” and I was practically bolt upright with my knees at nearly a 90 degree angle. A yoga instructor had said something similar to me, that my knees had been so well trained to function in protective mode that they would not let me bend them, and she suggested that perhaps my pain had outlived its usefulness. Carefully and slowly, over several weeks, I worked on inching further down onto my heels and was surprised in the process that it was my memory of the pain which had been more real than any physical pain. The result is that now I sit on my heels regularly and easily.
My experience with my knee suggested to me that pain does not always result from an outward cause, but is often the very real manifestation of something going on internally. Perhaps you’ve had a similar experience with pain. Emily sent me a link to a great article called “Aches and Pains” by Austin Baraki, MD and Starting Strength Coach, which gets at this point. Baraki discusses the inadequacy of the traditional theory of pain, the “‘bottom-up’ theory, [in which pain] start[s] at the tips of your peripheral nerves … and then converg[es] along a one-way street towards your brain” (1). He points out that this model is insufficient to explain the discrepancy between a patient’s experience of pain and clinical indications that a patient should or should not be experiencing pain, beyond the six week window during which injuries generally heal:
“There are countless patients with debilitating symptoms from fibromyalgia, chronic pelvic pain, chronic back pain, or prior sexual/physical abuse who have undergone numerous examinations, MRIs, and laparoscopies with no evidence of structural pathology or tissue injury. There are many more walking around with objective radiographic evidence of severe osteoarthritis and herniated discs who have no symptoms whatsoever.” (2)
The confusion that these patients and their health care providers feel as a result is attributable to the inadequacy of the “bottom-up” explanation of pain. Instead Bakari suggests that the biopsychosocial model of pain is more accurate. This model recognizes the complexity of our systems and the fact that “the brain uses multiple additional inputs to modulate our sensory experience” – inputs such as environment, emotional state, duration of pain (2). The biopsychosocial model recognizes both objective and subjective causes of our experiences of pain.
Based on this model, Bakari makes some excellent recommendations in dealing with pain, which in his example diagnosis was most helpful to me at the time, since he chose to discuss back pain:
“1. Managing stress, anxiety, and depression (much easier said than done)
2. Education about back pain to reduce the fear that your pain is reflective of constant ‘danger’
3. Getting adequate sleep
4. Avoiding use of opiate pain medications and ‘muscle relaxants’ (although acetaminophen / NSAIDs may be helpful)
5. Exercising – or, even better, training – to move through previously ‘threatening’ ranges of motion
6. Continuing to participate in normal activities (ie, avoiding immobility!)” (8-9)
Something similar might be said of pain that is purely emotional in its origins. Often we hang on to the memory of a wrong done to us or a traumatic event longer than necessary, causing us to avoid certain people or similar situations or to mask our emotional pain with distractions and destructive behaviors. Certainly the biopsychosocial model of pain suggests that physical pain can be the result of our emotional state, the manifestation of stress, anxiety, and depression. Perhaps we’d benefit from following these guidelines in situations of emotional pain too: take care of our physical health, learn what we can about the situation, and move through the pain rather than stuff it down or avoid it.
However that plays out in terms of emotionally generated pain, I know that going through the motions of my lifts on that first day back at the gym allowed the slight, lingering, achy feeling to dissipate further. Movement helped me change the painful mind-body conversation that my injury had initiated; it was a necessary part of my healing process. Those lightweight “medicinal deadlifts” were among the first steps in re-training my brain and in building a different kind of strength.