Movement as Medicine

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.

Medicinal Deadlifts
Medicinal Deadlifts

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.

Initial Steps in Understanding Pain

As a culture we seem to be somewhat conflicted in our views of pain. Many of us believe that pain is a part of exercise, an indication that we are working hard.  We confuse the discomfort of pushing ourselves in a workout with actual pain.  When we feel real pain in our training, many of us ignore it and push on.  We wear T-shirts with catchy slogans like “no pain no gain”, as though being in a state of pain is praiseworthy. And even while many of us almost glorify pain in the context of exercise, we mask the signs of physical pain in other areas of our lives with ibuprofen, and we hide emotional pain from ourselves in busyness and addictive behaviors, possibly viewing pain as weakness.

When we actually do take the time to investigate our pain, we often do so through our intellect rather than through our bodies. We research, Google, and read what others have to tell us about our pain rather than listen to what we are actually experiencing.  We are more inclined to trust what someone else tells us about our condition than we are to actually experience our own pain to learn what our own bodies have to say about what makes us feel better or worse.  We focus our attention outward rather than on what’s happening within us.

I am no different.  When I hurt my back recently my first reaction was to email my experts, Louise and Emily, asking them to decipher my pain for me from three states away. I wanted answers: What did they think I had done?  Pulled muscle?  Slipped disc?  Which specific muscles were involved? How should I fix it?  Louise tried to explain to me that really I would need to answer my own questions and that I would not find those answers through my intellect: “You can not think your way out of your back pain,” she told me.  Instead she suggested that I would be able to find the answers I really needed, what made it better and what made it worse, by listening to my body not my mind.  That I would be able to find the initial answers I sought through breath and feel and movement. Once I had those initial answers, I could go from there with better understanding.

This first step of understanding through our own bodily experience, rather than through intellect or through an expert opinion, is one that I was trying to by-pass, in my impatience to be better.  And as Louise and I discussed later, it is fairly typical of the way most of us function.  We often first look externally for a diagnosis, for generalized expert advice about how to deal with our specific situation.  This is often less helpful than learning how our particular bodies respond to our particular situation; as Louise says, it is like “putting duct tape over your crying child’s mouth without any conversation about what the matter is and what can be done to take care of it, both in the immediate moment and for the sake of preventing it in the future.”

It seems like many of us try to by-pass this initial step, not wanting to take the time to learn what our bodies might have to teach us.  While I’m definitely not advocating for people to walk around in constant physical pain, certainly not sudden or acute pain, without seeking treatment, what I am suggesting is that pain is neither a sign of weakness nor something that we need to fear any more than it is the hallmark of an effective training session.  It is really just our body’s way of asking us to pay attention, to turn our sights inward, to be aware.  Perhaps if we take some time to find our own answers first, to pay attention to what makes our pain more or less intense, to trust our own bodies, than we will be better able to advocate for ourselves and provide useful feedback if we do need to seek medical attention.  Perhaps if we try to understand first through feel and then through intellect we can be more active participants in our recovery.