As osteopaths, we frequently help people work through various types of pain. Pain may relate to a specific injury, or it could have been gradually building over months or years. Each approach to pain management should be based on the individual. Still, movement is one of the crucial elements of most treatment plans.
In this blog post, we’ll explore what pain is and explain how movement helps you recover from musculoskeletal injuries.
What is pain?
We feel pain when our brains interpret electrical impulses transmitted from pain receptors located throughout the body. The feeling of pain is like an alarm system, telling us to stop because our body is somehow in danger.
There are pain receptors throughout our bodies that, when triggered, transmit electrical impulses along the nerves to the spinal cord and then the brain. We don’t become aware of pain until our brains process and interpret those electrical impulses.
There are several different types of pain:
Acute pain: This is short term pain the usually comes on suddenly as a result of a specific injury. It can feel sharp, aching, burning or tight, and typically can last around 7 days. This is essentially due to the damaged tissue going through the process of clotting, like a scab that forms on a cut. After this period, the pain is considered to be sub-acute and can last 6-12 weeks for tissue healing and recovery.
Chronic pain: This tends to be the after-effects of an unresolved injury, or may occur gradually for no apparent reason. The pain can feel achy, stiff, or tight, but can also be sharp, stabbing or burning in nature too.
Neuropathic pain: This is caused by damage to the nervous system and is usually chronic. Pain isn’t necessarily triggered by an event or injury but can cause pains such as burning, numbness, shooting, tingling or pins and needles.
This pain can be caused by something in a part of your body getting too hot, compressed, or irritated by toxins.
Connective tissues absorb force, and when muscles contract, force is transferred through the muscle to the tissue. Connective tissue shortens and lengthens in response to these forces. The body will absorb some of this force, but it will get to a point where it’s interpreted as pain. Sometimes this pain will have a gradual onset. Your body may have been under pressure for a while, but your brain has only just started to interpret the pain.
For example, muscular pain could be caused by a build-up of tension. Joint pain may be caused because there is increased blood flow and therefore increased heat interpreted as pain.
How is pain measured?
Pain is measured by health professionals using the Visual Analogue Scale (VAS). This score allows us to measure your perception of pain on a continuum from nothing to the worst pain imaginable.
We use this scale to measure your pain at the initial appointment and to gauge your progress throughout treatment.
Why movement is crucial for pain and injury recovery
We no longer believe in the philosophy of ‘if it hurts, rest and don’t move’. Research has shown that movement and the correct exercises help reduce musculoskeletal pain. That’s why we prescribe exercises alongside manual therapy techniques (including manipulations).
But why does movement help pain? Exercise helps improve blood flow which carries away toxins and replenishes the nutrients around tissues. That’s essential in the healing process.
Let’s take inflammation as an example. Pain in the first few days will be a significant warning sign to your brain to protect yourself from further injury. The inflammation has stopped you moving, and the increased blood flow will be replenishing nutrients.
After the acute pain phase (usually up to 7 days), we want to start resolving the injury by looking at the cause. If you don’t fix this, you may easily re-injure yourself by going straight back to a full range of movement. That starts an injury-pain-injury cycle, which is not what we want to see.
Once we narrow down the cause of the injury, we slowly start to increase the load we’re placing on your tissues. The load is the force or resistance placed on tissues. When you’re injured, we take that load down to the bare minimum. But to recover, we need to build up the resistance again slowly.
Let’s say you’ve injured your knee. You certainly can’t squat, let alone with any extra weight or resistance. If you rest until you feel better then go straight back into weighted squats, your body will be put under immense stress. What we recommend is slowly building up the load again. If your knee is severely injured, that load may look like just lifting your shin.
Ultimately, I believe doing something is better than nothing. Our tissues respond to load; they heal under load. The can’t heal correctly while being rested.
When should I avoid movement?
While you need to move to work through an injury, there are some cases when you need to rest. If you ever feel a sharp, stabbing, or shooting pain, then you should stop moving. That’s a big warning sign to your brain that your body is in danger.
When we work with patients, we go through a series of movements and exercises to load the tissues within an acceptable and healthy level of ‘pain’. On the VAS, we would be looking at a 3 to 4. That will feel like an ache or tension and allow your body to continue building up load resistance. We know inflammation will bring regenerative nutrients to that area, and creating a healthy load is part of that. Moving within a 3 to 4 on the VAS is a healthy amount of inflammation. This is especially true when recovering from tendinopathy.
So what does all this mean?
Movement is a vital part of injury recovery. But the level and type of movement will always vary based on your individual needs and capabilities. While some low-level pain is expected during recovery, you should stop movement if you feel sharp or stabbing pain.