Hurt vs Harm
A common question when someone is dealing with a pain that is musculoskeletal in nature is, “How do I know it is safe to be moving?” When we are experiencing a new type of discomfort or even a pain that has persisted for years, we naturally become avoidant in fear of making it worse or enduring “harm” to the body.
There’s a lot to unpack when it comes to talking about pain. Firstly, I think it is important to acknowledge that pain is a protective mechanism interpreted by our nervous system. Yes, that means your brain plays a key role in every type of pain. However, how our nervous system is interpreting the pain can sometimes prove to be more unhelpful than helpful. Ever accidentally touch a hot burner? The body works quickly to withdraw your hand from the burning stove top as a protective mechanism. The nervous system understands that this type of stimulus can cause serious bodily harm. There’s no questioning that this is a helpful response. What about the individual that has a below-the-knee amputation but is suffering from foot pain or otherwise known as “phantom limb pain”? There is obviously no harmful stimulus being applied to the foot where the body must withdraw to avoid bodily harm. This is an unhelpful response from our nervous system. To better understand pain, we must recognize that there is pain that is harmful in nature and there is pain that is nothing more than hurt.
Understanding the difference between hurt vs. harm is not as difficult as it seems. Pain that can cause bodily harm more than likely is acute in nature. Acute simply means that it began suddenly and has only been present for minutes, hours, or perhaps days. If you recently endured a traumatic injury and are dealing with high levels of pain that is impacting sleep, is not improving with over-the-counter meds such as ibuprofen, or there is an obvious deformity, this could potentially be a “harm” pain where urgent care from an experienced medical practitioner is recommended.
Ironically, as I was writing the above paragraph I had an individual walk into my room with a question about her low back pain. Three days prior she was moving heavy equipment and awoke the next morning with severe pain in her back. To the point, she could hardly walk. Her symptoms were localized to her low back, ibuprofen had been helping, and she did not describe any pop/click/catch or instantaneous 10/10 pain after moving the furniture. By spending 10 minutes with her, I was able to obtain a strong subjective history, gently stretch her low back/hip, and instruct a few exercises.
Most of us have experienced the above type of pain or know someone who has endured those very similar symptoms. Again, it is natural for us to want to withdraw from the pain by avoiding movements, holding our breath, and psyching ourselves out that this could be something serious. By this lady taking the courage to pop into the room, ask good questions, and be willing to trust my evaluation, I was able to make her feel comfortable and safe, have her pain levels lowered, and most importantly understand that what she is dealing with is a HURT and not a HARM. I bring this up as I understand it is not your job to always know if it is a hurt or harm and sometimes seeking the right medical advice sooner than later is helpful. This individual will likely be pain-free within the next few weeks without the need for advanced imaging or prescription medication. Don’t get me wrong, maybe this could have been a “harmful” type of pain. A trained physical therapist will quickly know if this is something that requires a physician referral or not.
If we are dealing with a “hurt” type of pain, there are still very important characteristics to consider. This includes the level of irritability, the nature of the pain, and what aggravates and eases the pain. The level of irritability is perhaps the most important characteristic to understand to ensure you are not harming yourself. Simply put, how much stimulus is needed to make the pain worse, and how long does the pain take to calm down if it is irritated? Someone who is highly irritable, meaning the pain can spike with basic activities and/or can take hours or even days to calm down after being aggravated must be treated very differently than someone who requires 3 miles of jogging before the pain starts and the pain will then decrease within minutes after stopping their jog. Often, it is not helpful to push through your pain. The consensus with medical providers is generally anything more than a 4-6/10 pain is not helpful to push through. We must respect our pain as the “no pain, no gain” adage can sometimes be harmful and increase the irritability of our symptoms. Again, it is not your job to always know if it is safe or not to move so I recommend that if you are someone who questions this, please ask for help whether it is myself or another provider. Being in pain is not normal.You will be shocked by the value of understanding what is causing your pain, what is safe and unsafe, and what are the steps moving forward.
Now, there are certain situations where “no pain, no gain” does apply. A common diagnosis that fits this description is adhesive capsulitis, or otherwise known as a “frozen shoulder.” Someone with a frozen shoulder needs aggressive stretching to improve. Pain will be part of the process, but again, having the knowledge of what you are dealing with will instantly ease your symptoms and you will have not only have increased willingness to move but also understand when it is important to back off and respect your symptoms.
We all deal with aches and pains. It is impossible to categorize each type of pain in a blog. Here are some important takeaways you can implement to better understand the type of pain you are dealing with: 1. Acute traumatic injury with obvious deformity = get immediate help. 2. Nagging or worsening pain and not sure if it is safe to move = use your level of irritability as a guide for how much to push it. 3. Don’t push past 4-6/10 pain in any scenario. 4. ASK FOR HELP. It doesn’t always end in pills and surgery; often healthy movement is the prescription. 5. Knowledge is KING, understanding your pain will often begin to ease your pain.
Pain is so incredibly complex. I hope to write blogs in the future that dive much deeper into the understanding of pain. Don’t ever normalize pain and don’t wait for it to get worse. A 15-minute phone call or a 15-minute screen in the office with a physical therapist will likely be enough to steer you in an appropriate direction.
I offer free discovery calls which include a 30-minute block on my schedule to take the time to listen and understand what it is you are dealing with. A simple call with no strings attached can change your life.
Until next time,
Dr. Ryan