I saw a comment on Twitter today which really broke my heart, so I wanted to write this and make it clear:
If you are experiencing pain hypersensitivity (through central sensitization), there is every reason to hope.
If your nervous system has changed one way, it is possible to change it back.
It won’t be easy, and the way forward won’t always be obvious. But you can do it.
If you are experiencing central sensitization (as the result of an injury, a trauma, or other extreme physical or emotional experience) you have become more sensitive to pain than you used to be. Your body is using pain as a way to protect you, but it is treating you like you are made of glass. It is trying to protect you from everything.
Scientists are still researching the myriad of ways in which this happens. So far, they have identified multiple different mechanisms within the nervous system which can cause this extreme response to pain.
However, the good news is that we don’t need to know everything, yet, about how this process occurs to start treating it. (Although our treatments will only get better in the future, with more knowledge).
But you can start, right now, by learning what your body is capable of, and identifying the things your nervous system is warning you about that aren’t actually dangerous.
For me, it took a really smart and capable physical therapist who had studied with Neil Pearson. I expect that you will need a guide as well– someone who you trust, who can walk you through and help identify the ways it is safe for you to try to push through the pain.
Your best bet will be a physical therapist who has advanced knowledge of recent pain science. (A PT with this knowledge might not easy to find, at first, but luckily it’s becoming easier and easier. If you email me at email@example.com, I can help you get started).
What you need is someone you trust, who you will believe when they tell you your body is capable of more.
Someone who is able to think flexibly and come up with more than one way to do an exercise, if you tell them the first way they gave you doesn’t seem to work.
Someone who will understand that it’s not only about what they learned about the body in school… it’s also about you, your nervous system, and your experience as a patient. Your nervous system has to be convinced that your body is safe, before it’s going to stop making things hurt.
Changing your beliefs about pain can have a direct impact on the pain you ultimately experience. When you truly learn and understand that your body is giving you pain in order to protect you, it stops being so threatening. This is known as changing your pain from the top down— from the brain to the body.
Of course– it’s equally important to keep working on your pain from the bottom up– from your body to the brain.
If you have chronic pain, or have suffered from some type of injury, your muscles are probably tightened into protective spasms. This, in turn, will make them weak, if it goes on for long enough.
So you have to work on the pain from both angles. You need to calm your nervous system down, and help it understand that not everything is dangerous. But you also need to give your body what it needs, and do everything that you can to help it function optimally.
Doing both of these things is a balancing act. Getting back in to shape is not about pushing through the pain. It is not a “no pain, no gain” mentality.
Instead, it is about being mindful. Being careful. (And again, ideally, having a trusted coach by your side).
To respect your nervous system, and to accept your body where it is currently at. Not trying to do too much, too soon, but instead starting where you can. If you can only walk for 5 minutes, walk for 5 minutes. If you need to ice your injured knee before you work out, ice your injured knee.
It’s about bringing all of these different things together, and figuring out what works for you.