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 firstname.lastname@example.org, 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.
But then, 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.
If you are weak, you are going to have pain and be at risk for additional injuries. (This is why I went on to develop so many additional problems after I first suffered from compartment syndrome as a teenager, because I had ended up so out of shape).
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.
I touched upon this once in an earlier post, and I have to say, I think I phrased it really nicely:
“There is a middle way, where you learn to respect your body’s pain without automatically assuming you are injured. This means you respect the pain and don’t try to push through it, but you also know not to freak out because you recognize that your nervous system sometimes gives you false alarms. It’s about being okay with the possibility that maybe you strained something and need to take it easy, while knowing that you probably didn’t.”
This is the balance you eventually need to find, and having a trusted coach by your side who can help you understand what’s going on in your body can make all the difference.
This is the physical therapist I hope someday to be. The person who understands and can walk you through, even when the path ahead seems scary. I have been there myself and I know what it’s like.
I also know what it’s like to regain trust in your body. To go from feeling as though you are made of glass, to knowing what you are capable of– while also knowing your body has limits, and learning to honor them.
This is the balance you need to find. It won’t be easy, but it is possible.