Central Sensitization, Chronic Pain, Creative Writing, Pain Neurophysiology Education, Pain Science, physical therapy

There is reason to hope.

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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 sunlightinwinter12@hotmail.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.

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.

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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.

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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.

Favorites, Inspiration, mindfulness, My Story

San Francisco, Revisited

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It’s so interesting for me to go back to San Francisco.

As you may remember, I spent a few weeks in SF back in June, following a good friend’s wedding in Napa Valley.

I actually just wrapped up another trip out there. I spent most of September in SF, staying with a friend and trying to investigate whether I’d eventually want to move there for work and/or grad school.

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The city of San Francisco is symbolic for me, for a number of reasons.

Back in 2005, one of my friends from high school (CA) and I had planned to travel to the Bay Area and visit our friend Karen, who was attending Stanford University at the time.

Our trip was actually planned for the same time of year– September.

However, I’d just had my surgery for compartment syndrome that spring, and at the last minute, I freaked out and canceled my plane ticket. After all I’d heard about San Francisco’s hills, I just didn’t think my legs were ready, and I didn’t want to take a chance. So CA flew out by herself, and I stayed behind to mend.

I was 19 at the time, and although I didn’t know it yet, I actually had somewhat of a long road ahead of me. As I’ve mentioned in previous posts, I didn’t travel at all in the first half of my 20’s, and it was only in the second half that I started to ease back into it with local trips, such as camping in the White Mountains of New Hampshire.

As most of you probably know, I developed my problems with central sensitization (CS) around that same time, shortly after my leg surgery. I definitely don’t think the surgery caused the CS, but as something that the body perceives as a “trauma,” it may have been one of the precipitating events.

I’ll talk more about why I developed CS in the future, but for now, what I want you to know is that for the next five years, I didn’t travel at all. The second five years, I got back into it slowly, but only local trips, and not by myself.

So now, at 31, after everything I’ve been through: compartment syndrome surgery, discovering pain neurophysiology education, struggling to heal my sacroiliac joints…. it feels almost like I’m living in a dream world. To be able to travel to San Francisco and walk around to my heart’s content– it’s like I was transported to a parallel universe.

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Here was the moment when it really hit me, how far I’d come:

I was walking from my friend’s house to the gym, and I ended up walking up some really huge hills. Like, gigantic hills– the kind you think of, when you think San Francisco.

And I was just doing it. I wasn’t sightseeing– I hadn’t set out to “walk the hills.” I was just trying to get from one place to another, like anyone. Like a local.

And it was okay.

I mean, if anything, I got a little bit of a wake-up call about maybe needing to do more cardio. But after all the years I’ve spent only being able to work out in a pool, it was such an amazing feeling to be moving through the world, as fast as I wanted, feeling my heart pumping. I was free.

It was a feeling I’d forgotten– to truly push my cardiovascular system to its limits with each footstep, out in the wind, out in the sunshine. For the past few years, I only got to experience that feeling within the safe, weightless environment of the pool.  While I am so grateful for my pool workouts, my trek on this day brought back a form of muscle memory. With the thud of each footstep, I was awake. I was back.

The thing is, this isn’t really meant to be a post about physical accomplishment. Instead, it’s about my unexpectedly “Returning” to an aspect of life that I was prepared to live without.

I had made peace with not being able to move the way I wanted. Not being able to travel, and more or less being stuck in place, taught me to try to always notice the beautiful little things around me. I’m not saying I succeeded all the time, but it was a skill that I worked at, and I got better at it.

I had to learn to savor the little things– the colors of the leaves in fall, the glitter of sunlight filtering through the trees, the taste of really good coffee– because it was the only way to make up for the things I’d lost.

Over time, it started to come more naturally. Maybe I was just getting into a better place in my life, emotionally. Maybe I was just growing up. Or maybe it was all of these factors.

But the point is, it happened. I learned to live without running, without traveling, without feeling free in a geographical sense, because I realized there were more important ways to feel free.

Now that that kind of freedom has come back to me, it’s like an unexpected bonus. And I view it gratefully.

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My Story

Newfound possibility

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I’ve been away from my blog for the past month, and I have so much to tell you all. I took what was supposed to be a five-day trip to a wedding in California, and turned it into an amazing, impromptu two and a half week stay.

To be honest, I was really scared to take this trip. Since I first developed health issues at age 19, I have really not traveled very much at all. It’s only been in the past four years or so that I’ve started to open myself back up to small weekend trips around New England.

But California? I had to go… one of my oldest friends was getting married.

So I went. But I really didn’t want to.

I hadn’t traveled in so long that everything felt rusty. I’d clung to the same routine for so long, hoping my pain and SI joint issues wouldn’t get worse… and now, everything was about to change.

Now that I look back, I can’t believe I was so scared of a five-day trip. It’s not like I was traveling to the middle of nowhere. I was going to Napa Valley and San Francisco… two places that are hardly without amenities. I had just gotten so used to the idea that travel was not for me, that I felt as though I was traveling to a foreign country.

So I went.. and everything turned out fine. Better than fine. The wedding was in Napa, and then after that I spent two nights at my friend Karen’s apartment in San Francisco. We were having such an amazing time catching up, Karen finally getting to show me the sights and sounds of the city she’d been telling me about for ten years. After one day, we decided I should switch my plan ticket and stay. It’s something that felt so out of character for me… but I did it.

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It ended up being a great adventure, and in some ways… I feel as though I re-joined the modern world. (It feels weird to tell you all this, but it’s the truth). My health issues had forced me to stay still in one place for so long, that it seemed so much had passed me by.

Now, it was time for bootcamp. I had to remember how to book a plane ticket; how to check a bag and get through security. How to handle a rental car. I got an AirBnb account; I got Uber; I got Lyft. I had to navigate us all throughout Napa Valley for the various wedding events, and then back down to San Francisco.

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I had to put so many of my fears aside, because there simply wasn’t time for them. And I realized that (apart from the extreme amounts of money I spent on the trip) most of my fears turned out to be unfounded.

To be fair, I had some amazing friends to help me. My friend Karen is amazing, and so is my friend Amanda, who flew with me from Boston to be my plus one at the wedding. Part of the reason I asked Amanda to come – other than, of course, wanting her company– is that I was afraid I would need a lot of help physically, dealing with my suitcase and stuff like that.

But it was all okay, and if anything, I realized I really didn’t need Amanda’s help as much as I thought. Now, I actually think I could have made the trip alone (although I obviously still would have wanted to have Amanda come for the company!).

The lesson I’m taking away from this is that sometimes, change can be good. A new experience, particularly one that we fear, can be a great way for us to open ourselves to new possibilities, and to learn things we didn’t even know we didn’t know.

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Now, I’m not suggesting that things are always going to be easy, or that all those of us with health problems have to do is wave our magic wand, think positive, and hop on a plane, guaranteed a great trip.

There’s a lot that has gone into getting me to this point. Learning the right exercises to strengthen my body, and learning the right techniques to help calm my nervous system. My life is opening back up again, but it’s only been because of the time I’ve spent being mindful of how I live, and carry myself, and remembering to work with my body instead of against it.

This is why I feel so powerfully about some of the things I share on my blog– when you have chronic pain or fibromyalgia, it is possible for things to change.

I’m so glad I took this trip, and am so excited to see where my newfound sense of possibility takes me. I hope you will all stay tuned!

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Creative Writing, My Story

Graceful.

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I’m one of those people who is spiritual, not religious.  But I love holidays because of how everything slows down, and people come out of their shells.

In Boston, on a weekday… you better not dare to take an extra two seconds to make your turn, because you’ll definitely get honked at by at least one person.

But on a day like Easter, things are slower.  People come from out of town and are reunited with their families.  They go out for huge, multi-generational walks with grandparents and babies in strollers, friendly dogs pulling excitedly on their leashes, everyone actually saying hello to one another… It’s as if, for a day, the masks are taken off and you truly see the people you meet.

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These days, I am not always the most physically gracefully person.  Although I have had some good days with my SI joint, I’m still far from out of the woods.  Sometimes it’s really hard to walk and, in the hustle and bustle of everyone trying to get everything done, I often feel as though I am in the way.

And sometimes, people are not subtle about needing to get by me.  I don’t always walk with a visible limp– I don’t think people can tell something is wrong.  After all, I’m not elderly.  I don’t think it occurs to a lot of people that anything could be wrong.  It just looks like I’m oblivious, taking my sweet time and daydreaming while taking up space on the sidewalk.

But the thing is…I get it.  I know what it’s like to be in that mode.  I can feel myself switch into it when I’m in a hurry, and feeling a lot of external pressure to do things I don’t even really want to do (especially, in the past, when I’ve been on the way to a job I hated).

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I’m not one for trying to find the silver lining in every bad experience.  I don’t think everything happens for a reason.

I’m more about acceptance— about being okay with the fact that all this bad stuff happened to me, and there wasn’t necessarily a reason for it.  Maybe I didn’t need learn a lesson.  Maybe it just happened, and it was pointless.

However, something thing I’ve learned in the past few years of dealing with health issues is the value of going slowly.

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I realized I don’t like being in angry, rushing person mode.  I don’t like the stress that rushes through me when I don’t make a green light; I don’t like how I annoyed I get when the person ahead of me in line takes too long at the cash register.

I’d rather be the kind of person who notices that the painstakingly slow driver in front of me has just pulled out from a hospital parking lot, and that her teenage passenger is wearing a face mask (in other words, something’s seriously wrong).

The kind of person who realizes that the elderly man taking way too long ahead of her in line has probably just had brain surgery, and is out for his first post-surgery outing with his aide.  The kind of person who manages to smile at him as though nothing’s wrong, despite the dramatic white bandage wrapped around his head and the purple blood pooled beneath his eyes.

The kind of person who doesn’t think about herself and her needs first– instead, she thinks about how she can help.

I’ve been both of these people, and I know which one I’d rather be.

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Although I’m not as physically graceful as I’d like, it’s way more important to me to be a graceful person.

To be someone moves through life as smoothly as possible, without creating too much of a wake. To be someone who heals, and tries her best not to harm.  (And, when she realizes she’s made a mistake, apologizes).

After all, none of my lasting memories are about that great time I got exactly what I wanted.  My memories are about the things that move me: the times I went out of my way for someone else, and managed to sense intuitively what they needed.  The times when someone else did that for me.

People can be amazing, and incredibly smart and kind.  But you have to remain open to it; you have to let them.

I no longer measure myself in mile times.  I measure myself in how well I was able to make eye contact with that elderly man, without letting my face show how shocked I was by his appearance.

Or in knowing the right thing to say, when a friend comes to me for help in a crisis.

That, to me, is what’s graceful.

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Pink flower photo: alcidesota

Favorites, Interesting Articles, Pain Science

Neil Pearson: Blending Optimism and Scientific Evidence

One of the things I really admire about Neil Pearson’s approach to chronic pain treatment is his optimism about our ability to re-train our nervous systems, once they’ve become sensitized to pain.

Chronic pain is obviously not a cheerful topic. Those of us who’ve struggled with it know what it’s like to come home from the doctor’s office feeling totally hopeless (or worse, insulted).

Then, on the other end of the spectrum, are the people who promise things that are too good to be true. In the six years I struggled with chronic pain before discovering Neil Pearson’s work, I tried just about everything under the sun. Over time, I came to find that the more optimistic someone was about their ability to “cure” my pain for good, the less their treatments actually helped in the end.

Neil’s approach is totally different, because while he has a very optimistic view on our ability to change our pain, his work is very much grounded in science, thanks to his training as a physiotherapist.

(By the way: if you’re new to my blog and don’t know who Neil Pearson is, or why I’m writing about him, you should probably start here!).

Recently, I’ve been looking through some of Neil’s older, open-access materials, which are now available under the “Resources” section of my blog (thank you, Neil!). Although I’ve been familiar with Neil’s work for a while now, I hadn’t yet seen these. I found them really interesting, because they provide a window into the thought process behind his unique perspective.

In particular, his article on the “Optimistic Scientific Recovery Model,” laid out a few key points that I felt like I’d sometimes struggled to articulate to people, so I thought I’d share them with you now.

Basically, Neil’s work is about helping people find a way to get past the limits of what they, or their doctors, had thought their recovery from pain might be.

His work is not meant to take the place of other medical interventions. Instead, it’s geared toward patients who have fully pursued all of their treatment options, and are still in pain. In other words, it’s for the patients whose doctors say there’s nothing else that can be done.

Neil’s point is that something else can be done. And in my own personal experience, that something else can be life-changing.

It’s all based on the concept of neuroplasticity– the idea that, with enough practice, we can begin to change the way our nervous systems function.

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There are many different aspects to how we can begin to try to change our nervous systems.  I’ve written about pain neurophysiology education before– the idea that when we learn more about how pain works, as well as what’s happening in our bodies overall, it can begin to diminish some of the emotional effect that that fear has on us.

However, as I read through Neil’s articles, I’m reminded that there are many other different angles to exploring chronic pain/neuroplasticity. For example, in the “Optimistic Scientific Recovery Model,” he also writes about the importance of mindfulness and body awareness; learning to relax our bodies instead of remaining tense, which only increases pain. It’s not just about exercises to increase strength; it’s about learning to move mindfully, in beneficial ways (something I know I personally could work on!).

He also talks about the idea that we can distract the nervous system from focusing pain by giving it other information to process. Things like breathing exercises, meditation, and visualizations can all help accomplishing this, as can rhythmic movements such as gum chewing. (I first wrote about this a few weeks ago, and it still blows my mind!  For more about the gum-chewing study, click here).

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I really think that Neil’s approach has the potential to help a lot of people– which is, of course, why I’m always talking about it on this blog.

Since I started working on this blog a few years ago, I have met so many great, interesting people who have been suffering from pain for a long time, and are taking matters into their own hands by doing their own research.  Open-access articles like these can be a great jumping-off point.  Some of them are geared more towards other medical professionals than to patients, but hey: information is power.  I think there are a lot of great ideas contained within these articles, which is why I’m so happy to share them with you.

For more articles like this, check out:

Key messages of understanding pain

Pain management strategies

Understanding pain basics

and many others to be found under the Resource section of my blog!

And, of course, Neil’s website is www.lifeisnow.ca. He has updated it recently with a lot of really great new resources for both chronic pain patients and medical professionals– you should absolutely check it out!

Happy researching!

Inspiration

Crystallized

What I love about winter is how everyday scenes can become beautiful, under different conditions.

Here are some photos I took off of my porch after last week’s storm.  It snowed all day, and then stopped right before sunset.  I have lived here for almost a year, and I had never seen these colors.

I love these photos, because they remind me to stay open to the beauty all around me.

Beauty can be everyday– but you have to be receptive to it.  Stay in the moment; keep your eyes open.

It’s there– you just have to remember to look.

Even the ordinary can be beautiful.

 

 

 

 

Chronic Pain, My Story, Sacroiliac Joint

What’s going on with me right now

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It’s been a few years now since I first began to understand my pain problem– three, to be specific.

Since then, I feel like I’ve made a lot of progress in terms of how I view pain and my nervous system, and how much trust I have in my body.  Finally, I was able to break the cycle I’d been caught in for years, where where I’d go from doctor to doctor, begging them to explain why I was in so much pain.

Unfortunately, at the same time that I’ve gone through these mental and emotional transformations, I’ve also had some very real physical issues to deal with.

I mentioned at the end of “How a physical therapist helped me through my lowest point, Part 8” that I was developing chondromalacia patella in my right knee, and that it was made worse by the fact that my physical therapist told me the pain wasn’t significant and that I could try to ignore it.

I was 26 when this happened… I’m 29 now.

What happened in the intervening years is so incredibly frustrating to look back upon. I thought my problems were ending when I finally solved my pain problem, but thanks to the chondromalacia patella, things were actually going to get a lot worse before they got better.

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The only way to look back on the past three years without feeling completely powerless is to focus on what I could have done differently, knowing what I know now. Now I know:

If only I’d started physical therapy for the chondromalcia patella sooner, it never would have gotten as bad…

If only I’d known that the cortisone injection wouldn’t be worth it; that all the extra fluid in my leg would put me on crutches for a week…

If only I’d known how quickly I would become weak from inactivity, I would have refused to hold still…

If only I’d known that working out in a pool would be the only option for me, I would have joined a pool right away and not wasted any time trying to work out on land…

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Basically, I started physical therapy for my knees too late. I went to physical therapy and did everything my new PT told me, but all of her exercises weren’t enough to counteract the downward spiral I’d ended up on.

As I would learn, there are two ways to weaken a muscle. One is to not use it at all. The other is to completely overuse it so that it doesn’t have a chance to rest.

I was, unfortunately, doing both of those things. It was excruciatingly painful to put any weight onto my right knee, so I moved very, very little—causing all those muscles I wasn’t using to weaken.

Then, when I did move, I was completely overusing the muscles I could use—aka putting all of my weight onto my left leg and completely overworking the muscles of my left hip.

I was doing everything my physical therapist told me, but I just ended up with even more pain in the front of my left hip, and then my right hip, and then the chondromalacia patella started up in my left knee. Then I ended up with pain in my low back.

And then, about six months after I’d really started limping because of my knee, I developed some issues with the sacroiliac joint (where the pelvis meets the spine, in the low back).

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The sacroiliac joint turned into its own saga, which I will have write about in future posts, because there are basically no helpful articles about it online.

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Things only started to get better for me when I started to work out in a pool, and even then, getting stronger was no easy feat.

I finally feel like I’ve started to figure everything out now; three years later.

It meant I had to let go of a lot of things I’d learned about exercise in the past, and really study some basic concepts in order to help myself.

I had to really learn a lot in order to help myself. It was hard to get help from anyone else, because, as anyone who’s been a patient knows, physical therapists (at least in this country) can only focus on one diagnosis and part of the body at a time.

I didn’t need physical therapy for my knees anymore. Or my hips. I needed to strengthen everything.

I didn’t have just one or two weak links anymore… I literally did not have the baseline amount of muscle that would allow me to walk from one end of the house to another and hold all of my joints in place without pain.  (Both the chondromalacia patella and sacroiliac joint issues were ultimately caused by lack of muscle strength).

So I had to start from scratch. From less than nothing, because I had to find a way to move despite the fact that many of the movements we take for granted were impossible for me.

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Ever since the first time I wrote a description for the “About” section of my blog, I’ve said I planned to write about exercise and fitness. I haven’t quite gotten around to that yet, but now you, my readers, know why I will.

I don’t really plan to write about fitness from a bodybuilding or super-overachiever standpoint. That stuff is interesting, but it’s just so far removed from my daily reality right now that I don’t really have much use for it.

What’s important is the basics. Knowing that if you strengthen a muscle without ever stretching it, you will shorten its resting length. That there is a difference between strength and endurance, and if you only train for one, you will never develop the other. Knowing about this little thing called the Golgi tendon reflex, which will allow you to relax just about any muscle you want just by putting pressure on it (the concept behind foam rolling).

These are things that people with chronic pain can benefit from knowing. When I look back, I can actually see how a lot of my issues with pain—confused nervous system or not—were also related to the fact that I was simply so out of shape from the injuries and periods of inactivity I’d had when I was younger. I mean, yes, I had a heightened pain sensitivity, but at the same time, anyone who was as weak as I was was bound to be in pain. There’s just no way that wouldn’t happen.

I hope the things I’m going to write about will be helpful for you all. I’m going to talk about how my perspective on changed, and how I was able to use what I’d learned from Neil Pearson’s techniques to cope with what I was feeling, while at the same time knowing I had some physical issues that I couldn’t immediately change.

So much has changed in my life, even though all the while to the outside observer, it looks like I’ve been holding still. But that is just so, so far from the truth (sometimes I need to remind myself of that!).

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Photo Credits:

Inspiration, Uncategorized

Maybe everything is amazing

I first saw this Louis C.K. clip a couple of weeks ago, and I’ve been thinking about it ever since. (Be sure you watch until the 3:05 mark, which is where he really starts to make his point).

Studying anatomy and physiology and learning about the body has helped me to get to the point where I can start to appreciate just how crazy/complicated/complex our experience as human beings is.

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A lot of people seem to become intimidated when I talk about taking these classes, and say things like, “Yeah, but I’m not any good at science.”

It makes me really sad to hear people say that, because honestly—there was a time when I didn’t think I would be any good at science, either.

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I did pretty badly in science classes in high school because, well, my life was falling apart. I just couldn’t get it together enough to study enough, and when I did, nothing could really become cemented because I hadn’t really slept.

I did much better in the humanities classes, because it was easier to just wing it. I might have been to out of it to memorize chemical structures, but it wasn’t too hard to just read a novel and give my opinion.

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Then after high school: for years, in the back of my mind, I sometimes thought about becoming a physical therapist.

Originally, the idea was born more out of desperation than inspiration. I was so frustrated by the fact that there was always something hurting, all the time, and that I seemed to have a new physical therapy referral every few months. I was always really interested in the explanations the physical therapists gave me, and always did all my exercises, but it didn’t seem to be quite enough. I sometimes wondered if the only way out of this would be to take matters into my own hands, rather than relying on other people for the rest of my life.

Then I met Tim and watched Neil Pearson’s lectures, and all of a sudden my desperation turned to inspiration. There actually was a reason why I was hurting all the time—an overarching reason that I could work on, rather than targeting different parts my body, piecemeal, for the next several decades. And maybe I could help other people like me, like Tim had helped me.

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This is the point at which I actually started to look into what it would take to get into physical therapy school, and saw that I’d have to take all of the science classes I’d so carefully avoided in college.

Now I am grateful that I had to go back and take all of these classes. And I mean, we’re not really talking high level stuff here—we’re talking general chemistry, introduction to physics. The things you would take in your freshman or sophomore year of college.

Basic as they are, these classes have totally changed the way I look at things.

It’s like recognizing there are two sides to every coin. On one side, I can focus on my experience—the way a certain part of my body feels (or, in most cases, hurts).

If I want to flip to the other side of the coin, I can stop and think about the complex forces that are literally holding this part of my body together. The intricate chemical and electrical signals that sensations to travel from my the rest of my body to my brain, and then back again. And the different areas of my brain that are involved in letting me feel the pain, and determining how much of my attention is devoted to the pain, versus paying attention to other things.

And the thing is—you really don’t need to be an expert, at all, to develop this sense of appreciation. I mean honestly, I know nothing. If I wanted to go into more detail than what I just wrote above, well, I’d have to go open a textbook to make sure I didn’t tell you the wrong thing.

It’s not about mastering this information; it’s just about having been exposed to it, and having a sense of just how complex these things are. Complex, yet also orderly. Yes, we live in a chaotic universe, but our bodies have a blueprint that can be broken down into categories and understood.

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Sometimes I daydream about running a class for chronic pain patients. Not an academic class—more like a continuing ed class.

And we would just go over the very basics from anatomy and physiology. And my students could see that, when you just begin to learn about the body, it’s actually more like a language class than a science class.

Just as you would make a chart of the different parts of speech (past, present, future, etc.) you can make a chart of the major systems of the body. And then you can look at each system and break it down further; for example, you can break the skeletal system down into different types of bones, and then look at individual bones.

And then, as teacher, I would focus on the bones of the spine, since the spine is such a grave, sometimes threatening concept for anyone with back pain. I would explain that even though it looks like some kind of alien invention when you look at a diagram, the spine can actually be simple:

There are four parts of the spine. From top to bottom:

Cervical spine= 7 vertebrae that make up your neck

cervical vertebrae

Thoracic spine= 12 vertebrae in upper- and mid-back

thoracic vertebrae

Lumbar spine= 5 vertebrae in lower back

lumbar vertebrae

Sacrum= fused vertebrae at the bottom of the spine, which make up the center of the pelvis

sacral vertebrae

These terms are things that back pain patients hear all the time, and may even have explained to them. But, in my experience, there’s a big difference between having a doctor mention these things to you in passing—in an appointment where you’re scared of what he or she might diagnose you with—and learning something in a calm academic setting.

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The spine is just one example– there are so many different aspects of our physical being that sound complicated, even scary, when explained by a doctor, but look simple– and interesting– when broken down into smaller categories.

It’s helped me immeasurably to begin to understand this. Having a “second side of the coin” to flip to means it’s easier for me to change my perspective on the physical realities I sometimes can’t change.

Now I can’t think about how much something hurts without thinking about the fantastic nature of how it hurts. The fact that I have a bone, with muscles attached to it, with nerves that let those muscles communicate with this fantastic brain I have—it’s all pretty incredible.

Interesting Articles

Introducing the Sunlight in Winter Youtube Channel

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Ever have one of those days where you want to keep working/thinking/being productive, but your body just wants you to lie down with a heating pad?

That, unfortunately, has been happening to me quite a bit recently.   I’ve been wanting to sit at my computer and either study or work on my blog, but my neck and shoulders have just not been on board.

Trying to look on the bright side, I remembered that there were a ton of pain science-related videos on Youtube that I’ve been meaning to check out.  So I decided to use my “lying-down” time to catch up.  I started saving my favorites to playlists, so that I could just lie down and listen, and not have to worry about getting up and selecting the next video.

And then it occurred to me—maybe other people would enjoy these playlists too.   It’s a lot more relaxing to just start a playlist and let it run, instead of having to get up and go to the computer every time you want to start a new video.   It also makes taking a break a lot less frustrating, since you can keep your mind going with something productive.

So, check out my channel!  So far I’ve broken things down into a few separate playlists, some based on topic and some by speaker.  I’ll be adding to it as time goes by.  Let me know if you have any comments or recommendations for videos I should add.

To go directly to some of my favorite videos:

Lorimer Moseley: Why things hurt

Elliot Krane: The mystery of chronic pain

The evidence for physical therapy for chronic pain

Hope you enjoy!

Photo credit: Dan Barbus

Chronic Pain, Fibromyalgia

How a physical therapist helped me through my lowest point: Part Four

This is the fourth part in a series about an amazing new approach to physical therapy for chronic pain patients.  To start from the beginning, check out Part One, Two, and Three.

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For the first few visits, all Tim and I did was talk.  He didn’t have me in the gym doing exercises like all the other patients I walked by on the way in.  Instead, we sat in a quiet area and talked about what I had learned from Neil Pearson’s lectures.

What I learned is that pain is so much more complicated than we think.  When I first learned about the nervous system in high school biology, I was taught that nerve impulses travel through the spinal cord to the brain, where they are interpreted.

simple nervous system

This is a very simple model, and on a basic level it’s true.  That is how nerve impulses get to the brain.  But when it comes to the experience of pain, there are many additional factors.

Normally we think about the nervous system as a one way street, where signals are only travelling to the brain. But what I learned from Tim is that the experience of pain is a lot more complicated.  Our brains are constantly evaluating input from our nervous system, trying to sort out which signals are important for us to know about, and which aren’t.

Our brains are filtering our experiences all the time, determining what is and what isn’t important for us to know about.  After all, it wouldn’t make sense for us to be aware, on a conscious level, of every little thing that’s going on in our bodies.  We don’t need to feel, at all times, the sensation of clothing on our backs.  We don’t need to wake up out of a deep sleep just because there is a blanket touching our legs.  Our brains filter out information all the time, so that we can focus on more important things.

On the other side of this equation, the brain can actually “turn up the signal” on something it thinks we need to know about.  If a part of your body hurts and you try to ignore the pain and go about business as usual, your brain will make that pain louder.  It isn’t doing that to be annoying; it’s trying to protect you.

Lorimer Moseley tells a revealing story about the time he was walking in a nature preserve when a stick brushed against his ankle.  He had once been bitten by a poisonous snake in that same nature preserve, also on his ankle.  He freaked out and fell to the ground, writhing in excruciating pain.  He told his friends to call for help, thinking he needed to get to a hospital as soon as possible.

A few moments later he looked at his ankle and realized there were no bite marks.  There was, instead, a stick lying on the ground next to him with a sharp point.  He was then faced with the awkward task of telling his friends he was wrong, that there was no snake, that he’d freaked out over nothing.

This is how the nervous system works.  It is not meant to be “accurate.”  It is meant to protect us.

When Moseley’s nervous system felt the stick scrape his skin, it knew that the last time it felt those sensations, there had been great danger.  It also knew that not only was he outside, but he was walking in the exact same nature preserve where that same danger lurked.  His nervous system decided to tell him about the dangerous thing that had just happened to his ankle, and it told him about it loudly.  This is how the nervous system works; it decides how much danger we are in based not only on physical sensations but also on context.

Normally when we notice these little idiosyncracies of the nervous system, we are embarrassed.   These little errors in judgment can make it seem like we’re crazy, or overly anxious or neurotic.  But this is how the nervous system works.  It is not meant to be “accurate,” it is meant to protect us.   Even when our nervous system doesn’t have the whole story, it fills in blanks as much as possible, taking our fears and beliefs about the situation into account.

In people with chronic pain, the body’s protective response has gone haywire.  It’s as though the nervous system’s threshold for action has been lowered, and things that didn’t seem dangerous before now seem very dangerous.

It’s like we’re Lorimer Moseley walking through the nature preserve, all the time.  The difference is that Moseley’s case was a singular event based on coincidence: the stick brushed up against him in the same place that the snake had bit him, and he was walking in the exact same park where he had encountered the snake before.  While Moseley’s experience had a concrete end, every day chronic pain patients encounter “sticks” that our bodies interpret as “snake bites.”

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The good news is that, because the nervous system takes our conscious beliefs about pain into account when making judgments, we can actually affect how it reacts to various stimuli.  (I want to be very clear here: we do not cause chronic pain with our thoughts and beliefs.  This is an oversimplification, and it’s also insulting).  But the nervous system does pay attention to context when deciding how dangerous something is.

In his lectures, Neil Pearson says that when your pain starts to get worse, you should ask yourself “Is this really dangerous?”  An increase in pain is a sign that your nervous system has decided whatever you’re doing is dangerous.  But is that really the case?  If you’ve been living with pain for a long time, it might not be.

This is where your conscious thoughts and beliefs can play a role in breaking the cycle of pain.

I had lived with pain for so long that my view of what my body could and couldn’t do had gotten very warped.  I felt pain every time I tried to walk, or lift something, or go up and down stairs.  I thought my body was weak, that there was something fundamentally wrong with it, and every time I pushed myself it seemed to get worse.

Tim helped me to recognize that the pain I felt was not necessarily an accurate barometer for what was wrong in my body.  The reason I had a setback every time I exerted myself, he said, had more to do with my nervous system freaking out than the fact that I had actually pushed my healthy twenty-five year-old body to its limits.  When my body began to hurt, I was to say to myself, “There’s my nervous system again.  Freaking out.  But that doesn’t mean anything is wrong in my body.”

Tim and I talked a lot about how the body works, and how I wasn’t going to hurt my back, or my legs, or my ankle just by doing basic things.  Because one of my major complaints was back pain, we talked about the anatomy of the back, and how my MRI showed I didn’t have any serious pathology.  Tim promised me that my body was so much more capable than I thought it was, and that once I could help my nervous system calm down a little bit, I would see that.

We also talked about what kinds of things would produce pain in a person whose nervous system wasn’t freaking out.  It honestly really helped me to have a trained physical therapist to bounce ideas off of.  I trusted Tim.  If he told me the pain I felt was likely coming from my freaking-out nervous system, rather than any physical damage, I believed him.

We talked about my leg surgery several years before, and how I was afraid my compartment syndrome was going to come back if I pushed my legs too much.  We sat down and had a rational discussion about this; how unlikely it was, but what the worst case scenario really would be if it came back.  This helped to reduce some of my fear, and give back a sense of control.

We also talked about my ankle, which I had sprained a few months earlier.  It still hurt a lot of the time, and I had a lot of trouble walking and driving.  Tim explained that I wasn’t going to re-sprain my ankle just by performing normal activities.  Since it had been a few months, he said, the majority of the healing had already occurred.  As long as I kept my ankle within the normal range of motion, I wouldn’t be doing anything to make the sprain worse.

This actually made a striking difference in the amount of pain I felt in my ankle.   My nervous system had been interpreting the sensations in my ankle as very dangerous, and as a result it was very painful.  But once my brain understood that my ankle wasn’t in any real danger anymore, my nervous system no longer saw the need to tell me about it all the time. Over the course of the next few weeks, the pain in my ankle gradually melted away.

It’s almost embarrassing to admit something like this– that my ankle, which had been bothering me for months, stopped hurting as soon as someone explained to me that it wasn’t really dangerous.  But it shouldn’t be embarrassing.  This is how our nervous systems work: they take into account both physical signals as well as our mental interpretation of events.

If you’ve undergone the process of central sensitization, your nerves, spinal cord, and brain have changed in ways that cause you to be more sensitive to pain.  Scientists don’t yet know whether or not these physical changes are actually reversible.  But the good news is that whether or not you can undo the effects of central sensitization, you can still break the cycle of pain by changing how you react to pain on a conscious level.

Continued in Part 5.

**The top picture was taken in the Australian Outback, which is where many of Lorimer Moseley’s stories take place.  Published by Mark Veerhart under a Creative Commons license.**

**Mulberry sticks picture courtesy of JodiGreen**