Let’s talk about the necessary evil of acute pain.
Acute pain is something that we have all experienced at one point or another. Often, patients find the pain of their injury quite distressing, which is fair. Pain is a noxious stimulus, it excites the alarm centres in the brain, setting off a series of protective mechanisms including a psychological distress response. However, I want to spend some time thinking about how acute pain can be used as a training tool to fix bad habits, learn new things about exercise or training loads and be beneficial in our experience of life.
First, let’s consider what I mean by bad habits. Often acute pain is due to tissue stress, caused by abnormal loading of muscles or joints – bad habits or poor biomechanics. Our bodies are amazing things and are extremely patient with our bad habits and poor techniques. Bodies have a biomechanical tolerance, meaning that you can perform an activity with bad technique without experiencing pain up to a certain point. This point is different for every body, some may reach it sooner than others, but at some point, tissue loading reaches a point where the joint/ ligament/muscle is no longer able to tolerate the abnormal biomechanical loading. This point is where tissue becomes pain sensitized by an inflammatory response and requires treatment/adaptation to the mechanics to settle down.
To explain this using a real-life example, let’s talk about knee pain. A patient may present with a 3-month history of knee pain that is worse with running, squats, lunges, and stairs. They have recently stopped exercising because of the pain and are feeling quite down about the impact the pain has in their life. Prior to the onset of pain, they ran 5km a day, even though they ran with a “knock-knee” pattern. A month before the pain started, the patient started a gym class with lots of squats and lunges. In this example, the patient is experiencing a condition called Patello-Femoral Joint (PFJ) pain, which is typically caused by poor biomechanics of the knees. In this case, the patient’s knees tolerated 5km of running with poor biomechanics for years before any symptoms arose. It was only with the increased load of squats and lunges that the knees became painful during their regular activities like running and stairs.
The patient can utilise their pain to their benefit, by using it to correct the longstanding biomechanical flaw in their running and squatting pattern. When the knee is positioned properly, the patient will be able to significantly reduce their pain. This is a helpful way to use pain. It becomes a feedback tool for the patient in helping them learn new movement patterns that will ultimately reduce the recurrence of pain in the future. Better movement patterns lead to better performance, stronger bodies and less wear on joints. Therefore, pain is a helpful tool in life. It is unavoidable, everybody feels acute pain and with the correct management and guidance from your local physio can assist in making you better at what you do.
