Jake Tumber, PT asked me what things I know now about pain that I wish I was told in 2002 when I visited my Family Doctor after a minor car accident. I decided to get it down on a list here:
1) You are probably not damaged!
Despite all the impact demolition derby drivers sustain, they have ultra low incidence of chronic whiplash and persistent neck pain. It has nothing to do with the forces (they get blind sided too) but everything to do with the meaning and context of what happens.
This study may not be the most robust (Retrospective). But it does pose a pretty challenging question to some base assumptions. Physical damage is a poor predictor of how much pain you will experience.
2) Move it or lose it!
If you treat your body like it is fragile and damaged, it will become more so. There is a something called Hebb's Rule after Donald Hebb which states "Cells that fire together wire together". What this means in this case is that if you move less, you will lose some of those capacities to move. That sounds kind of dire but of course this happens over time. And time is pernicious when it comes to chronic pain. If you allow yourself to act fragile and breakable you will slowly, physically and mentally, change to support that belief over time. You are much more robust then you realize and with a little creativity you can find something that you can do. This makes all the difference in the world.
3) Banish fear!
Being afraid of the pain getting worse makes you fearful of movement. Along with point 2) this kind of attitude can lead to catastrophising, depression, and more fear. All these may cause you to stop exercising or challenging yourself which creates self perpetuating loops that slowly paint you in a corner. This is why "letting pain be your guide" is not helpful to your recovery.
4) Pay attention!
Blasting past the pain and ignoring flare ups will piss off the nervous system. And nobody's happy if the NS isn't happy. Diane Jacob's talks about the "Critter Brain", Todd Hargrove mentions the "Wild Animal". They are talking about that older part of you that is constantly monitoring threat and mounting defensive responses if it deems it necessary. Treat your newly sensitized nervous system like a wild animal or ancient critter brain that you are attempting to tame and soothe by building trust.
5) Exercise and move for the general benefit!
You can't stretch out the pain. And strengthening only indirectly affects pain, most likely because exercise and movement are so helpful in general. So forget about weak muscles and asymmetry, if you walked in the room and didn't fall over your core strength is just fine. Paul Ingraham started me on a wild journey a few years ago with that first stretching article, his site is well worth a visit.
6) No therapist should increase your pain!
If you ever have any therapist that increases your pain during therapy and implies that it is somehow good for you. Punch them and get out of there. (I'm talking to ART people especially here.) Increasing your pain through therapy can heighten the sensitivity of your nervous system which is the exact opposite of what therapy should be going for. Sometimes the best thing a therapist can do is Do Nothing as Barret Dorko writes.
7) Looking inside isn't going to help!
Getting any imaging done should be an absolutely last resort. Unless there is a serious red flag, chances are any findings on MRI's, X-rays etc will just cause you to worry about something unnecessarily. Many people have no pain and would have plenty of abnormal imaging findings.
8) Your brain is king (or queen) of it all!
Your brain is in complete control of the pain experience. Pain is produced as a pain experience just like hunger and thirst. Only with pain it is similar to a car alarm that has been set on high sensitivity. Sometimes the alarm may go off because a strong wind has just blown or some car stereo bass shook the windows as it went by. With pain, there doesn't have to be anything wrong for the experience to occur, it can be simply because the sensitivity is up to high. This one is the most vexing because it feels so real. And it often feels like your pain has a distinct location. You would swear under oath that something is wrong "right there". But our brain can be tricked very easily, I mean very very easily. You can't trust your experience.
9) Your brain can get cranky!
Your brain extends throughout your entire body. 72kms. All nervous tissues have their own blood supply and can get very cranky if they are not well fed. This is where you may need the help of a competent therapist. And the earlier the better. A proper therapist will always help you regain your inner locus of control, they will never attempt to be the "healer" or the "guru" with special knowledge that only they understand leaving you dependent on them for recovery.
10) Quacks are after your money!
Finally, here is a quick list of money wasting therapies. Craniosacral Therapy (CST), Ultrasound, Myofascial Release (MFR) Acupuncture, Cupping, Moxibustion, Ayurveda, Homeopathy, Naturopathy, most Pathy's, reiki, Therapeutic Touch, energy work (of any kind), TENS, Chiropractors that believe in Subluxation Theory, traction devices, most anything that buzzes, whirs, bleeps, or rumbles, magnetic anything, copper bracelets, quite a lot of surgeries, any instruments that are used to scrape the skin in some way (especially aggressively), or any treatment that approaches the body as some dumb lump of meat that has no super sensitive tissue permeating every square millimetre of it.
Knowing this stuff 11 years ago would have put me on quite a different (and less money wasting) track than the one I ended up traveling so I hope it gives someone who is starting out now a leg up. I would love to hear from your experiences if you'd share them below.