What Doctors Have Told You Might Be Making Your Pain Worse

Fear, pain beliefs and expectations have a huge influence on the pain we experience. And sometimes, what you’ve been told could be making your pain worse!

My knees are bone on bone

My back is out of alignment

Don’t run or go to the gym it’ll make your pain worse

The above are regular beliefs held by patients, but are they founded on truth, or are they in fact making your pain worse? We’ll go through each of these a little later. 

Our knowledge of pain science has evolved drastically and we now understand there is more to pain than just tissue injury. Take this example of how pain experience can vary,  a cyclist with a fractured knee cap after falling off his bike mid race can continue to cycle a further 60km, yet many people experience excruciating debilitating pain following simple movements, such as picking up a pen in the office, grabbing shopping from the back of the car, or walking up stairs.

It is this that makes me believe that the narratives from healthcare professionals, media, family and friends has led to a fearful population. These fearful beliefs are conditioning us to being fragile.

Our advancement in technology allowing us to scan the physical body and see what we thought was the cause of all our pain, led to tunnel vision on our understanding of pain. We focused too much on the structural changes in the body, and the psychological and social influences weren’t given the same attention.

Have we created a fragile population due to a lack of understanding in pain science and overuse of the biomedical model in the treatment of chronic pain?

The biomedical model looks for physical changes to the body to explain pain and disease. Some of these changes may include structural damage, posture, alignment/shape, imbalances, or muscle activation/ weakness. As the primary model for pain this has created strong beliefs that structural change or imbalance must lead to pain. Add to this the unsupported articles in newspapers, and the marketing of devices to repair your posture and you can begin to see why these beliefs are embedded in us. But research is beginning to find that it is much more complex than this.

The modern biopsychosocial model is one model that explores more than just the physical when it comes to the pain experience. Psychological and social factors are now known to be just as important as the biological factors in the individuals experience of pain. Yet many healthcare professionals are still trying to relieve pain in the same way you’d repair a car by either taking parts out or putting parts in. Sadly this just doesn’t work our pain experience is much more complex and human.

Let’s take two examples, both patients of similar age, of the same sex, and with similar health previous to experiencing low back pain. One has a family history of similar pain and a parent that had to retire early due to their pain. They’ve been told by the doctor that their back looks 20 years older than their current age on a scan and that they’re likely going to aggravate the pain should they continue doing their favourite activity. 

The other is experiencing their first real episode of pain that isn’t recovering as they expected. They have also been to see a doctor about their pain but were explained that the changes in the back are normal age related changes and have little correlation to their pain experience. Although continuing at the same intensity of activity prior to the pain may be a little too much for now, they’ve been advised to continue doing some activity that they enjoy but at a pace and intensity that they feel is tolerable. 

The beliefs of these two individuals will drastically differ not due to the physical changes to their body, but due to the beliefs and expectations they have surrounding their pain. The power of words, especially from those that we respect and have a greater understanding on a certain topic such as health, drastically influence our beliefs, expectations, confidence, and our understanding of recovery.

My own work is that of working with people in pain, and most of the time a certain belief that a patient has regarding their pain is holding them back. Take Mrs X for example. Mrs X came to see me regarding her hip and knee pain, she’d been experiencing this pain for 8 months had been to see her GP and had gone through the conventional pathway of taking medication and having physical therapy. 

Early on in her process of seeking aid for her pain the GP had advised her to avoid the gym, running, and mountain walking as it would make her pain worse and instead the patient should go swimming. This was advised without asking the patient if they had even tried any of these activities since experiencing the pain, and what effect these activities had on the pain. To add to this the patient hated the water and was a weak swimmer, something again the GP hadn’t asked. Therefore for the 7-8 months prior to our appointment, this patient had avoided the activities she enjoyed in the fear that they would aggravate her pain and had lost confidence in her GP as she didn’t feel listened to. 

Let’s now clear some common health beliefs that could be making your pain worse.

My knees are bone on bone

It is very unlikely that your knees are bone on bone. Although the cartilage does decrease in size over a lifetime, it does not disappear. It has also been found that those who partake in weight bearing exercises had no greater risk of knee arthritis compared to those who didn’t (Bricca et al 2019, Chakravarty et al 2008). Therefore when considering the many other benefits to being physically active and doing weight bearing exercises, ‘won’t my knees wear out’ is not a valid reason. 

My back is out of alignment

Our backs are strong, just look at what you’ve done across your lifetime, walked, carried, climbed, fallen and got back up, and more. Most of the time without an ache or pain. The joints in your back don’t just slip out of place and don’t need putting back either, the clicks and cracks you hear in your back are a sign that your joints are moving through a large range of motion. You may even want to test this range of motion more regularly. Our bodies are highly adaptive, and will change depending on stressors you put upon it. Want to make lifting heavy things easier? Lift heavier things more regularly in a variety of ways. Want to touch your toes again? Then start now, stop reading this blog for just 60 seconds and reach down.

Don’t run or go to the gym it’ll make your pain worse

These are just some examples of certain activities that are regularly stopped, but you could replace these with any activity you were doing prior to experiencing pain. A specific activity in itself is not good or bad for you when you are in pain, it has more to do with how much, how intense, and what is it you can tolerate at any one time. This may vary from day to day due to changes in sleep, stress, energy levels, but it doesn’t mean you need to stop.

Look at modifying distance, time, speed, number of repetitions, load, anything that will change the intensity of your activity and allow you move with as little pain as possible. Find what works for you and continue it until you feel strong & confident enough to progress. It doesn’t have to look pretty, but movement of any kind with a little pain is better than not moving due to the fear of pain.

So I ask you, the next time you get asked to stop doing something you enjoy, read some glorious article promising miracles, challenge it. Don’t allow fear to restrict your life, and remember you are highly adaptive and strong. Get after it and try something!

Please note: This article is made available for educational purposes only, not to provide personal medical advice.

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