One in five British Columbians live with pain. Shocking, right? This statistic is being widely publicized by Pain BC, a not-for-profit group that is trying to help people battle chronic pain. I treat people in pain every day and I can say that I was honestly surprised by this stat. However, reflecting on the wide variety of patients I see, it makes sense. What I’d like to discuss below are my thoughts on how people initially get stuck in chronic pain cycles and what you can do to prevent this from happening.
The Pain Spiral
Pain BC has created what they call the pain spiral. It is based on the healthcare community’s latest understanding of pain science.
So, how do people get stuck in this cycle? Well, I thought the best way to answer this question would be to share my very own personal story of a knee injury that I sustained prior to becoming a physiotherapist.
Like most of the injuries I currently see as a physiotherapist, my own knee injury had no real mechanism of injury. I didn’t fall and twist my knee or get hit by someone tackling me. No, instead my pain came on very gradually as I was getting back into running after a period of relative inactivity. At first the pain was mild enough so I just tried to “tough it out” and kept on running through it. However, after several weeks of increasingly worse pain I began to have soreness not only during my runs but also while I was walking. By the time it got so bad that I started walking with a limp, I decided (at the suggestion of my doctor) to finally see a physiotherapist.
When I arrived for the appointment I was sure that I would be told that I had some type of terrible knee injury that had to be operated on. However, much to my surprise, my physiotherapist told me that in fact I did not need surgery! It turns out that I had a highly treatable knee injury called IT Band Friction Syndrome. At first I didn’t believe my physio. I told her “that can’t be possible, this pain was too severe, it was lasting too long”. However, she made a deal with me – take her advice and stop running for 1 full month, and do my exercises regularly, and see if my injury gets better. At this point, I figured I had nothing to lose so I gave it a shot. Again, to my surprise, she was right! It did get better, but that’s not the end of the story…
The start of my pain spiral
So, while my pain was better for the first few weeks, it did return after about a month. So, I repeated the advice she gave, I rested for a month, did my exercises, and then returned to running. Once again, my pain was better but then returned. Being the stubborn type, I continued at this cyclical routine for several more months. Finally, I resolved myself to the fact that I was just, “not cut out for running” and gave up the sport that had been one of my passions since my youth. I did not even attempt to run again for 3 more years.
How I broke my pain spiral
Well, thankfully for me, my positive experience with my physiotherapist ended up encouraging me to enter into a career as a physiotherapist. It was during my training that the light bulbs gradually started to turn on when it came to understanding my own injury. I realized that I had not exhausted all of my options with regards to managing it conservatively. In reality, I had actually only given it a very meager attempt.
So, I started to pursue more treatment with a physiotherapist and educated myself more and more. I realized that my knee injury actually had a lot to do with my back – tightness in my back muscles was actually causing referred pain in my knee and tightness of the muscles around it. I ended up getting this resolved with IMS treatment. However, just because my knee muscles were tight, didn’t mean they were strong (a topic I wrote about in a previous blog here). So, I started to address this through the appropriate corrective exercises (one of which was a hip exercise I wrote about here). Finally, I ended up having to re-train how I actually ran so that I struck the ground with my forefoot and not my heel (a likely future blog post I will write, haha). You can see Pain BC’s version of how to break a pain spiral below:
The end result?
Well, I am happy to report that I have been able to run pain-free for the past six or seven years. My only regret? Not getting my injury dealt with sooner. However, losing those 3 years of not running is way better than not being able to run for the rest of my life.
My take home lessons
- Don’t “tough it out”. Your body cannot heal on its own for every injury, even if it was a repetitive strain injury. A good rule of thumb I tell my patients is that if it doesn’t get better in 7-10 days on its own, it’s not likely too. One of our physiotherapists, Eric Ginter, wrote a great blog article listing several other ways to tell if you need physio treatment. You can read it here.
- Recognize your own myths about pain. Mine involved thinking that living with pain in my knee every time I ran was just how it was going to be and that I was just “not cut out for running”. Pain BC has great resources that may help educate you further and uncover some of your own flawed views on pain.
- There is no magic cure. In reality, my injury took several different forms of therapy to finally recover. This involved IMS, home exercises, and gait retraining. What worked for me may not work for you, but most injuries can at least improve if not recover fully. Try not to be too closed-minded after not getting success with one particular type of treatment, or even after only a single session.
So, how can physiotherapy help?
Well, we can accurately assess musculoskeletal injuries and tell you if further imaging/consults are required or if conservative treatment can help. We have several different forms of therapy that we can combine to try and find the right solution to get you feeling better. For information from Pain BC you can visit their page here.
MScPT, CGIMS, CAFCI, CSCS
Co-Owner of South Cowichan Physiotherapy
Want to learn more about how he can help you? Then check out his bio by clicking here