Why does my pain return?

Why does my pain return?

Many patients ask why does my pain return? There's quite a few reasons, here are the most common ones:

Returning to an activity too soon after an acute injur
An acute flare-up usually takes 2 to 3 weeks to resolve fully and we advise our patients to rest or modify their activity until then. However, sometimes they feel so much better and think that they are ready before their bodies actually are.

In my experience it also helps to let the area settle directly after an osteopathic treatment. We will re-test the area to ensure we have made a difference, but it is best not to keep repeating the painful movement over and over to "see if the treatment worked." All you will do is encourage the inflammation to return.

I also love patients who say it hurts more "every time I poke it"...quite simply...please stop poking it! 🙂

Bad posture, desk or repetitive work
For many of us, work is sedentary and the human body is just not made for sitting all day! We sit  in front of a computer, sit in our car to get home, then sit on the couch to relax. And do it again tomorrow. No wonder we get sore necks and backs after a few weeks. As for posture, you have two types of muscle fibres, fast twitch and slow twitch. Slow twitch fibres are postural muscles like your core, which are designed to keep you upright with minimal effort. Fast twitch fibres are your big mover muscles like the hamstrings or the trapezius, which are designed to move your limbs quickly and powerfully. If you use fast twitch muscles to do the work of your postural muscles, they tire quickly and ache, which is what we find in patients with poor posture.

Stress
Stress changes the way we stand and move. Imagine facing off a tiger just a metre away, you can feel your shoulders clenching, your legs getting ready to run away. Now imagine the same tiger but behind a glass wall. Feel your muscles relax? Stress also affects the way our bodies compensate after injury. No one is perfectly symmetrical, pain happens when the body is no longer able to compensate.

Chronic or progressive conditions
In some cases, the body is never going to return to its pre-injury state. For example, some forms of arthritis, disc injury, joint replacement surgery. Often, these patients have to work harder to be pain free, be more careful about how they move and remember to do regular exercises/stretches. Osteopathic treatment is aimed at maintaining their level of function or slowing down their disease progression. In other cases the problem is so chronic that it takes more time to convince the body of it's "new normal." Connective tissues that have been shortened for a long time may take longer to stetch out again for example. Your overall health in terms of nutrition and hydration also contribute to how quickly your pain resolves.

Increased nerve sensitivity
In chronic pain, the nerves start to behave differently in that they respond to lower and lower levels of stimulation, such that they go straight to alarm mode even with normal stimulus. According to Professor Lorimer Moseley, speaking at TedXAdelaide:  "Pain is an output of the brain designed to protect you. Pain isn't actually coming from the tissues in the body." If you don't believe this, check out the experiments done with an artificial limb. The more neurons run pain, the better they get at it, so a smaller number of neurons can produce the same level of pain. The networks also become less specific, so the pain spreads, becoming unhelpful and uninformative. Prof Mosley, a clinical and research neuroscientist at the University of South Australia, added that chronic pain can be reduced by training the brain to better recognise, imagine and move the affected limb.

Other reasons
Pain can be merely physical, or it can have a deeper emotional or spiritual component. It can have its roots in a old strain from a trauma/fall that did not get addressed at the time. Often, the start of the healing is accepting that there are other reasons for the physical pain to persist.

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