Pain is more than just damage to our tissues – there are other dynamics which influence how we experience that pain and how we respond to it. Hugh gives a brief introduction to some of the new ideas that are emerging about pain and how to work with it.
We often think that pain is just associated with tissue injury or inflammation at the site of pain. But it is far more complex than that. It also turns out that the solutions are elegantly simple – and just make a lot of sense – when we understand how pain works.
The work being done by Lorimer Moseley at Adelaide University in Australia and Thomas H. Black in the US provide a more nuanced picture. It also leads us to more ways in which we can interact with the body and make a difference in resolving our pain.
So what is this more nuanced picture that they are giving us?
Pain isn’t just a sensation somewhere out there – it is deeply personal and as a part of that we have an emotional response. In fact, when we experience pain it engages cognitive, emotional and interoceptive* networks in our brain. Unlike other sensations this all happens simultaneously so our emotional response, what we think about what’s happened and the sensation itself are deeply entwined within each other. So when one of these aspects is triggered it drags all of the others with it. No other sensation is processed in quite the same way.
This means that when we experience pain it is flavoured and coloured by our previous experiences. This can include what was happening at the time that the pain or injury occurred and the understanding we build up around that. Sometimes this is obvious to us but at other times, especially if it was a long time ago, it’s not. My own example of that is that every time I head a football my neck involuntarily tightens and protects – reminded of a poorly managed neck injury from the past. Fortunately I have found ways of managing that.
To an experienced bodywork practitioner this can be felt in the body as small involuntary movements within the tissues themselves – they are reflexive. Being involuntary these aren’t responses that we choose to have but we can become aware and interact with them. Alternatively we can ignore these reflexive responses but this comes with its own costs. It can be part of the reason we re-injure the same part of our body again and again – something significant has not actually been resolved.
Accessing our involuntary responses to pain is beneficial for even acute injuries and pain but is essential if it is long standing or chronic. I don’t know if you have ever had one of those acute back injuries where everything goes into spasm and you can barely move. At that time it feels as though something catastrophic is going on – what Moseley describes as a danger response.
At this time what we need is a practitioner who can support the body and help us to feel safe. When the feeling of danger has passed the spasm will reduce – there is less need to protect – and the body begins to trust that it can move again. This initial settling often occurs in the course of one session though more work is generally needed to address any underlying issues. I have seen this happen again and again. (Incidently, by calming the over-arousal in the nervous system it reduces the local inflammation which also reduces the pain – but that is best saved for another time).
Another aspect of this dynamic is how we find meaning in the pain. This can have an impact on our recovery – just ask any sportsman who has had a career threatening injury. The work in rebuilding their confidence goes hand in hand with the physiological repair. This is where resilience develops. This felt sense of confidence within ourselves occurs when we re-establish the flexibility of those small reflexive responses within our tissues. As we experience this flexibility again we re-develop the trust that our body is able to withstand the demands of our sport and other activities.
So by paying attention to these involuntary, emotional responses within our tissues it can both speed up the recovery time and make it less likely that we will find ourselves in the same positions where the injury can re-occur or cause recurring pain. In working in this way we also develop a healthier relationship with ourselves and our body.
But in practice what does this look and feel like?
In Ortho-Bionomy we work both with the body as a whole, with the relationships across joints and directly with those reflexive responses we’ve been talking about. We move the body into positions where the tension is relieved and track what the tissues and the body does next.
In effect we are helping the body feel itself and how it responds to certain movements and stimuli. For example – is there a resistance? Is there a sense of wariness? Where does it tighten up and where is it free to move? How does this impact on the pain or the coherency of movement and how do we interact with that in a way that allows for more responsiveness?
This exploration allows us then to apply the techniques of Ortho-Bionomy to engage with those structures, those tissues and those reflexive responses in a way that facilitates change and resolves whatever it is that is going on. There is nothing else to be done.
What this feels like for the client during the session is generally a feeling of comfort, a sense of being calm, a stronger sense of their body and movements. It results in a reduction in pain, more ease in the body and more cohesive movement. When we are able to feel in our bodies we also tend to feel well within ourselves.
When we understand that there are different aspects in our response to pain and how these responses manifest in the body, it gives us more ways in which to interact with the dynamics underlying the pain or dysfunction. This doesn’t necessarily require us to work differently – but it does ask us to engage with our clients and pay attention in a broader, more inclusive way.
*Interoceptive – literally being receptive to our internal sensations – it refers particularly to those sensations of the viscera and organs, the constellation of which relates to various emotional states