Hurt Versus Harm

Most people that book an initial physiotherapy assessment are in pain. Quite often they do not have mechanism of injury that is apparent to them. It is common to hear, β€œI’m so sore but I didn’t do anything that I can think of to feel this way”.

Not knowing what made them sore in the first place adds fear into the equation. When I ask them what their goals are by seeking help from physiotherapy, they often reply, β€œI don’t want to do anymore damage or permanent damage so I want to know what is going on”.

When people are afraid of doing damage they decrease many of their favourite activities. Therefore, it is our goal to get you back to doing what you like to do as soon as possible. The first step to doing this is educating people about pain mechanisms.

To simplify things, I like to divide pain into one of two categories.  The first is INJURY where there is tissue damage. This includes sprains, strains and fractures. Injuries have an apparent mechanism, and while the tissues heal you may do HARM if you load the tissues too much. This is why these injuries may require splinting or bracing as they heal.

The second category is PERSISTENT PAIN where the main mechanism is a guarded nervous system rather than a tissue problem. If we do something our nervous system is uncomfortable with, it will start to guard and then it will begin to let us know we are exceeding the tolerance limit by HURTING. We are programmed to avoid pain, so by causing hurt our nervous system is trying to control or change our actions. If we are sore after doing an activity in this instance, we have not done damage to something. Rather we have upset our nervous system that is monitoring and processing all forms of sensory input that is coming at it.

Why is your nervous system upset?

The main reason….OXYGEN.

More specifically, a lack of oxygen.

The metabolism of cells is dependent on oxygen which is carried via blood flow. If blood flow to a tissue is restricted, metabolism in that area is compromised and the nervous system registers this as a possible threat. When this scenario happens often enough or it builds to a significant level, then your body hurts. This usually causes us to change our actions in one of two ways: move or fidget to return blood flow to the area, or restrict activity to minimize loading the tissues.

When your nervous system gets irritated and starts to protect, it keeps some muscles turned on continuously to splint movement to try to minimize strain on structures. However, this continuous muscle tone can later become problematic by partially compressing blood supply thus registering as a threat to the nervous system and causing hurt.

Treatment of persistent pain I boil down to two main factors:

  1. Reduce muscle guarding.
  2. Improve blood flow to tissues.

Teaching people how to do this as well as helping them to identify their aggravating factors allows them to stay active while addressing the problem. Knowing that you may experience some soreness after an activity without doing harm allows you to maintain a certain level of activity until things can return to normal.

Your body has the capability to repair itself when doing the right things. Our role as physiotherapists is educate, guide, and assist you so that you may achieve this.