PRIDE Physiotherapy – Pain

Neil - Doctor of PhysiotherapyPain0 Comments

*warning – long personal story ahead*

The body is capable of achieving incredible things and in order to do that we do need to push the envelope, but there’s a very fine line. Pain is a normal, natural, necessary mechanism we need to guide us and we do need to listen to it; but it doesn’t control us – we control it. Pain is an *output* from the brain, not an input. It’s a response to an actual or perceive threat to the body. Listen to it and you’ll be fine, but don’t let it control you.

Last weekend I saw an elderly gentleman on a road bike at the top of Springbrook national park. I asked him how many kilometres he would be doing; “220 to 230” he said. It was going to take him 7 hours. If he was under 60 years old I would be very surprised, yet he was doing something most 20 year olds couldn’t do.

Building physical competency, capacity, and skill is a lifestyle just like showering and brushing ones teeth on a daily basis. Being physically healthy is also a lifestyle choice. It’s a biological fact of aging that after about 30 years things start to slow down and change…if we do nothing. Keeping active, strong and healthy helps to defy the inevitable age-associated decline in function. Pain may be a part of that. If you want some guidance, ask for help. If you’re concerned about pain, as for help. The chances are “it’s fine; there’s no damage; it will go away; just get on with it”.

Pain is complicated to say the least. It’s fair to say it’s the most common reason for someone seeking my advice as a Doctor of Physiotherapy.

This is my own experience of pain so far this year.
Because I’m a Physiotherapist, teach kettlebell classes every day and visually look pretty healthy (well, that’s what I see), my guess is that my patients think I’m a picture of health and live a life free of pain and injury. Au contraire! Most of the time I feel worse than my patients.

If I’d known at the start of 2016 that I’d be writing this post now I would have kept a record of the number of days I’d been in pain, but I didn’t. Without a doubt it’s been more than half, possibly as much as two thirds.

Some of the pain has been self-inflicted; I’ve pushed myself too hard; there’s been a clear mechanical reason for it and it’s just been an annoying intrusion into my life. On other occasions I’ve had intense, disabling pain that’s stopped me in my tracks for weeks on end.

When I started to learn about the physiology of pain, I would actively start telling myself “it’s fine; I know there’s no damage; I know it will go away; just get on with it”. Without exception, that’s what’s happened. It’s called regression to the mean – the natural process of returning to normal without intervention. Your body is extremely good at taking care of itself. Granted, there have been occasions when it took longer than expected for my pain to go away, but every single ache and pain has resolved (apart from the ones I have right now as they’re new this week).

Given that it’s been on average at least every second day, I think that’s a pretty good result. Passive treatment has been almost zero. I’ve managed to persuade my wife to give me the occasional massage which has definitely provided some temporary relief, she’s cracked my back when I’ve felt like I’ve needed it (I have another unrelated physical reason for wanting that and she’s also a doctor), and I’ve been through plenty of Woolworths Home Brand paracetamol and ibuprofen.

PRIDE officially opened Nov 30, 2015. In the weeks leading up to and following our opening, my regular routine of exercise dramatically declined (embarrassingly so), stress levels went up and I lost 8kg. Until then I’d been pretty pleased with myself that the gym-induced aches and pains I used to get had all but disappeared since training with kettlebells.

In summary, in the first 4 months of this year I’ve got back into a regular routine of exercise (kettlebells only), I’m feeling as strong and healthy as I’ve ever been (which is saying something at 40), I’ve finally reached physical targets that not too long ago I thought were unattainable, yet I can’t remember having had so many different aches and pains in such a short space of time. It’s been a pain in the neck, quite literally.

In the past 15 years, I’ve had gym-induced injuries which have affected both knees and both shoulders and I’ve had more than 12 months of pain from each joint; in my head they no longer really count though.

Almost everyone experiences pain one way or another. Those unfortunate few who don’t feel pain at all, typically have a short life expectancy. It’s a normal, natural phenomenon that comes and goes and for the vast majority of us, and it’s just not significant. This post refers to the type of ‘mechanically-patterned’ pain, not the pathological sinister type, as that’s an entirely different challenge altogether and persistent pain adds yet more complexity.

Shortly after PRIDE opened I must have strained my shoulder, probably training; I have no idea how as nothing hurt at the time. I had an annoying ache and weakness but it wasn’t bad enough to stop me, but it did persist for at least 2 months before it rapidly became disabling. By that stage I couldn’t lift my arm overhead, couldn’t train very well with that arm and was struggling to even use a laptop. After 2-3 days of paracetamol and ibuprofen it disappeared.

Immediately after that resolved, I woke one morning with what’s called a wry neck – that intense pain and difficulty turning the neck. I didn’t think anything of it as I’d had it several times before; I told myself it would be gone in a day or two and just got on with it. The next morning drying my son after his shower I sneezed and practically disabled myself. The pain was intense and I could barely move my neck at all in any direction and it was uncomfortable lying down; that little sucker took a week to go. I have no idea why I was in so much pain, but I knew there was nothing wrong and 10 days later it was if nothing had happened. Shortly after that while swinging a kettlebells in class doing something I’d comfortably done a thousand times before, I experienced an acute pain between my ribs which took my breath away. There was a clear loaded mechanism and I knew I’d damaged something but I was in the middle of taking a class and continued anyway; I’m a male and that’s the sort of silly thing we do. That one really caused me some challenges. I’m usually a side sleeper but was forced to sleep on my back; just getting in and out of bed was excruciating and took my breath away. I was unable to lie flat on my back on the floor at all for 3 and a half weeks and had to have someone else demonstrate any exercise which involved that position. Training pretty much stopped completely. At times it felt like I may have fractured a rib, but an X Ray ruled that out, so that left some form of soft tissue strain which would likely take about 3 weeks to resolve; and that’s exactly what happened.

With the back to back shoulder, neck and rib pain, I felt pretty disabled for a good 6 weeks. Without being able to exercise properly I was deconditioning; I felt very frustrated and a bit miserable with it all. I’m a Physiotherapist; I’m supposed to ‘fix’ these sorts of things, not be a poster boy for listing them all.

Once I got back into the swing of training (excuse the pun), I quickly got myself back on track to achieving 100 single arm swings with a 32kg kettlebell in under 5 mins followed by 10 Turkish get-ups with the 32kg bell in 10 minutes. Poorly managing training load or failing to acknowledge the risk of injury with high intensity acute training in relation to chronic load and deconditioning (what I was doing) is a recipe for disaster. Fortunately I dodged the injury bullet I’d set myself up for but have had a significant amount of low back ache since, pushing the envelope of function. There’s a phrase, ‘if you’re not living on the edge, you’re talking up too much space’; that’s got male bravado and ego written all over it, but for those of us who are physically active males, it’s an all too common and misguided approach to physical function…..that sometimes we just can’t resist. It’s like it’s in our genes.

I was a mature-aged student studying Physiotherapy and I frequently used to get myself into these physically competitive challenges with a good mate who was 20 years old and in his physical prime (I *thought* I still was); he managed to successfully run the Gold Coast marathon without stopping on the back of one single 10km training run. One day in the Uni gym I’d loaded up the leg press with my max weight for 6 reps and I told him I was going to do 6 reps; “bet you can’t do 10” was his reply. On the 8th rep the tendon under my knee cap tore and I spent over a year in pain. That was just male-stupidity and we (I) do it all the time. I guess it’s like women buying shoes on sale?

Today my back pain is mild, but that’s probably because it’s been masked by the shoulder and elbow pain I’ve inflicted upon myself (again) this week. In the 4 months since we’ve been open I’ve been looking at our Olympic rings wondering how long it would be before I would be able to do a strict ‘muscle-up’, if ever. During a training session on Tuesday I was practicing what’s called a false grip pull-up which is the start of a full muscle-up. For some reason I just kept going and without planning I’d done the full muscle-up and it felt easy; my first ever! Absolutely overjoyed I of course tried to do it again to get one on video. Attempt 2 – fail. Attempt 3 – fail. Attempt 4 – strained my elbow and shoulder. Two days later (yesterday) and still in mild pain but determined to nail it, I tried again (that was a stupid decision).
This time I failed in style and strained both shoulders quite badly. So now I’ve had to face reality (yet again) that I’m not indestructible and will have to practice what I preach and be sensible about managing my training load and avoid trying to run before I can walk.

Occasional aches and pains with no apparent reason are indeed an odd phenomenon and can be completely disabling. Bending forward and picking up an object from the floor only to be struck down with immobilising pain is a classic presentation. During class on Tuesday evening after 3 rounds of exercise, I started to experience a really intense localised ache in my left thigh which felt like I’d been hit hard with a blunt object. It was really uncomfortable. I couldn’t continue to squat properly but kept going. After we finished up and went home I’d forgotten all about it. I have absolutely no idea why it happened and don’t need to care; it’s gone now and I know there was no damage, just pain, and I’m the one in control of that.

Being a Physiotherapist doesn’t mean I’m immune to pain and disability; it’s part of being human.

Do as I say, not as I do (the good stuff, not the stupid stuff)?


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