Pain Science

IMPORTANT INFORMATION ALERT:
Pain is not (always) a good predictor of injury or tissue damage.

Pain is our most important survival mechanism. It is obviously unpleasant but also lets us know if we are in danger. Without pain, we would probably live substantially shorter (though arguably more care-free) lives. However, when pain starts to last longer than we’d like and without a seemingly reasonable explanation, it can dramatically interfere with our lives; for some, it can mean permanent disability.

First, we need to clarify another important point about pain. Pain isn’t simple, it is a complex experience, it is a learned behavior, and does not always mean something is wrong at a tissue level. A lot of people would feel the term, ‘it’s all in your head’ to be a taboo and apathetic phrase, however it couldn’t be more true. The brain controls everything about your pain experience. It takes into account past experiences with pain, and your subconscious perception on how this current perceived threat may impact your life, along with many other variables to determine if you are in danger. If your brain believes you are in danger, it will relentlessly create the experience of pain.

One clue to help us understand that pain does not necessarily rely on tissue damage or injury, stems from amputees who experience phantom limb pain. These people feel pain in a place that no longer exists on their body. How else can we explain this except by understanding the brain’s role in interpreting and creating the experience of pain.

In those suffering from chronic pain, we see changes in the regions of the brain that represent the area of the body experiencing pain. The area of the brain actually becomes ‘smudged’, explaining how over time, it gets harder and harder to localize where the pain is coming from.

The pain cycle perpetuates as we continually believe we are in danger. As we start to worry about the pain, avoid movements that create the pain and start to avoid activities that bring on the pain, we essentially reactivate the alarm system that tells us we're in danger.

So what’s the take-home from all this? Pain is not simply a matter of, ‘I hurt myself, now I'm in pain.’ Pain is a complex experience that the brain orchestrates based on many factors and can be present with or without any actual harm. And just as a pain experience can be learned, it can be unlearned over time. Start to question your pain. Ask yourself, ‘am I in danger?’ One of the best ways to help answer that is to talk with a relevant health professional whom you trust.

To understand this further, 'Explain Pain' by Butler & Mosley is probably one of the most up-to-date and easy to understand explanations on this topic.

Written By: Dr. Ryan Albert, Chiropractor & Medical Acupuncture Practitioner
Instagram: @dr.ryanalbert

Available for appointments at our Richmond location

Anyone who has ever ran, cycled, walked great distances or been generally physically active has probably experienced the notorious “tight” and painful IT band. Foam rollers (otherwise known as the modern day torture device) have become mainstream in treating these “tight” IT band issues. You likely own one, have used one or have seen those wonderful pieces of foam lying around your gym.

Don't get me wrong, I am a huge advocate for foam rollers. I use one semi-regularly and recommend their use to my clients all the time. They often produce quick (however painful) relief from whatever lower body issue being faced. However, there is a time and a place for their use and it is important to recognize when your foam roller is just not doing the trick.

Quick anatomy lesson. Despite common belief, the Iliotibial Band (ITB) is not a muscle and is therefore not under our active control. Rather, it is a passive piece of connective tissue that runs from the side of the hip bone (the ilium {ili-}) to the top/outside portion of the shin bone (tibia {-tibial}). The ITB merges into two key muscles at the hip, the gluteus maximus and tensor fascia latae (TFL). Activation of these muscles puts the ITB under tension to allow for specific hip movements and stabilization of the outside of the knee.

The ITB can in fact be “tight” in some individuals. Limited hip mobility and lack of flexibility throughout the connective tissue of the entire body are usually contributing factors to this “tension”. In these individuals, foam rolling can be VERY effective (and also usually VERY painful).

However, you can still get pain in your outer thigh, hip and knee and not have a “tight” ITB. Rather, your pain can be due to the ITB being overworked and broken down as a result of specific weaknesses at the hip. A small amount of foam rolling can still give some relief, but it is not an adequate long term solution in this case.

Ever seen someone who has “knocked knees”? Some individuals are born this way, meaning their joints and bones are structured naturally in this position. However, the majority of individuals I see with ITB issues are not in fact born this way. Rather, they have developed weaknesses over time that has caused their knee(s) to fall in towards their midline while standing, walking, cycling, running, jumping etc.

 

(Supermodel Karolina Kurkova with “knocked knees”)

The gluteus medius and maximus are two very important muscles in the outer hip that work to prevent the “collapse” of your knee(s). Both are often underdeveloped and under utilized in individuals with ITB and outer hip/knee issues. Stand on one leg and perform a mini squat. Does your knee fall in as you squat? Or does it stay straight over your second toe? If it falls in, or feels unsteady, your gluteus medius (and maybe maximus) are likely to blame. These two muscles work together to keep your pelvis level and your leg straight and steady beneath you.

So how to fix this? You need to first learn how to isolate and recruit these muscles in a non-functional (or non weight-bearing) way. Clamshells and glute bridges are likely familiar exercises and a great way to start depending on your degree of weakness (see below). However, it is important that you then progress into “functional exercises”. You must learn how to activate your glutes in weight-bearing positions with focus on controlling your knee during different movement patterns. If you can't activate your glutes to prevent your knee from falling in during a small one legged squat, you definitely won't be using these muscles while walking, running, cycling, jumping or doing your activity of choice.

 

If you're interested in where you may fall on the spectrum of “weak glutes” and/or have a nagging hip, knee or ITB issue, I would be happy to fully assess you and tailor a program that is specific to your needs.

Feel free to e-mail me at lauren@catalyst-health.ca if you have any physio related questions. I am always happy to discuss any issues or concerns you may have. 

Lauren Sutherland

Registered Physiotherapist

Registered Strength & Conditioning Specialist

Catalyst Health