I tell people that I’m pain-free, but that is, of course, a lie. “Yep, I’ve got feet flatter than a geometric plane, but no pain here!” I say this to encourage people to think differently about their personal body weirdness, but I’m covering up a terrible secret: Everybody hurts sometimes.
Hell, being a massage therapist is a game of “what weird new injury can I acquire this week?” It might be a funky shoulder, a thumb that doesn’t like it when you open jars, an ankle that doesn’t… you know, work.
This game might sound familiar to the athletes among us. Pushing yourself physically often results in weird little things going wrong, or sometimes weird big things. This happens to athletes all the time, but they tend to be little bumps in the road as they continue on toward their goal.
What’s their secret? How can they be constantly getting hurt, but still generally okay? You see, when an athlete hurts herself, she treats it.
Ignoring It Works Too, Right?
What? No. What?
I mean, sure, sometimes. In fact, the body is pretty good at getting you to recover from injury. If you twist your ankle, you probably don’t need to do anything special to get better. Wanna know why? Because your body bullies you into treating it differently. It forces you into compliance via inflammation.
Our Frenemy, Inflammation
Inflammation is the near-instantaneous process that the body uses in response to any injury, bump, pinch, or poke. Hell, it’s what the body uses when you catch a cold, or have an allergic reaction, or drink too much. It’s called a non-specific immune response because your body uses it for every situation, much like your friend who plays “Your Body Is a Wonderland” every time he finds a guitar at a party.
So let’s say you roll your ankle. You have to limp around for a month because of the damage, right? There’s, like, ligaments and cartilage all torn and shit, right? Maybe a little, but all that pain and swelling is coming from your body’s inflammatory response.
When you get a cold, all the pain and dripping and tiredness is because of the evil microscopic invaders, right? Nope, that’s your body’s inflammatory response.
So WTF is inflammation? What are the symptoms, and why do they exist?
- Swelling, redness, and heat. Pro-inflammatory chemicals released by your body’s cells cause your blood vessels to dilate (become big) and become leaky, causing plasma to gush out into the surrounding tissue. This serves a couple of purposes: One, suddenly your tissue is full of white blood cells that are ready to begin the repair process and/or the disease-fighting process. Two, it’s really hard to use that body part when it’s the size of a softball.
- Pain and malaise. Those same pro-inflammatory chemicals stimulate your nociceptors (you can think of them as “pain receptors”), which actively cause you pain. That rolled ankle doesn’t hurt because it’s damaged, it hurts because your body turned your pain switch from “off” to “on.” This keeps you from doing anything stupid, which is kind of sweet in a dopey way. If inflammation is widespread enough, you’ll also feel malaise, which is that flu-like feeling of being completely drained. Again, your body wants you off that ankle.
- Scar tissue formation. Along with all of those chemicals and leakiness come these little guys called fibroblasts, cells that lay down collagen. If you tweak something, cut yourself, or even turn your head funny and end up with neck spasms, your friendly neighborhood fibroblasts will drop by and lay down a thick web of extremely strong protein. Some of this will be resorbed over the next few weeks, but some will stick around to reinforce the area.
Altogether, these add up to incapacitation. Slammed your knee on a table leg as you were sitting? Your body is going to make you limp for a while as it sends the clean-up crew in to check shit out. Step on a nail? That foot will be so painful it will be useless until the body has had a chance to make some repairs. Hit by a car? Here, have some forced bed rest.
Well, I Guess the Body Knows Best…
The body knows shit. It’s acting off of very limited information, and it’s using responses that made way more sense in a world before desk chairs and modern medicine.
If you twist your ankle, no matter how much damage was actually done (it may have been close to none), your body will use pain and swelling to create a hydraulic and psychological cast. Suddenly you can’t use that ankle, and you’re forced to stay off it for a week, and then treat it gingerly for a month. In the meantime, those little fibroblasts are laying down collagen willy-nilly like humans boarding up a house to defend against zombies, effectively creating a physical cast.
Basically, it’s a rush job, and it’s usually a huge overreaction. This is where it’s time to treat your injuries in the same way that athletes do.
When an Athlete Gets Injured
Athletes know that they need to get their inflamed tissues to calm the hell down before anything can turn chronic. As I’ve said in previous posts, your bodies tends to overreact due to the limited information at its disposal. We need to get it to dial things down so that we can heal functionally rather than just quickly.
The two main weapons in the athlete’s fight against pain are ice and compression. Both slow down the body’s inflammatory response, and both have been proven to reduce pain (especially when used in tandem).
Next, they keep working. If an MMA fighter has knee pain, he’ll be on the stationary bike until it recovers. If a volleyball player hyperextends her elbow, she’ll drill exercises that aren’t painful until she can start playing again.
This isn’t just to stay in shape. Athletes know that active recovery gets them back into the game sooner, and that it promotes functional healing. If they injure themselves, or even if they have surgery, they’ll reintroduce movement as soon as they can in order to make sure that pain doesn’t linger.
Basically, athletes are constantly covered in ice packs, they always seem to have one part of their body or another wrapped in a compressive brace, and they’re always modifying their exercises to work around injuries. The question, o chronic pain sufferer, is why don’t you?
Your Athlete-Inspired Protocol
So you’ve hurt yourself.
First, definitely listen to your body and take it easy for a while. Don’t purposely cause yourself pain.
Second, ice your injury twice a day for approximately ten minutes. Any kind of ice pack is great, but I like to use the Mueller Cold Wrap when it’s practicable. It adds some compression, and it keeps it in place without me having to think about it.
Third, wrap your injury for about 8 hours a day using either an ACE bandage
or a brace meant specifically for the body part in question. Go simple; I recommend the knee braces that look like socks, not the ones that make you look like Robocop.
Finally, resist the urge to reduce your activity level completely. Wrap your injured area and get moving. If you can walk, experiment with going on walks while you’re injured. If this doesn’t exacerbate your problem, carry on. If you can’t walk, can you bike? Can you use stretchy bands?
Start slow, and reintroduce more intensity and variety as time goes on. If your injury is something complicated, do this under the guidance of a physician, physical therapist, or an especially knowledgeable personal trainer.
What About My Chronic Pain?
Treating your injuries will help you manage your other aches and pains by keeping your overall inflammation levels lower, and by preventing a decrease in your pain threshold (see my article “Got Chronic Pain? It’s Time to Think Differently“). Also, as you learn to deal with new problems that crop up, you can prevent these things from becoming part of your chronic pain menagerie.
Can you use these techniques on your chronic conditions? The answer is likely yes, but with some modifications. Wrapping a chronically painful knee that’s currently in a “flare-up” is an excellent idea. Icing a hip that you just tweaked seems like a damn fine notion to me. That said, you may want to experiment with things like heat, stretching, and strengthening… but that’s a future post.