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So You Have Back Pain – But Is It Injured?

(Updated May 2020) This blog talks about a really important question, especially for the back pain sufferer. The answer seems so obvious, but it is much more interesting than you think!

The obvious answer

If you have back pain, the automatic response to this question is ‘yes, if it hurts, there is damage. Of course, you moron!’

In acute pain, that may be a more accurate statement (but even then, it isn’t as simple as that, as we will demonstrate later!)

If you have persistent pain, the relationship between pain and injury becomes even less clear.

Doesn’t make sense? Read on …

Why does this matter at all?

This isn’t just being pedantic and fancy with science and words. This distinction is actually really important, especially if you are someone that is coping with persistent pain.

Why is it important? Because it can completely change your whole approach to your problem.

if pain equalled injury, why would you move if it hurts?

 

If you believe that pain and injury are the same thing, no one can blame you if you don’t want to move!

If you have persistent pain and you believe that your pain means that you are proportionately injured, then why would you want to move? Why would you challenge that body part at all with movement or activity? Instinctively, you would avoid doing things that hurt (unless you were a sadist).

On the other hand, if you understand that tissue injury isn’t necessarily proportional to pain (particularly if the problem is longstanding) it is liberating! Then you can start to appreciate that some things can hurt even when they are healed.

Then you can start to move with pain and work with pain with some confidence (rather than being afraid of the pain, avoiding it or battling against it).

This is a key concept that underpins the current best practices for helping persistent back pain.

Let me tell you an amazing pain story

We refer often to the book ‘Explain Pain’ by David Butler and Lorimer Moseley when we are talking about the subject of pain science and injury. It really is the gold standard in pain education texts.

There are many great examples of amazing pain stories in Explain Pain. These stories demonstrate that pain and injury are not the super tight BFFs that we often think they are, even in acute injury situations.

Here’s an amazing pain story that I found last year.

A young lady in East Perth was unlucky enough to be stabbed in the thigh at the local train station by someone demanding her phone. You can read the story here. First, she described feeling nauseous and cold. Then:

“The moment that I fell down, I felt that I was surrounded by my blood, because it was all warm,” Ms Trevisani said.

Ms Trevisani said she “lost her senses” shortly afterwards and woke to find police surrounding her.

“I was kind of shocked. I didn’t feel any pain,” she said.

Wow! How does that happen? Her brain was making some executive decisions in the moment that pain wasn’t really helpful for her and so she didn’t experience pain.

This was despite the veritable flood of high priority danger messages that her brain must have been receiving from her thigh. Tissue had been damaged and sensors would have been generating priority signals in great volume to her brain.

pain and injury are not the same thing

 

You can have pain without injury and injury without pain

Now you can see that the relationship isn’t quite as simple as you might think! And not just in persistent pain, but in acute pain too.

I haven’t been stabbed though! It’s my back.

What this story demonstrates is that the relationship between injury and pain isn’t fixed, but it works both ways.

Just because you have back pain doesn’t mean that it is injured tissue. And just because you have injured tissue doesn’t mean that you will have pain. You could have been stabbed in the leg, bitten by a shark, or shot (check out last week’s blog on what it feels like to be shot), but it doesn’t necessarily mean that you will have the pain that you might expect.

Taking that one step further, you could have a back that plays up from time to time. It might feel like it ‘goes out’ then it’s OK for a while. You might even stir it up by doing something or lifting something heavy.

The instinctive and understandable conclusion is that each time it hurts, it has been injured. This article might give you a hint that maybe, just maybe, it isn’t always the case.

Hopefully you might see that if you do have persistent pain, there is a bit of pain science info that is really good to know.

Once you have a better understanding of how pain works, it can be quite liberating!

free online pain education course

If this information is whetting your appetite, we have a Free Online Pain Education series, and we would love for you to check it out!

The series is 6 weeks long. You will get one email per week with a link in it, which gives you access to information that we have written to explain some of the key concepts, plus videos and other stuff that we have collated over the years.

This is some of the best information that we use to help explain pain to our patients to reinforce what we talk about in the clinic.

We estimate that you would need about 20 minutes for each module, but you may find it useful to review it to really let it sink in!

As Kim correctly pointed out, it is like getting 6 free physio sessions!

If this interests you, all you have to do is email us at admin@adelaidewestphysio.com.au, and we will get you started!

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About the author

Russell Mackenzie
Russell Mackenzie
Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He received his physiotherapy degree from UniSA in 1994, and has since also become a Credentialed McKenzie Therapist. Russell is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed after becoming a Watson Headache Certified Practitioner to show his dedication and passion for headache and migraine treatment. Russell also aims to spread the word about the role of physiotherapy and non-surgical methods of helping persistent pain, low back pain and other conditions. Learn more about Russell on our About Us page.
Russell Mackenzie

Russell Mackenzie

Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He received his physiotherapy degree from UniSA in 1994, and has since also become a Credentialed McKenzie Therapist. Russell is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed after becoming a Watson Headache Certified Practitioner to show his dedication and passion for headache and migraine treatment. Russell also aims to spread the word about the role of physiotherapy and non-surgical methods of helping persistent pain, low back pain and other conditions. Learn more about Russell on our About Us page.
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