Research shows that ~45% of the population are suffering musculoskeletal pain. What does this tell us about the majority of management methods?

This might get a bit heavy, but I think it is so interesting because it challenges what I learnt as a physiotherapy student in 1990!  Below is the start of a three part blog on pain....I have to make it clear...I didn't write any of this! This comes from the latest research from the RMII.  And to be honest, i wouldn't be able to put it into any better words.  I will add it as a page on my website for easy reference if you ever want to share it with someone you know who is suffering from pain.  I have highlighted the part I find most interesting and that summarises what this is all about!  


The number one misunderstanding about pain:

• That pain is a feeling.

There is growing body of neuroscience and physiotherapy research that is making it very clear that pain is not a feeling.

This research has clearly shown that there are no 'pain receptors', no 'pain signals' from the tissues, no tissues ‘feel’ pain and there is no pain ‘in’ any body part.

This insight is very helpful to directing our attention to the factors that need to be fixed to get rid of pain.

What does the latest research explain?  Pain is actually created by the brain - for good reasons.

• Understanding that pain is created by the brain allows us to focus on fixing the structures everywhere and anywhere in the body that are the underlying cause of our brains creating the pain
• This sometimes means that treating areas different to where the pain is created is the best way for most rapid and long-lasting results

Why is this such an important differentiation?

These signals tell the brain the state of the tissues

This differentiation allows us to understand what is required to resolve pain most quickly.

If we accept that pain is not a feeling, should we try to fix the problem by solving the pain?

Imagine the scenario of a car that is malfunctioning with a bright engine warning light on the dash.  Is it sensible to think that we can fix the problem by doing something to the warning light?  Or would it be more sensible to acknowledge the warning light and then check out every possible structure that could be causing a problem to the car’s engine?

Recent studies teach us that pain is the brain's equivalent of a dashboard warning light.  When we stop to think about it this makes a lot of sense and this way of thinking fits all types and scenarios of painful conditions.  In other words, this way of thinking appears to be the simplest and most ‘true’ way to understand pain.

This warning light analogy is a simplification because the body’s the warning light, i.e. pain & symptoms can be created by the brain as an experience 'in' any part of the body for any problem anywhere in the body.   Taking into account these variations, the principle of a creation of a warning signal is incredibly helpful.

For example, it may be that when you hit your thumb with a hammer, the warning signal produced by the brain creates an experience like is pain 'in' the thumb - and usually this is a very successful protective mechanism that results in moving the thumb out of it's dangerous position to prevent further damage.  Or it may be that injury occurs in the spine and the warning signal produced by the brain creates a pain-experience 'in' a limb (or vice versa). This way limping, or stopping walking, is a protective mechanism to stop strain to the spine - because the leg hurts.

• Seeing conditions this way ensures that we treat the body parts that need the most help and not just where the pain is created
• The added bonus is that this approach is similarly successful in alerting us to avoid behaviours that add more strain to the damaged area that matter the most for  the condition - this is prevention of recurrence.

It is important to note that this way of thinking does not lesson the significance of pain.  On the contrary, it actually validates how important pain is as a warning signal.

Pain is a very important indicator to for us to pay attention and change what we are doing to protect us from harm.

The brain is very smart and at least one step ahead of our consciousness.  This is fundamentally a good thing because if we relied on our conscious awareness to avoid danger we would not do as well at protecting ourselves. For a start, our conscious awareness is too slow and distractible to respond effectively; and secondly, it would be too easy to consciously 'override' the warning by continuing our preferred activity despite the damage... until it's really too late.

 After the brain receives the signals it decides how to respond

This way of thinking about pain does mean that we need to rely on atypical means of solving why the pain is occurring - to fix the problem most effectively.

For example, if someone's right arm uses a mouse most of the day in an excessive forward-shoulder position and this creates a gradual build up of strain in the mid-back; in some people the response by the brain is to create the experience of pain like it is 'in' the right arm.  Often this is also accompanied by muscles, nerves and joints suffering a condition (diagnosis) in the right arm also.   This usually has the desired effect of changing the behaviour to avoid the poor mousing position with the right arm, and results in decreased strain to the mid-back.  When effectively solved with good physiotherapy; release of strain to the mid-back results in the brain ceasing creation of the right arm pain (and rapid resolution of the arm condition/diagnosis); then changing the mousing position, or posture, to minimise mid-back strain results in the brain havingno reason to create the right arm pain again.

This way of thinking gives us good reason to explain why pain and symptoms are not good indicators for figuring out how to solve a dysfunction.  In the example above, treatments to the pain in the right arm would not solve the problem, or gain a rapid and long-lasting result.

Just to build the suspense a little... Ridgway Method Certified Practitioners have much better ways for figuring out what is causing the dysfunction and what needs to be treated to fix the problem, than trying to fix the 'warning light' of pain.