S3 E2: S3 Ep 2 – The Myth About Pain Recovery (Why It’s Not a Straight Line)

Hello and welcome to the Pain Free Living podcast with me, your host, Bob Allen.

I'm an osteopath and this is Claire Elsbury.

She's a therapy coach.

Today we're going to be talking about why pain improvement is really inconsistent.

So one of the things I've noticed in what I do is that people have an idea that when they have an injury, it starts off excruciating pain and then it just progresses nice and smoothly to the point where they are pain free.

And that is how I would love it to be.

Unfortunately, it doesn't do that at all.

Rather than being a straight line from pain to pain free, it goes all over the place.

And the idea of this podcast is to give you an idea of why that happens.

If it does happen, don't be too disheartened by it and rest assured that it will get better.

So we're going to start talking about it from a physical therapy point of view, which is my arena.

Yeah.

And, yeah.

So one of the things I see a lot, particularly with low back pain that has been there for a while is that progress from pain to pain free can take a while.

Everyone is different.

Different diets, different health levels, different fitness levels, and that all affects recovery.

So if you're a smoker.

Yeah.

Give up smoking because one of the.

One of the most common things that will impact on low back pain or recovery from any kind of injury is smoking.

So give up on that straight away.

What tends to happen when people are recovering from pain is that it gets a little bit better, so they tend to do more.

So when they come see me, I will give the.

I'll treat them and I'll give them exercises to do.

And the exercises are geared around what they can do and injury.

My mantra is movement is medicine.

The more you move in the right way, the quicker injuries will heal because it increases blood flow.

Increasing blood flow increases nutrients to the injured area, takes away waste products from the area, gets more oxygen to the area, takes away carbon dioxide.

So movement, increased blood flow will help to help to reduce injuries and help you to recover quicker.

Now, when I give people exercises, it's where it's always progressive.

So we'll start off with, say, I'm just trying to think of an exercise that people might recognize because I do lots and lots of different types of exercise.

Okay, so let's say we give them an exercise, they will do the exercise, we'll do a treatment.

Well, they'll do the exercise, they'll feel a bit better, they'll go home with homework exercises to do.

Now, the problem is because everyone is different.

There is no one size fits all exercise.

As I said, it all depends on physical makeup, good nutrition, sleep, that sort of thing.

As a little aside, because everyone is different, if you go on to TikTok, go into Google, go onto Instagram, you will see influencers who will tell you that if you do these five exercises, it will get rid of your back pain.

Most of the time it doesn't.

I see lots of people that come in to see me and before they've come to see me, they've gone on YouTube and they've found an exercise which is guaranteed to get rid of their back pain.

And it often doesn't get rid of their back pain, occasionally makes it worse or doesn't make any difference.

The reason for that back pain, particularly because there are probably 30 plus reasons for back pain.

And if you have a disc issue and the person whose exercises you're following had a facet joint issue, then it's potentially going to make it worse.

So any exercises you see on the Internet, take with a massive pinch of salt and don't be surprised if they don't actually help.

That's the digression.

We'll come back to what we were talking about before.

So I give people exercises to go home with.

They're tailored to whatever will benefit them.

Now, doing the exercises will help, but I don't know how many exercises they can do.

So my watchword is a little discomfort while you're doing it is okay and to be expected.

But if you get more pain when you're doing the exercises or you get more pain afterwards, you've done too many.

So reduce the number, carry on doing the exercise.

Because as we know, exercise is the best way to heal.

Movement is medicine.

Throw that in again.

So what?

As I said, everybody wants a nice, linear, smooth path from pain to pain free.

It never works like that because you feel better.

You think, okay, I did 10 of those exercises yesterday, I feel fantastic.

Today I'm going to do 15.

You do 15 and it really, really hurts.

And I've had people that have done that, they've overdone it, they've gone out and spent too long in the garden pulling up the weeds or whatever it is, and their back hurts again.

Again.

What I always tell them is that, you know, because they'll come in and they'll go, yeah, my back's gone again.

I don't know what I've done.

And we talk about it and I say, yeah, I was in the Garden for three hours.

Well, that might be why it hurts.

And my back's gone and it's as bad as it was before.

Well, one of the things I always do, every treatment is I will reassess.

So we'll talk about where they are, whether they've had any episodes of pain or not.

And even when they're talking about, yes, it's the worst pain I've ever felt, I go, well, okay, when you first came in, this is where you were.

Remember that?

And I go, oh, yeah.

So actually it's a little bit better.

So recovery from an injury is there's.

There are times when people will overdo it and it will feel worse again, but it's very rare that they overdo it to the point where if they are as bad as they were when they first came in.

So as I said, the whole point of the video is that, yes, recovery from pain is not a smooth process.

You will.

You will have days when it feels fantastic, and you will have days when it feels fantastic.

You overdo it and you.

You regress a little bit.

But all that happens is you start from where you are.

So, you know, it's.

I've never had anyone who's felt pain as badly as I did when I first came in, but you give that a chance to recover, and then things will progress and improve from there.

So that's kind of where I come from, from a physical therapy point of view.

How about you, Claire?

Do you see that sort of thing in therapy, coaching?

Yes, to an extent, but it's where it's interesting for me, it's all about the trust in the process.

Yeah.

So that, again, we're coming back to our belief system.

What do we actually believe about what's going on and if.

What I should say about beliefs, and we've talked about this before, we could do a whole podcast on the belief system.

But I could say about beliefs is that, you know, they're not necessarily true, so we've got to be able to question what our beliefs are.

So if, say, we believe that our progress is going to be linear, and then it isn't, but we firmly believe that it should be.

And this is this word should.

It's all about managing expectations.

Yes, absolutely.

Yeah.

And the trust in what is going on.

So that could be the trust in the medic that's treating us or the trust in me working with a client.

You know, why am I not feeling better than.

You know, I. I think I might be even feeling worse.

But as a.

The.

One of the the beauties of positive psychology is, and a bit like Bob was saying about, he will always reassess with positive psychology.

I will always start each session with where are we now?

And I will provide, be able to provide evidence and we'll have like a work in progress, if you like.

So we'll be able to actually prove and evidence that things aren't actually as bad as what they were in the beginning.

And sometimes that takes a bit of education, a process to go through for the client to realise that and appreciate it and again question their belief system.

But the trust part is interesting for me because what happens is if we start to lose trust in what's going on, we can start to get anxious about what's going on and that causes low overload to our autonomic nervous system.

Our sympathetic nerves, nervous side of it kicks in.

We have the emission of stress hormones, which is like tension, muscle tension, whatever, however that presents itself and then, which almost creates a self fulfilling prophecy.

So we think we're worse and therefore we get anxious about being worse and then we, that actually fulfills and we do feel worse.

So you know, no matter what's going on in terms of physical side, our mental side can actually fuel that as well.

Yeah.

And if we take it a step further, that can lead to catastrophizing.

So in other words, thoughts like what if, what if I never get better?

What if this is my life now?

I have seen that, I have seen that self talk is so important and it's, and it's one of those things I will.

My appointments tend to be longer than average because as exactly as you were saying, it's all about managing expectations and I like to take time to explain why someone is why we're doing the exercises that we're doing.

Yes.

And the benefits of doing those exercises.

So in, in the real world, exercise compliance is generally very low.

It might be 15, 20% because people will be given exercises with no explanation of what the benefits are.

Particularly these days, particularly in the nhs, physios are actively discouraged from doing any hands on.

So they give people exercise sheets.

If they're lucky, they will get people to do the exercises first.

A lot of the time they don't do the exercises so they may potentially be doing them wrong and cause themselves pain.

Yeah.

And people subsequently stop doing them.

Again, you're self fulfilling prophecy, aren't you?

Exactly that.

Exactly that.

So I believe that managing people's expectations by giving them a good explanation of what they're doing, why they're doing it, what the benefits of doing it are.

So my exercise compliance is.

Is 80.

90%.

Most people will do them because.

Because it makes sense.

Yeah.

You know, once they understand why they're in pain and once they understand the benefits of doing movements to get out of pain, they'll do them.

Yeah.

You know, they may stop once the pain's gone, and then they come back in six months and say, my back hurts again.

Well, yeah.

Are you doing the exercises?

No, it stopped hurting.

Yeah, that's fairly typical.

But that's okay because.

Because they know how to manage that.

So, yeah, it is.

It's knowledge and having information.

And I would probably reframe.

Reframe the expectations, possibly by saying you might not be improving fast enough.

But you are improving.

Yes.

So it's about what does.

What does fast enough mean?

Yeah.

And people have expectations of their recovery, how quickly they'll recover.

Yes.

Yeah.

And that, again, is all part of the initial talk or the initial information that you give a client as to say, you know, the timelines.

It's probably a lot easier for you than it would be for me because.

Not really.

You know, I sometimes find I've got Pandora's boxes.

So you start off in one place and it ends up going to.

But then I think you've said to me, you've got exactly the same.

Absolutely.

Yeah.

Somebody with five years of knee pain, and it turns out the problem wasn't his knee, it was his hip.

Yeah.

You know, it's.

And that's the thing.

So you always.

You start where that.

Start where the person is, and then you progress from there.

So sometimes if it's a really.

If it's pain that's been there for a long time, you end up treating three or four different areas to get a resolution.

But that's.

Okay.

I don't get.

I don't have issues with that from my clients because I explain.

This is.

This is where we are.

This is what I'm going to do.

Let's see how this goes.

And then if that's better.

Oh, my shoulder starting to hurt.

Well, okay, let's look at the shoulder and see if there's that link between that and your.

And the opposite hip.

And we just go from there.

So, yeah, it's pain.

I'd love to say that it's a linear, smooth process resolving people's pain problems, but actually it's not.

Sometimes it is, but most of the time it isn't.

So.

Yeah, because we have our brains to.

Deal with and everyone's different.

Everyone's different.

Any more on that one, Claire?

I don't.

I don't think so.

I think it's more.

My takeaway is that to be just really clear on managing expectations, on giving information.

And you said the magic word, benefits.

The benefits of doing something.

Yeah.

And if there were risks, I'll explain those as well.

I think once people.

Once, and in my experience, once people have all the information, they're good to go.

They are happy for you to go through the process with them because they understand what you're doing and why you're doing it.

And I think that's the thing that's missed out from a lot of medical interventions nowadays because they're just told, this is what's happening, this is what we're going to do to you.

And it's not a partnership, it's.

This is being done to you rather than being done with you.

And this is the same with mental wellbeing as well.

Is giving someone a toolbox which they understand and they know which tools they can use in different circumstances, and it's just having the confidence to know that it's there and they can use it.

Yeah.

And that reassurance that it's there, they can use it.

Absolutely.

Absolutely.

Yeah.

Okay.

I think we have got to the end of yet another pain Free living podcast.

And as always, if you liked it, tell your friends, tell your family, tell everyone, tell your enemies.

We don't mind who you tell as long as they subscribe to the podcast.

And that's it for now.

Goodbye from me, goodbye from Claire, and we'll see you at the next one.

Thanks for watching and listening.