Know Pain, Know Gain

Know Pain, Know Gain

Know Pain, Know Gain! I first read these words, written this way, in a photo of a high school gym where the wrestlers trained. The obvious meaning was that in order to win, one had to experience pain. In my mind, it further lent itself to an acceptance of pain shared by those on the team. Pain does rely on context. The pain an athlete would feel as a result of contorting his body to pin his opponent in order to win a state championship would be welcomed. The pain of a season ending injury would not. That is because pain is not purely a sensory experience. It is an emotional one, as well.

I have come to a different understanding of these words. As a physical therapist I work with people who experience pain that is unwelcome. The message that pain sends includes a threat. The value assigned to that threat greatly impacts the experience of pain. For example, someone who has a stiff shoulder will find it painful to reach and perform normal daily activities. As a result, many people will avoid using the arm. That, in turn causes the shoulder to become stiffer. The stiffer a shoulder gets, the less activity it takes to become painful.

Improving someone’s understanding of the pain they are having is an important step in their recovery. In the above example I would give a simple set of instructions. The first is that just because using a stiff shoulder is painful, that does not necessarily indicate that more damage is being done. I explain the difference between “hurt” and “harm”. Hurt is a temporary increase in pain that goes away after the pain provoking activity is stopped. If it hurts to reach up into a cabinet for a food item, but that pain goes away once the arm is back into its normal, resting position, then the arm was not harmed. A good thought for this person to keep in mind is that “my hurts don’t harm me”. Harm is a new or re-injury. If someone fell onto a stiff shoulder and that resulted in increased pain that persisted, and also caused them not to be able to do things they were previously able to do, then the shoulder was harmed.

Sometimes the exercises that I instruct people to perform may be painful. I give people three clear instructions in regards to pain with exercise:

  1. Pain experienced during the performance of an exercise should go away when the exercise is stopped. 
  2. Pain experienced during an exercise should decrease as the exercise is repeated. (If it hurts at first to do, that pain should lessen as you keep working on it.) 
  3. You should realize a benefit from having done the exercise. (Why do something that hurts if you don’t get anything out of it?!?)

In the coming installments of my blog, I will write more about the nature of pain, how chronic pain differs from acute pain, and how having a better understanding of pain can help people to move better and feel better. Check back next month!