Why things hurt

My broken arm bone healed years ago and the tendon is clearly not involved; why can’t I move my hand well? —SJ


I threw out my back, but years later my legs hurt. Why? —KR

Without pain, we’d never know when we have exceeded the natural motion of a joint. We would never know that we have sprained, strained, or broken something. We would never know that we had some sort of inflammation.

In turn, we’d go on doing whatever it was we were doing—never knowing we were injuring ourselves.

In short, without a pain signal, we’d all be dead. Nothing would tell us we had exceeded our physical limits.

My hips were very tight and sore. I feel relief and relaxed now after doing manual therapy. —BB

Without a pain reflex, we would never pull our foot away from that sharp object.

Pain Reflexes: As Your Friend

don't let joint pain impact quality of life - fix what's wrongYou’re walking along and your knee starts hurting. A pain sensory nerve in your knee sends a signal to your spinal cord. Three things happen:

  1. Faster than you can read the rest of this line, the pain shoots up your leg to a pain reflex in your spinal cord which immediately sends the message to that leg’s muscles: “Pull back! Stop!” The leg pulls away from the sharp pain.
  2. Just as fast, another reflex arc crosses your spinal cord and goes down the opposite leg: “Here comes all the body’s weight! Balance!” Those muscles respond so you don’t fall over.
  3. Eventually, a bit later, the pain signal arrives in your brain and you become conscious of what just happened. Usually after the pain reflex is done.

You inspect your knee; two more things happen:

  1. You delicately test the area to see the extent of damage.
  2. A signal arrives in your brain: “All is fine!” You walk away.

You twist your ankle, step on a thumbtack… same story. Except depending on the damage, you might retain some of the pain reflex while the joint is tender, or until the sprain or strain heals in a couple of hours or days. The “All is fine!” signal might sound more like “The pain’s a little better now” for a bit.

When pain is not your friend

This gets tricky. Your body can learn the wrong thing.

Although no one knows why the body can learn inappropriate pain reflexes, we know it can.

Pain can get “stuck.”

An inappropriate pain reflex is when there is nothing there; no remaining injury or inflammation to keep the pain going, yet the body and mind act as if there is.

This is very different from the situation where a person has some underlying chronic inflammation preventing the sprain, strain, organ, ulcer, blood vessel, bulging disc, or other situation from healing.

When a person keeps doing things that irritate the body, the body does not properly heal. This is an appropriate signal by the body to the brain: “Something is wrong! Not ready to do that yet. Need more time healing.” If the source of irritation is still present, the damaged area never moves beyond the swollen, red, painful first stages of inflammation to the stage where healing can occur. This can go on for years unless addressed.

Whether it is getting out and running on that injured ankle too soon, or eating foods that irritate the body—which many people don’t even realize they are doing, or being exposed to toxic chemicals or metals even in small amounts, or not setting the bone back into the right place, etc.. There are many ways to block the body’s innate healing process.

What is an “inappropriate pain reflex?”

young woman with sudden back painSimply put: It is when pain gets stuck in a cycle of telling the body something is wrong when nothing is wrong. It is the lasting memory trace of the pain or injury—even though there is no current injury or source of pain.

In manual therapy, the mechanism is called the “pain reflex cycle.”

Basically, the theory is that the pain reflex that arcs across the spinal cord gets stuck. Nothing communicates to the brain “all is fine” or sometimes not even “it’s a little better.”

The brain perceives the injury as still there because there is no “all is fine” message received. Sometimes, the brain also perceives the environment as a threat, even if the thing that caused the injury is gone. People get in a car accident and can become afraid of driving. Emotionally, this can create tremendous conflict when a person consciously knows there is no injury or threat yet a portion of the mind is saying “be afraid” or “protect” or “attack” or “run” or “avoid.”

But often, it’s just a mysterious pain or loss of movement aimed at protecting an area or avoiding re-injury when there is no longer any threat.

Occasionally, the pain reflex cycle is so great, it shuts down the connected motor neurons and you cannot contract your muscles despite all of the muscle and ligament connections and nerve conduction tests being normal.

I broke my wrist. Seven weeks later the bone had healed but I’d lost movement in my thumb. X-rays and ultrasound showed that everything was in the right place, no ruptures. I could move my thumb with my other hand and had no pain, all the muscles moved, I’d lost no sensations; I just couldn’t consciously get my thumb to move—it just stayed limp. It was as if the communication line was gone except physically everything was all fine.

After just a few sessions, manually releasing restrictions in my wrist joint but also all the way up to my head, we began to restore conscious movement. I’ve so much more hope my movement and power will return. –MS

Healing an inappropriate pain reflex

Myofascial trigger point therapy is effective at treating the cause of pain and immobility because it addresses the pain reflex arc directly.

Your fascia are thin membranes of connective tissue holding muscles together and connecting them. Fascia also connects organs; in fact, fascia coordinates itself to hold bundles of body parts together as you move.

Trigger points, or restrictions in the fascia, can cause pain directly or indirectly and can keep a pain reflex going even after the threat or injury is long gone. Trigger points can cause a muscle to remain contracted, or fail to contract; they can retain fluids of inflammation. They are often felt as very tender points. Because the fascia connect far-reaching areas, trigger points in one area can affect points far away—a pattern of pain called “referral.”

Unsticking the “stuck” pain signals

I suffered with back pain for years, making it hard to work all day. I would have to stop what I was doing, and sit, stretch and try to rest my back just so I could continue my work. At home, I’d be in a lot of pain from mowing the yard, working on my trucks and riding my motorcycle. Some mornings it would hurt to tie my shoes. Now, thanks to corrective adjustments coordinated with muscle and soft tissue work, I can work all day and do the things I love to do without pain and without drugs. Thank you all very much.” –GD

Manual therapies that release the trigger points do so by applying pressure, gently or as deeply as needed, to the restricted areas that are holding the pain; the tender points. Sometimes this includes gently stretching the muscle and the fascia along well-mapped therapeutic lines.

As the trigger points are worked, the pain will lessen and release. This can be felt by a well-trained therapist, but even still, too much pressure is just as counterproductive as too little pressure. “Deeper” is not always better.

As the muscle softens and moves more smoothly, as the fascial fibers move more appropriately, they begin to send the “it’s getting better” signals to the brain.

The lasting memory trace doesn’t release all at once. Manual therapies are very powerful, but need to be repeated to give the muscle and brain “practice” working again as a team—one that doesn’t include inappropriate pain reflex arcs or frustrating fear or avoidance.

Speeding up the healing process

Keep your therapeutic gains as the restrictions become less by stretching and moving through your pain free range of motion in between therapeutic sessions. Whether you manually move the limb, or your back, neck, shoulder, make sure to move it correctly and without creating a new pain reflex or recruiting other muscle groups. Focus.

You will know where your pain free area is, what is meant by correctly is “in a way that is appropriate for that joint or muscle group.”

Baby steps. In other words, if you are trying to move your shoulder, move just your shoulder. Don’t recruit other muscles. Move just the shoulder muscles in the way they are intended to be moved, even if the distance does not appear to be as great. You can manually move the joint using techniques a well-trained therapist can demonstrate. Don’t train yourself to move by bringing in other muscles. Eventually, movement will increase and will be correct and not so stiff.

Likewise, if pain prevents you from moving in a certain way, stop there. Again, don’t recruit other muscles because you don’t want your muscle groups learning the improper movement. But don’t push into the pain area and invoke the pain reflex memory.

Keep the pain from coming back

trigger point and myofascial releaseDeal with any perpetuating factors. Fascial restrictions are worsened by anything that causes inflammation because inflammation prevents true healing. In fact, those things causing inflammation can cause trigger points—and on the top of the list is sugar. Starting an anti-inflammatory diet or better yet calming inflammation with Nutrition Response Testing® is one of the best ways to truly heal.

Another common factor is posture. Whether your bones are misaligned or you slouch, slump or sit funny, or perhaps you have leg length differences, your body will compensate. This alone can lead to wear and tear and trigger points that now cause the pain reflex in other places. Fixing malalignments through the Gonstead Chiropractic method is our specialty.

Get your body parts working as a team

Your brain, bones, and muscles can work together and do what you want. We’d love to help. call us: 907-743-3040

Deanna Cresap

A certified Myofascial Trigger Point therapist and 2007 graduate of the Pittsburgh School of Pain Management, Deanna helps empower people to take care of themselves though effective self-care instruction that restores health.  The practice of trigger point therapy is a recognized non-surgical and drug free approach to relieving pain and restoring function to the muscles and soft tissues. By teaching self-care techniques in an integrated medicine setting that finds and fixes the underlying causes of muscular pain, patients are guided to achieve faster pain relief, have less recurrence and can achieve stable optimal health. Deanna is a nationally certified and recognized Licensed Massage Therapist.

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