Fear of movement and persistent pain

I recently wrote about how my thoughts on movement have changed over the past couple of years (part 1 and 2), and I thought I'd delve a bit more into the evolution of those thoughts and why I posted them. Why I think our emphasis needs to shift a bit from the overly formulaic and prescribed movement to exploring enjoyable movement if we are to really get over the fear of movement that often accompanies pain. We now know that pain can persist long after an injury heals and the tissues have been repaired as much as possible. We also know now that pain can exist in the absence of any sort of underlying tissue damage at all. So pain does not equal tissue damage, the state of the tissues is only one of the many factors that contribute to our experience of pain. Our stress levels, physical movement, relationships, attitudes, beliefs, expectations, culture, interactions with the medical professions, googling our symptoms, and our fears and worries and anxieties, are other factors that contribute to an experience of pain as well.

Pain is an emergent, conscious experience, not a sense

Pain is protective. It's trying to help us. Pain tells us something is up and gets us to take notice so that we can address threats and restore safety, or homeostasis. Pain involves many systems, including our immune, endocrine, and nervous systems, as well as our movements and behaviors and thoughts and environments. Sometimes we feel pain long after the threats have passed. When we are in fact safe and healed and ready to get on with it. Sometimes we feel pain for no detectable reason at all. With persistent pain, it's usually the systems meant to keep us alive that need to get set right, not just a problem in the tissues where the pain is felt. My systems became wonky after an injury to my right hip at work just over five years ago. The tissue damage was eventually surgically repaired, about thirteen months after I felt the initial twinge, yet the pain persisted. I started to move differently because of the pain, avoiding some movements all together out of fear of making the pain worse (which I thought meant making the damage worse. That it had to mean I'd messed up my surgery).  Over time I became more isolated and withdrawn, filled with doubts and confusion and uncertainty. I worried about what the pain meant for my future. All I could think about was the pain. It usurped all of my attention, all of my capacity for doing simple tasks, my ability to make the simplest of decisions. Pain sapped my energy, stole my my joie de vive.

My deal

So what happened? There was some issues in the tissues. I was eventually diagnosed with femoroacetabular impingement. And there was also fears and worries about what the pain meant for my career, my financial security, my future. A whole lot of threat that went well beyond the structures in my hip. The structure was ultimately repaired by a 'successful' surgery. Successful in the sense that the anatomy looked great post-op, I healed up and had great range of motion and strength. Yet I still had pain. Lots of it. Long after surgery. Long after I was healed. Long after I was fixed. And I was worried about that. Very worried. The most debilitating, nauseating, visceral pain was resolved, yet I still had pretty significant sacroiliac joint pain. This pain would creep up into my low back or extend into into my groin. Sometimes it would radiate down the back of my leg and  I'd experience bouts of troublesome numbness and tingling. For a long time my whole right leg felt 'other', like it wasn't mine. And I still had pain-flare ups that could drop me. That still drop me, though less frequently now than before (and now I don't freak out!). I was scared. What did all this mean?

Fear of Movement

I was terrified of the pain because I thought that it meant I was damaging my hip again. I believed that pain meant there had to be an injury. So if I moved and felt pain, I was reinjuring myself. Having been fixed by surgery, it seemed I had to be reinjuring myself for the pain to persist. How? I came to believe I wasn't moving properly or sitting properly or sleeping properly. So that meant I had to correct my posture, my sleeping position, my movement patterns. And correct I did, becoming ever more rigid in my movement and my rules. Ever more tense, braced, guarded. And the pain would go up and I'd control my movement and posture even more. It didn't so much stem from a fear of the pain itself. I can deal with the pain. I've had lots of injuries over the years as a competitive athlete and firefighter. Some injuries that required surgery under anesthesia. I've played games with broken noses and sprained ankles and trained on the drill ground with more injuries than I can remember. I never had a pain problem. It was the stress and worry about what this pain meant that did me in. I was terrified of not moving in a biomechanically sound way. I was so obsessed with my hip position, my spine position, my lumbopelvic rhythm, how my joints were stacked, and any other number of things that I was always always always thinking about it.

How am I sitting? How am I standing? How am I walking? What can I do to make it better?

Unhelpful thoughts

When we're told that our postures are causing us pain, that our movement patterns are dysfunctional, it messes with our heads and can make us focus too much on trying to create perfect movement rather than just focus on creating natural movement. I was doing everything right. I was diligent in my therapy. And I thought I was avoiding protective and guarding responses through this hyper-awareness of my body position. I've since learned that when we're in pain for a long time our proprioception (our sense of where our body is in space, how it's positioned, how it's moving, etc.) and interoception (our sense of our inner-workings, the stuff going on inside our bodies) can get skewed, not always painting an accurate picture of where our body is in space or what's happening inside of us. So it seems that rather than changing my postures and movement based on good information, I was trying to change my movement based on some sensory misinterpretations (both of the cognitive sort and the sort we make at a biological level without conscious thought), as well as misinformation that there is a universally ideal way to move. There is no perfect movement or perfect posture. We are variable beings by nature. We humans are really good at adapting to the demands of the environment around us and the activities we engage in. I used to obsess over my posture and every move I made, for fear that any thing I did "wrong" was going to exacerbate my pain and prolong my recovery. But it was the fear of moving wrong that exacerbated my pain and prolonged my recovery.

Pain doesn't mean damage for most chronic non-specific pains

Once I understood that that I wasn't doing damage to my body, even though it hurt, it was life-changing. Knowing that one little “wrong” movement wasn't going to undo the months (years!) of physical therapy, was life-changing. Once I understood that we are all asymmetrical beings with all kinds of different movement patterns and that that is not only normal, it’s beneficial, it was life-changing. Once I understood that pain does not equal damage, it freed my mind from the constant stress and worry about doing more harm, allowing me to actually start living again and move on with life. Once I got over my fear, I was able to let go of the need to always control my posture and "protect" my hip by not moving it. In letting go of that need to control and protect, I started moving again without thinking about it all the damn time, in all sorts of ways, without so many rigid rules. Sitting and standing and everyday activities should not be so much work!

Easing into movement, getting over fear

I'm not saying go full bore and start cranking on the hurt body part. Always pushing through pain doesn't help us overcome pain any better than avoiding movement to avoid pain. It’s important to ease into movement and to do things that you enjoy. To move in ways your body wants to move. We often don't listen to our bodies when we're in pain, understandably so. Our pain shuts down our ability to do that. Oftentimes, all we feel is pain and we no longer think of our body as a whole, we only think about the part that hurts. It makes us fearful of moving for fear that it will hurt. It distorts our mental map of our body, it distorts our propioception and interoception and feeds our protective systems with bad information, which feeds into our pain cycle and makes it worse.

Take some time to figure out what works for you

So we have to take the time to sit with our bodies and figure them out a bit. The whole thing, not just where it hurts. We have to figure out what movements we're good at, which movements we tend to do over and over again, and what movements we're not so good at, what movements we avoid. We have to find that edge of pain and hang out there for a minute to explore it, to feel comfortable there, and then to nudge it a little bit. I had a great fear of hopping or jumping on my right leg. For a long time, I just stood on that leg and thought about hopping. It took a long time for me to make the leap, which was giant in my mind but was in actuality a couple centimeters. But the victory wasn't in the height of the hop, it was in the clearing the mental hurdle that had prevented me from hopping for so long.

Moving from avoidance to engagement

We all avoid some movement when we're in pain, it's natural. We avoid bending with back pain, avoid turning our head with neck pain, avoid stairs with knee pain. But bending, turning, climbing, these things aren't causing our pain, we just associate them with pain. We can't avoid these things, anyway. They're a part of everyday life. So it behooves us to stop trying to avoid them (unless were in the midst of an acute injury that needs some time to heal), which we'll never be able to do anyway, and to get better at doing them. To ease back into movement and then practice. And to get moving again in all sorts of ways, in all sorts of contexts.

Movement doesn't have to be physical therapy or a gym session. It doesn't have to be 'exercise'. Movement can and should be enjoyable. Something we look forward to. Something we want to do. There can be structure and planning, but there should be play, too.

Movement is walking, playing catch, practicing yoga, training in martial arts, dancing, golfing, swimming, boarding, snowshoeing, hiking, boxing, skiing, climbing, taking pictures, geocaching, hopping, skipping, jumping, running, having sex, playing sports, crawling around on the ground with dogs or kids, cooking, painting, lifting, carrying stuff, stretching, pilates, biking, going from sitting to standing and back again, twisting, twirling, turning, bending, kicking, throwing, kayaking, paddling, peddling, exploring, wandering, running, playing. You get the picture. Movement includes doing stuff that we just plain enjoy, that feels good, that makes us feel warm and flushed, invigorated and energized, active and happy. Remember that feeling from when we were kids?

Motion is lotion..

It's just moving. Getting better at what were not so good at, getting back to the things we want to do. Getting out of our old habits that once served to protect us but that are no longer serving us. Getting over our fears. What is important is that we pay attention to the whole body, not just the painful part, that we move the whole body through full ranges of natural and necessary motions. When we're in pain, the body part that is in pain tends to steal all of our attention and become our sole focus. We forget that's it a part of a whole, complex system that all works together to get us from A to B, to complete our chores or work tasks, to sing, to dance, to play, to eat, drink and be merry. To get all the parts moving again and to regain confidence in moving in the areas that are of the most concern to us, the part that hurts, is a life changer. It removes limitations and allows us to engage in the world again. It allows us to live life now, without waiting for the pain to be gone. It allows us to pursue what matters to us, even if we have pain.

This doesn't mean push through pain, but we can nudge it

I’m not saying just push through the pain. Pain is a signal, not of damage, more of a “whoa – this might not be good for me right now, let’s do it differently or do something different”. But I am saying we can nudge the pain a little bit. One of the greatest contributors to my chronic pain was a fear of moving "wrong". But it was not moving "wrong" that caused or prolonged my pain; it was the not moving that took place as a result of it that did. We're meant to move, in all kinds of ways and in all sorts of situations. Our bodies love to move. Preventing my hip from moving exacerbated and prolonged my pain. It wasn't until I understood that I didn't need to fear movement, that one little "wrong" move wasn't going to cause me damage or set me back, that I was able to begin to overcome my pain. That I was able to move, to explore movement, to try out different movements, to really start paying attention to my body, not just my hip, when I was moving.

The only correct posture is moving through lots of postures!

Move through a variety of postures all day long without worrying about if they were 'correct' or right. There is no correct or right, any sustained posture, no matter how perfect, is going to cause some discomfort or pain, even if we don't have a pain condition. When I finally realized this I was finally able to walk, sit, and move without fear and without overthinking everything. I was able to move without worrying about it so damn much. It allowed me to accept that pain was still here but that it didn't mean I was damaged. That I could still move and be active and engage in life. That my movement may not be the same now as it was before my injury, but so what? I also have a few more gray hairs and wrinkles, some of these changes are just a part of aging. These realizations also meant that my pain levels improved dramatically. And my engagement with life and play and activity improved dramatically. My health and happiness improved dramatically.

Just keep moving

I am trying to flip the script for everyone in pain from one of viewing movement with fear and trepidation to one of recognizing the positive role that movement plays in our rehabilitation, our health, our happiness. Our bodies are designed to move. All of our parts are designed to move, even the ones we're worried about, the ones that cause us pain. It will take some careful nudging and easing into movement in those areas we have been trying to protect. It will take work. It will take time. It will take exploration and creativity and discovery. It will take accepting that the pain might be here for a while and that that's ok. We can still live life now. We can still pursue what matters to us now.

Our stories can change. We're the narrator after all.

We can take comfort in knowing that we are not weak, fragile, and breakable. That we are not damaged goods. We are resilient, adaptable, and capable. We thrive when we are able to move in ways we enjoy. Our brains and organs and systems and muscles and joints thrive when we move. Our attitudes, mindsets, thoughts, moods, emotions, awareness, and outlook improve when we move. Our lives thrive when we move. When we overcome fear and despair. When we embrace our current self, pain and all. It will take time, persistence, consistency. It takes some self-reflection, some mindfulness, some increased awareness. It takes the acceptance that the best solutions lie within us, not in a pill or a surgery or a particular type of therapy or doctor. It takes commitment to doing the things we find that help us with our pain and reducing the things that flare up our pain.

It takes work, hard work, but it's worth it. And we're going to get there, folks. One step at a time.

As always, thank you for taking the time to read my post. I'm trying to be more brief but I find I have so much to say that conciseness fails me. I'm sure I'll get better as I write more. It doesn't help that I'm also in the midst of writing my book (yay!) so my mind is crammed with every thought I've ever had in order to try and get it down in some cohesive format that people will actually be able to (and want to!) read. 

 And I'd love to hear from you; feel free to send me an email via the contact form or add a comment below. Or if you prefer social media, connect with me on Facebook or Instagram (I'm on Twitter, too, but I'm not so good with the tweeting thing). I

If you like what you read, please share it! 

Photo credits:

The stop fear image is courtesy of Stuart Miles at FreeDigitalPhotos.net

The kayaking picture of me, my mom, my brother, and his girlfriend by the marvelous Ms. Michele Klaver in Interlochen, MI, my homestate.

The bottom pic is my own, taken in my home away from home a week ago, Fraser/Winter Park, Colorado.