Pain is one of the biggest reasons my clients come to see me. People are often looking for help to manage their pain. Many have tried multiple treatments. Everything from PT to acupuncture with oftentimes little improvement. They have been to many doctors, had imaging done and nothing seems to come up to explain the pain they are experiencing. Many of these clients often feel improvement once they start a regular Pilates practice. I’ll get into why this might be in a moment…
1/5th of American adults suffer from chronic pain, defined as having experienced pain most days or everyday for more than 6 months. This can be anything from back pain, sciatica, migraines, or even IBS. Many people turn to a number of methods to manage it. Surgery, eastern medicine, pain killers. These often bring relief. This leaves many people feeling frustrated and hopeless. They feel dismissed by many in the medical community as their pain being “in their head.” or exaggerated. What we are finding is that the brain is playing a much bigger part in pain experience. The brain may actually be responsible for ALL of it
“This does not mean the pain is imagined or “all in the head.” It’s a brain response, like blushing, crying or elevated heart rate — all bodily reactions to emotional stimuli. “Pain is an opinion,” neuroscientists often say, suggesting not that pain isn’t factually present but that all pain is generated by our brains, and is thus reliant on the brain’s fallible perception of danger.” (Nathaniel Frank Washington Post article “Chronic Pain is Surprisingly Treatable, When Patients Focus on the Brain”)
There was a great Washington Post article posted back in October that touched on this very phenomenon. Why do some people experience chronic pain with no evidence of tissue damage to support it?
First, it’s important to note that we have known for some time that chronic pain and tissue damage/herniated discs rarely correlate. There have been a number of studies that took both patients experiencing chronic back pain and patients without pain and did imaging (CTs/MRIS). The imaging did not correlate with those experiencing pain. Meaning there were actually MORE people with images of herniated discs or abnormalities and NO pain than those with pain and herniated discs. This has been validated with a number of studies and produced the same results.
“Indeed, a large body of literature shows that exposure to stress or adversity, such as trauma, childhood difficulties or job dissatisfaction, predicts chronic symptoms, including back pain, fibromyalgia and irritable bowel syndrome, better than any physical measure. It’s long been known that expectations and beliefs about pain can affect how and whether it’s experienced, with sham surgeries and other placebos able to trick people into feeling relief, and simulated injuries able to produce pain when people think they’re being harmed. If emotional and experiential factors predict chronic pain, that suggests the culprit is not physical, as does the fact that legions of people have resolved their symptoms using psychological interventions alone.” (Nathaniel Frank- Washington Post “Chronic pain is surprisingly treatable — when patients focus on the brain”)
So what can be done to improve chronic pain if it appears to be more mental than physical? A treatment called “pain reprocessing treatment” (PRT) has shown to have extremely promising results. This treatment aims to rewire neural pathways in the brain in order to deactivate pain. Often, chronic pain patients develop conditioned responses – the brain creates an association between certain physical activities and the onset of pain (i.e. walking leads to back pain, typing leads to wrist pain, etc.) Another component of Pain Reprocessing Therapy involves helping patients break these associations, so that patients can engage in physical activities without pain.
So why might my clients pain experience improve after working with me?
I encourage positive movement. Meaning instead of saying things like “if you move this way you will throw your back out”. I encourage my clients to move in general! That means in as many different ways as possible. I do my best to coach my clients into believing they are strong and capable, not fragile. I also like to challenge my clients just as much mentally in our sessions so it requires them to be in the moment. It’s essentially practicing a form of meditation with movement. They often leave feeling better because they actually moved which is really the most important thing! And they are learning to move without fear!
Here’s the thing- it doesn’t have to be limited to Pilates! Any positive movement experience will likely show results. People often get caught up in seeing movement as a negative thing when managing chronic pain. I believe it’s our jobs as movement specialists to encourage our clients to move, not to be fearful of movement.
Pilates and PT have often been a place of “fear based” movement. These spaces have often used fear tactics to change someone’s movement and have actually caused more damage than helped. The old school thought of if you do ABC it will make things worse or you must have done “this” to cause an injury which often leaves people with shame and fearful of movement.
MOVEMENT IS MEDICINE! Simple as that. If you are someone dealing with chronic pain it may be in “your head”. But that does not mean you are not experiencing it. Depression and anxiety are in “your head” too but they are painful and can be treated. Your brain may just need some “rewiring”. Your body is not as fragile as you think.
Check out full Washington Post article HERE