Understanding Pain and How our Nerves Create the Sensations we Feel Understanding Pain and How our Nerves Create the Sensations we Feel Other Posts See
Over years of working with clients struggling with movement and pain, we have seen many healthcare and rehab trends that sometimes have unintentional negative long-term impacts. One of these trends, the topic of “mobility,” has been particularly persistent in the last 30-40 years and has become even more widely accepted and practiced due to its popularization on social media.
Mobility is defined in a variety of ways by practitioners, books, and scientific research. It is inconsistently separated from flexibility and range of motion (ROM). Most often, it has been defined as specific available motion around a joint and often includes terms such as “soft tissue mobility,” “myofascial restrictions,” “trigger points,” and “joint mobility.” While this section will not go into the nitty gritty details, it is important to know that common beliefs about “fascia” (the thick layer of tissue surrounding your entire body) and how joints move or don’t move, are scientifically inaccurate, with many being downright myths.
We do not say these things lightly as our team has decades of cumulative years of training and experience with different types of manual therapies, including ones built around myofascial and trigger point theories and joint mobility.
While “mobility” may change from a stretch or manual therapy technique, it does not change for the reasons that are widely believed to cause a change in mobility. Traditionally, manual therapists are taught that the problem with mobility of a tissue or joint was a “static problem.” As a result, manual therapists and rehabilitation professions believe, and teach clients, that a stretch, mobilization, or manipulation somehow structurally changes or “fixes” the problem they believed to be “static.” However, this idea that mobility is a static problem that needs some sort of “fix” or “adjustment” or “stretch” has CONCLUSIVELY been shown to be false.
Structural elements, such as the size and shape of your bones, muscles, tendons, and ligaments, are relatively “static” and stable, but in order for their “static” qualities to change, they must be significantly injured (torn) or have surgical reconstruction. What we mistake as a “static” change in mobility, is actually a change in the “dynamic state” of an area of mobility limitation. It is an active process in which multiple physiologic processes maintain a “mobility boundary” in any specific area by dynamically limiting and/or improving mobility moment by moment.
All functional mobility limitations are dynamic and are “personalized” in nature. We all express “Biomechanical Individuality.” No two skeletons and all the tissues needed to coordinate movement and postures are the same. Our mobility is the dynamic “Movement Boundaries” given to us genetically and personalized over a lifetime, changing moment by moment solely to meet the specific demands currently required.
Movement Boundaries are built around our structural skeletons and dynamic tissues that make up the, somewhere between 250 to 360 joints (depending on genetics and who’s counting), in our body. While individual joint movement boundaries are small and limited in their physical capacity, the beauty of the interconnected human kinetic chain of joints means our movement and physical capacity is far greater than what is available to us in one specific region. This means it is important to see movement boundaries not just from the local region, but from the perspective of neighboring joints and regions and how they play a part throughout the entire human body. This also hints at the myth that joints will “compensate” or “take over” for other joints resulting in increased “harm.”
When we perform a movement, such as throwing a ball, it’s not just our finger and hand joints that need to do the work (if it were, the ball would hardly move!) Instead, it consists of our anatomical neighbors and the greater body working together to create a movement pattern that is coordinated, situation specific, and with enough effort necessary for the task at hand. The idea that one area or another “compensates” in some sort of negative way could not be further from the truth. More often than not, the body’s unconscious automatic movement “rules” in our body limit the numbers of joints needed to perform a movement. This means that the efforts of a particular movement MAY NOT be shared across enough joints! Allowing for the opportunity to distribute the work across more joints will ultimately allow our bodies to tolerate more and will make movements much more coordinated and fluid when being carried out.
To further understand these dynamic Movement Boundaries, we need a better understanding of the human body’s movement system. First and foremost, movement and postural control comes from the automatic unconscious coordination of our muscle actions. We have very little direct control over the way our muscles work. We are pretty good at contracting them harder or putting a little emphasis on one muscle over another, but we are terrible at trying to get our muscles to relax. Even with some of our best efforts to control muscle tension with stretching, massage, joint mobilization/manipulation (physical therapy/chiropractic/osteopathic), relaxation, body scans, biofeedback, acupuncture/dry needling, and countless more, our automated systems (the elephant we ride) ultimately decide just how much we can consciously lower muscle tension. Even when we do significantly decrease it with dedicated periods of time, the moment we shift our mind elsewhere, our “elephants” will take over and default to the levels of muscle tension they want. When our elephants run unsupervised for a long time, they pick up some unhelpful habits that can carry over into the quality of our movement and postures. This can lead us into some physical discomforts (i.e., pain), especially if those habits are combined with a physical injury.
While we have deliberately tried to minimize the technical jargon in this manual associated with the neuro, endocrine, and immune sciences that are related to pain, we need to introduce a couple of terms to clarify the overlapping mechanisms between pain and movement such as, nociception, range of motion, mobility, and flexibility.
It is a common misconception that our body is filled with “pain sensors” that create “pain signals” that warn us of danger. Although there is no such thing as a “pain sensor” or “pain signal,” we do have certain processes that function in a similar manner. One of the processes related to pain is called “nociception” (literally: noxious sensation). This involves all the sensory nerve information that is related to actual, or potential, harm to the body. Again, this term is commonly used in the medical world related to pain, however, in the scientific literature of the human body, it is vitally important to many non-painful functions of the body. We can notice these processes associated with the amount of movement that occurs around a joint and muscle flexibility.
Put simply, our mobility and flexibility are dynamically regulated by our “elephant’s” tolerance to nociception generated by the stretch of our tissues. In other words, our body has written unconscious rules and expectations for how stiff or flexible our tissues should be. Every tissue has a specific tolerance to nociception that changes moment by moment. Something could feel “loose” one moment, and a second later, feel “tight.” Most of the time, we don’t even notice these changes because our attention is not focused enough to pick up this hidden information. That is why you need someone, such as your Movement and Pain Specialist, to shift your attention towards this information in a meaningful way. Rather than trying to “really feel” a good stretch, we can accomplish this by assigning a “movement swimming” activity that helps you learn about this basic function of movement quality through a direct experience.
This may be a good time to speak about stretching and manual therapy, but we will describe how stretching activity is able to impact flexibility later in this manual in our resources section. This section is mostly focused on understanding certain “movement prisons” our body creates and places our tissues in.
Many individuals have described the idea of a “movement prison” related to fear of movement, but we are going to take a different approach. We want to focus on the physical behaviors that are occurring in our body and understand how we can work with them better. In fact, we’re going to be so bold as to say, movement prisons define all our experiences with sensations of stiffness, tension, tightness, and their associated movement limitations. Effectively, we have all experienced a body part in a “locked down” state at some point in our life and it’s important to recognize why that may be occurring and know what you can do to help it get “unstuck.”
Movement prisons occur when the unconscious automatic systems (your “elephant”) significantly limit your movement in any given area with a high level of tension or “tightness.” It can be brief in nature, or it can seem to be a place you are frequently “stuck.” It may or may not be painful, particularly not when you move inside the range it gives you, but movement beyond the “prison walls” are sometimes painful and can be almost impossible to move with due to the tension from your muscular system holding you back. Classic examples of movement prisons include a “stiff” neck or back, a “tight” shoulder, “tight” hip flexors, “stiff” knees, “tight” ankles, and so many more.
An important note to acknowledge is that our bodies are constantly creating “boundaries” for movement. Not all these boundaries have to be bad, or imprisoning. In fact, these boundaries can be helpful. We need our body (“elephant”) to create these boundaries to limit the extremes of certain movements. Movement boundaries help us to have coordinated and precise movements. You want multiple movement boundaries on all the joints of your arm as you begin to reach for a glass of water to allow for precision in grasping and ensure you do not spill any water. At the same time, you don’t want the boundary to be too rigid so your arm cannot adjust to any subtle changes you need to make in how you grab the glass after you realize it is more full or less full than you anticipated. Without some degree of flexibility in your movement boundaries, you will create an awkward movement that ultimately results in a spilled glass of water!
Now at an extreme scale, we see this behavior become unhelpful with pain. Nociception (remember the definition above?) processes can become more sensitive and less sensitive for several reasons, especially in response to our body’s chemistry, blood flow, and mechanical actions around the nerves monitoring your tissues. Immune chemicals (such as those related to inflammation) and the endocrine system (such as those related to stress and emotions) can make nerves more sensitive, increasing the likelihood of nociception occurring. Blood flow reduction and mechanical strain can also increase nociception such as muscle tension that is too high. Now remember, since nociception is involved in a lot of processes, that means increased nociception does not guarantee pain. In fact, it can simply mean that a feeling of stretch, tension, or even compression might arise sooner. For instance, suddenly bending at the back becomes stiffer, more tense, but maybe not painful.
Many people, including those without chronic pain, have experienced a blood flow and chemical version of this in the morning when they wake up as their backs and many other joints are perceived to be stiffer. People with notable immune conditions such as rheumatoid arthritis could experience an extreme version of this over 2 hours in length! Also, with these conditions there appears to be noticeable swelling that occurs and adds into the stiffness, and believe it or not, that swelling is also related to nociception!
These movement boundaries that build to an extreme and create a “movement prison” can happen anywhere in the body and can impact multiple areas, or even your whole body. They can happen to anyone, but individuals that are already struggling with pain and movement problems for a long period of time are more vulnerable.
WORKING WITH “MOVEMENT PRISONS”
Now that we’ve got a basic idea of what movement prisons are, we want to introduce how to work with them more effectively. We will acknowledge upfront that you can use stretches, mobility exercises, manual therapies, and any sort of intervention you can come up with to create a quick change in your movement prison. Sometimes single “broad stroke” or crude interventions like these can even make some short- and medium-term changes in improving your movement boundaries and flexibility for some time. However, there is evidence that some of these interventions lose their effectiveness in modulating nociception (our unconscious “elephants”) for a number of reasons, and for some people they never worked to begin with.
Furthermore, many movement prisons will return even if you were able to break free from them temporarily. Therefore, we do not generally advocate for extensive stretching or “mobility” work, although we might create movement experiments that look like these traditional interventions but with a different intention.
This is also why we advocate for a more comprehensive approach that accounts for the complex processes that may reduce the effectiveness of these “quick fix” interventions on movement prisons. If you can develop skills and habits that are sustainable over a lifetime, you will feel less trapped in these movement prisons, and can escape more readily when they inevitably show up in your life.
Unfortunately, we have to start with the most difficult part which entails giving our movement prisons permission to exist. We often say it gets harder before it gets easier!
The harder we fight to break free of them, the less likely they will let us go, and the more likely they’ll come back with a vengeance.
This means to learn about any given movement prison, whether it’s around your back, your neck, or even your pinky finger, you need to approach it in a kind, gentle, and non- judgmental manner. Also, it’s important to use the open, aware, and active process skills to explore your movement boundaries beginning with small movements and gradually progressing to ultimately make bigger changes over time. Although it can be extremely challenging, we must learn how to slow down to make faster changes. Small is big, slow is fast! “Speed kills” so to speak, albeit not literally in this case!
With these fundamentals, it is time to begin the process of working with your movement prisons.
OPENNING UP TO THE HIDDEN SENSORY INFORMATION IN THE AREA OR STIFFNESS OF TENSION THAT DEFINE THE MOVEMENT PRISON BOUNDARIES
DEVELOP AN AWARENESS OF OPTIONS
COMMIT TO A MEANINGFUL ACTION
When you read through this, some of this may seem simple, or even obvious. Some people may acknowledge that they have already tried these tasks, but it “doesn’t work.” This is usually an indication that your intentions are to “fix” or “change” the movement or flexibility with what you are doing. Ironically, that’s the first step to getting stuck in a movement prison. By forcefully trying to get rid of a movement prison, you are activating the physiology that promotes chemical, blood flow, and mechanical responses that will only increase nociception and decrease our tolerance to stretch.
Like we mentioned before, it gets harder before it gets easier. We can certainly force a prison break from time to time in a pinch, but we can’t keep up with that over a lifetime. There are far too many systems in our body that will resist, along with our elephant doing what it wants to do, which may lead you down a path of getting more stuck. Instead, we must first engage with the process of “letting go” of the fight with the prison walls, and slowly work with the boundaries we currently have. Although it may seem like a slower method, having the patience and persistence to work with these boundaries ultimately allows us to expand our movement in a more sustainable manner over time.
Ok, that was a lot of information! Do you feel like you have more questions than answers right now? Good! That means you’re opening up to new ideas and are willing to give it a shot. We promise that with enough practice and persistence, it will get easier to break out of these movement prisons. It’s hard to do all by yourself which is why you have your Movement and Pain Specialist to guide and support you as you learn how to engage with your body (“elephant”) and find ways to make it more workable.
Understanding Pain and How our Nerves Create the Sensations we Feel Understanding Pain and How our Nerves Create the Sensations we Feel Other Posts See
WORKING WITH MOVEMENT BOUNDARIES AND MOVEMENT PRISONS Over years of working with clients struggling with movement and pain, we have seen many healthcare and rehab