Let me share an example with you. Two people, Mike and Dan sustain a similar low back injury at work. Both of them have pain, miss some work, see the doctor and get the same medical care initially. After a few days Mike starts feeling a little better and shortly thereafter returns to work and life as before. His back bothers him occasionally but he has found that with some regular stretching he is good to go.
Dan’s low back pain on the other hand does not get better; in fact it seems to get worse. When his pain persists he re-visits the doctor and has more testing done. He is given a stronger pain medication which seems to at least keep the pain manageable. He visits with his neighbor about his condition and he tells him of someone he knows who had back pain that was actually cancer. He sees a health care provider whose explanation of his pain was confusing and even scary, especially when he pulled out the spine model and started talking about herniated disc ruptures, tears and bulges. Some days he feels better than others but his job is physically demanding so he is afraid that going back to work will only increase his pain. He doesn’t really like his job and does not get along with his boss. He is afraid that he may end up losing his job over the injury. His wife is getting worried as well and tells him she is not sure they will have enough money to pay the bills this month because of being him being off work.
His doctor calls and says that his MRI results show a herniated disc and tells him that he should do more therapy but that if that doesn’t work he may need surgery. The only thing that seems to give him relief now is the pain medication and he is carefully counting his pills, worried that he may run out before he can get a refill. He can’t help but feel depressed, anxious and fearful of his ability to return to work and life as before.
Let me remind you that Mike and Dan sustained the same type of injury, one was not worse than the other! Yet, despite their similar injury, Mike was able to go down the path of recovery and healing where Dan was on the path of fear, anxiety, stress, job loss as well as possible medication dependency and long term disability. One may argue that Dan had a “positive” MRI finding of a herniated disc that would explain why his pain persists. But researchers have found that approximately 40% of people with absolutely no low back pain have a bulging disc on MRI! That means that he could have had the same MRI findings before he had the back injury.
My previous article on pain talked about our nervous system and how our nerves become sensitive after an injury but then most of the time slowly calm down. This is what happened to Mike.
For others, like Dan, after an injury occurs the nervous system does not calm down and remains in an elevated, sensitive state. Factors that are called “yellow flags” such as, different explanations for the problem, job issues, persistent pain, fear and anxiety, family concerns and failed treatments can all be drivers to keeping the nervous system ramped up.
Now, let’s talk about how our bodies were designed to handle stressful situations. You may have heard of the sympathetic nervous system also known as the flight or fight response to stress. This system works like this:
Imagine you were sitting in your house watching your favorite TV show and suddenly a roaring lion jumps into your room! Certain automatic, physiologic responses happen in your body. Your heart starts to beat faster delivering blood to the large strong muscles of your body so you can run out of the room, or fight the lion if trapped. Language is influenced, you may shout, scream, or say some choice words. Your breathing becomes faster and shallower, your food digestion is slowed or put on hold allowing all possible energy and blood flow to be allocated to the immediate, much needed other systems. Other functions of your body like pain, sleep, reproduction, immune etc. are shunted to deal with the lion in your room. These responses are automatic and normal and were and are integral in our long term, evolutionary survival as a species.
Now imagine that the animal control officer comes in and captures the lion and removes it from your house. You probably won’t return immediately to your TV show, and it may take a few days to calm down but after a few days you may actually laugh about it. But what if the lion was not captured?
In our previous example, Mike and Dan both figuratively had a lion jump into their room when they were injured. The difference is that in Mike’s case, the Lion was captured and his nervous system calmed down. In Dan’s case, the lion has never left his side. The lion is a metaphorical description of the aforementioned yellow flags; all stressors that keep his sympathetic system out of balance and nervous system elevated.
The neat thing is that our understanding of how pain works is increasing and alternative treatment options like Physical Therapy and Pain Neuroscience Education are showing to be very effective in helping calm the nervous system by addressing and eliminating the “yellow flags” that keep our nervous system extra sensitive.
Darren Marchant MSPT
FIT Physical Therapy