• Matthew Anstey MCSP HCPC

Why is it you can be in pain one day, but not the next?


If you think about it, it's not like your biology is changing one day to the next. One day you have an injury, and the next day it's gone. It doesn't work like that. Injurys heal over time, for example a muscle injury often needs several weeks if it's a genuine strain.


So why is it that for some episodes of pain, it can last much longer than a typical injury healing time, and symptoms often vary hugely one day to the next?


Lower backs are by far the best example of this. A sprain in the back should heal and settle at the same rate as a sprained ankle, but it's common to see back injuries drag on for months and even years. Why?


The simple answer to a complicated question is that pain is not actually very closely correlated to structure in chronic pain cases.


Instead, the pain system becomes 'overprotective'


See, our pain system at it's core is designed to keep us from harm. Touch a hot plate, and your pain system will whip your hand away before you actually burn yourself and cause actual damage - this is a helpful, useful pain system.

But if it becomes overprotective, it not only starts protecting us from actual threats, but also non-existent threats as well.


A good analogy is a broken car alarm - you want your car alarm to sound if someone breaks through your window to steal a bag off the seat, but a car alarm is completely unhelpful if it sounds everytime someone brushes past it.

Pain works in the same way. You want your pain system to kick in if there is an imminent threat, but not every time you bend over to pick something off the floor.


Pain is in fact much more to do with perceived threat. If you hate bending because you back 'went' in 2011 and you've avoided bending since, your pain system will perceive bending as a threat, then when you do have to bend, your pain system will kick in and cause you pain, which perpetuates the problem!


You don't avoid walking through the woods again because you sprained your ankle in 2011 and you're worried you'll do it again. But we have so much more fear of our backs as a body part, compared to injuries to other areas.


You need to get your back strong, and teach your pain system to become less protective about the activities and movements that are normal and important to you. Only then will your pain system start to level out and return to the days when you could bend over to tie your shoe without feeling like you're going to 'put your back out'!


So... Why is it your pain can vary so much day to day? It all depends on how protective your pain system is being. That can depend on what you've done physically, but another huge factor is the psychological element to pain. If you've not been sleeping well and you're tired, or if you are particularly stressed. These other factors drive an increasingly protective pain system, and pain increases.


So then we have to try and control some of these factors as well. If sleep isnt well regulated and you're not managing stress well because your pain is stopping you from being active, you can see how the cycle can be tough to break.


Make time for the things you enjoy, or the things you want to be doing. If you are unable to do these now because of your pain, you need a clear action plan for how to start on your road to recovery.


Azzurro uses evidence based, biopsychosocial models towards pain reduction and improving function with great results. Check out our pain to performance programme for more information.


https://www.azzurrotraining.com/p2p


We are so confident we can help, we even offer a money back guarantee on the first month in the programme!


In January we will be offering a free consultation for a limited time only. Private message use to register your interest.


Be brave and you can start to make some positive changes. You've nothing to lose, and everything to gain!

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