That sounds really interesting. Pain science interests me, especially as I've heard a lot of doctors aren't well trained in it and apparently those with the best pain training are vets.
A lot of pain science is VERY new, and agreed, a lot of doctors aren't current. Here's a really short course (obviously simplified), that could be useful:
- there aren't really "pain" receptors in our body. There are receptors that report on heat, cold, and various kinds of pressure or stretching. Those receptors send data to the brain and the brain, based on that data and on all of its experience, and the context "decides" whether or not to create pain signals.
- one of the brain's top priorities is to keep your body safe. and it's VERY conservative (seems like a good approach). For example, the brain is good at predicting whether a situation might end with rapid deceleration (like jumping from a high place), and tends to avoid such activities.
- when the brain decides you've been injured, one of its chief strategies is to put the injured area into "lock down". So if you hurt your wrist or ankle or whatever, the brain will send pain signals if you try to move the injured tissue. Again, a good strategy to promote healing.
- But there is a sort of "brain bug"... when everything is functioning well in your body, the brain and body have a strong, richly detailed "proprioceptive map". In other words, the brain gets a steady steam of detailed feedback from all over the body, and that makes the brain feel confident. But when you lock down a part of the body for even a short time, the communication channel gets fuzzy and the data not so reliable. This weakened comm. channel makes the brain concerned, and one of its strategies is to further "lock down" that spot in your body. So one side effect of locking down a body part to promote healing is that the brain-body communications get weakened. Now we're into a negative feedback loop.
So a very common occurrence is that months and years after damaged tissue has healed, the brain is still keeping that tissue in lockdown, just to be safe.
PRACTICAL STRATEGY: As soon as your doctor says it's safe to, you want to start doing movement exploration exercises with the healing tissue. The more pain-free movement exploration you can do with the healing tissue, the sooner your brain will regain confidence and relax its lockdown, and reduce its pain messages.
AMAZING FACT: The correlation between pain and tissue damage is surprisingly weak!!!! This is really not intuitive and you have to let that idea rattle around in your mind for a while. In one study, a large collection of the world's best spinal surgeons were given a large collection of spinal x-rays. As a group, these top doctors were completely UNABLE TO PREDICT which patients were in pain and which were not. Healthy looking spines were crippling some patients and seemingly damaged spines were not hindering others.
ANOTHER PRACTICAL STRATEGY: If your doctor approves, you should be doing controlled articular rotations (CARs), every day. These "stretching on steroids" exercises will help you maintain a strong, detailed mind-body map and will also allow your brain to relax any of the lockdowns it is maintaining that you might not be aware of.
ANOTHER CRITICAL FACT: As time passes, the field of biomechanics is suffering from a lot of valid criticism. Top performers in ALL fields DO NOT repeat bio-mechanically "perfect" movements. Individuals who take this approach are far more likely to suffer from repetitive motion injuries. So the best blacksmiths, and dart throwers and tennis players and on an on, DO NOT exhibit perfect, repeating form. In fact every iteration of their movements is different than that last.
IT'S A SYSTEM: Another idea that's appropriately losing steam is that disfunction of some tissue is a problem with that tissue. Sometimes yes, very frequently NO. If your ankle is stiff and sore, it could be because you have poor hip mobility. Many cutting edge PTs have a sort of running joke "guess the actual culprit". Your whole movement system is A SYSTEM. For example, if you have lower back pain, it's quite likely that your lower back is just fine, but it's being stressed out because some other part of your system is out of whack! And the current thinking is that we cannot know for sure what's out of whack, so the best strategy is to make sure the whole system is as healthy and mobile as possible. So for example, more mobile ankles might cure lower back pain, more mobile shoulders might cure lower back pain, and so on.
Again, check with your doctor, but doing those CARs every day can cure a surprising amount of pain...
ho ho ho
