Fear, Trust, and Physical Pain

A client of mine, who I will call Lisa, is currently working with me to better understand which movement habits and patterns she can change to feel better in her body.  She currently has some shoulder pain, low back pain, and knee pain that have interfered with her physical activity.  She additionally wanted a weight loss program.  Since I don’t specifically work with weight loss, Lisa hired a personal trainer who she sees a couple of times a week in addition to working with me and going to Bikram yoga regularly. 

Since Lisa started working with her personal trainer, I noticed some hesitation and skepticism in her voice when talking to me about him and his plan for her.  She would ask me my opinion on things he was telling her, what I felt was an early sign that she didn’t fully trust him.  He also put her on a diet she knew wasn’t good for her body. She decided to give it a go since after all, she hired him to help her, and maybe he could be onto something. But, the diet caused her to have negative physical symptoms in her body, confirming her original intuition.  Between the diet and the workouts over the course of the last month, Lisa hasn’t lost any weight and is super discouraged although her trainer insists that she’s not following the diet strictly enough.  In addition to the diet, Lisa’s trainer is encouraging more cardio, getting her to run again.  Lisa used to run regularly until her knees started bothering her significantly.  She hasn’t run much since then is quite fearful of what running may do to her knees again (her knees are currently feeling much better than they used to, so she fears reverting to a more painful state).

The other day, Lisa asked me, “Do you think running is good or bad for me?”  Lisa’s trainer is increasing her mileage on a weekly basis, and she’s feeling really nervous about it.  On the one hand, she understands that running is an activity we as humans are naturally designed to do.  On the other hand, her previous experience with it left her with knee pain that greatly affected her life and she’s terrified of it happening again.  Maybe she specifically is not built to run?  Or maybe, she just isn’t running with proper form? These are the questions she was asking herself.

Here was my answer.  

If you’re scared to run because of your knees, and if you don’t trust your trainer to prepare you for running again, running is currently a bad option for you.

Now, hold up.  I am NOT saying “Never do anything you’re scared of doing,” or “Fear of pain should be your only guide for choosing how to physically engage with the world.” That’s actually far from what I encourage or how I choose to live my life.

What I AM saying is that pain is actually influenced by a huge variety of factors.  We now understand that pain is not necessarily a response to actual tissue damage to our bodies (source).  Social context, past experiences, and belief systems integrate with our biology to modulate our perception of pain (source).  In Lisa’s case, as far as what she’s communicated to me, there are two red flags to consider. Her previous experience of running is leading her to fear (possibly expect) a future bout of pain from running. This is a problem because fear of pain is a risk factor for future pain (source). If Lisa is nervous about running because of potential pain in her knees, she is already more likely to actually experience pain in her knees with running.  The second red flag is that Lisa doesn’t trust her trainer.  Had she not pre-paid for her sessions, she would have already found another trainer to work with.  People who distrust their doctor, physical therapist, trainer, coach, etc., are more likely to experience pain (source).   Our relationship with a professional is an extremely valuable platform from which we can affect change in our bodies. The more we share beliefs and values with a professional, the more likely we are to witness positive change with our pain experience.

Lisa is nervous about running, really doesn’t want to experience knee pain again, AND she believes her trainer—of whom she’s already skeptical—is progressing her too quickly into running.  This doesn’t bode well for her.  Does this mean she will definitely have increased knee pain if she continues to run as her trainer suggests? No, we can’t assume anything for certain. However, she already feels some twinges.  So my answer for Lisa is NOT that she should never run because it’s bad for her knees.  My answer is that running right now in this context may not be setting her up for the best experience. 

If she can: 
1. choose a trainer she aligns with more
2. gain some confidence with strength training
3. experience a variety of physical movements that don’t contribute to knee pain to positively reinforce the idea that her knees are strong and capable
4. increase her running capacity at a pace that encourages her to get excited about her new ability rather than be scared of it

then my answer would be, “Sure, running sounds like a great idea.”

Rarely are any physical movements inherently “bad” movements. This is a common idea among professionals who advocate a movement optimist philosophy around physical activity. The concept is based on preparedness—any movement is a good movement as long as you’re physically prepared for it. But I would take this a step further and say that physical preparedness is only one element of it. Mental preparedness may be equally important. What are your current beliefs about the activity? What are your previous experiences with it? With whom do you plan to practice the activity/movement? How do you feel about that/those persons/s? What are you current beliefs about your body?

While this kind of inquiry might sound taxing at first, I believe it has the potential to engage us with our experience of pain in a more empowering way while addressing avoidable challenges to new movements/physical practices at the outset.

keep moving.
xoxo