A Pain in the Neck Story: How to Avoid Catastrophe and Restore Function
Almost 5 years ago, I was trying to transition out of the food and beverage industry into teaching yoga full-time. I knew I needed to make the leap and just figure it out along the way, but that was too scary. So instead of quitting waiting tables to teach full-time, I quit waiting tables to take on a bigger role managing a small cafe, and also took on more classes . . .
It’s no surprise that the ensuing 3 months were a few of the most stressful months I had experienced in a long time, all compounded by the fact that deep down, I knew I made the non intuitive choice. Maybe the second month into my new job, I woke up with a crick in my neck. It didn’t seem like a huge deal until it progressively got worse over the course of a couple days and I found I couldn’t move my neck at all. Nothing I did would relieve the tension I felt running down the side of my neck down to behind my shoulder blade, sharp and stiff at the same time. I don’t remember exactly how long it took to go away, but it was at least a month. It was definitely long enough that I had to train myself to sleep on my back (I was a belly sleeper).
Over the course of the following 5 years, that pain has revisited me a few times, although never to the same extent. Until last month. The discomfort had been slowly creeping up over a couple of weeks, I chose to ignore it, and I woke up one morning and had to cancel my sessions for the day. I could barely move. However this time, the pain was 98% gone within one week.
There are two contributing factors to why I believe I was able to get rid of the pain quickly that I have incorporated into my MO over the past few years. Whether it’s been twinges in my knee, a tug at the bottom of my foot, or pain at my wrist, the following two factors have been largely responsible for my ability to move foreword when these things come up. (I am not referring to acute injuries such as tears, fractures, etc that happen from sudden impact. I’m referring to the seemingly random aches and pains that accompany a moving and aging body).
**Side note: stress is obviously a huge baseline factor. I’m taking for granted that everyone knows reducing stress is ideal for pain management!! These two factors are in addition to that.
DON’T CATASTROPHIZE
Don’t catastrophize. The word “catastrophize" seems aggressive, and may sound even a little patronizing. But it’s actually what’s used in the literature as a contributing factor for pain. Pain catastrophization is defined as “a tendency to magnify and ruminate about pain and having a helpless attitude toward actual or anticipated pain” (source). When we catastrophize, the situation—more than even the pain itself— becomes all consuming. We act as though we cannot function because of the pain, and we even behave this way toward anticipated pain.
When I was a kid, small cuts to my skin were a total shitshow when it came time to shower. A cut on my finger would be bandaged and no longer hurting, but the idea of the sting when I put it under the water was horrifying. I would dread the shower all day. If I couldn’t avoid showering, I would awkwardly bathe with one arm and at least avoid washing my hair. If the wound was on my foot, I’d stick one foot out of the curtain or stand at the edge of the pooling water on the tub floor. I wish I was lying when I tell you that to this day, I sometimes avoid getting my finger wet if I have a paper cut. That’s catastrophization.
The paper cut example isn’t so consequential. The neck example, however, is. Catastrophization has been show to actually predict the chronification of pain AND impair response to medical intervention (source). That means that you may start out with a bout of back pain that you’ve never had before, and with a little catastrophization, you’re more likely to experience chronic pain in that area for months to come, AND more likely to have a poor response to your efforts in physical therapy, acupuncture, or other treatments. In essence, it makes you less resilient. Now that you know this, the fact that catastrophization has been clearly linked to anxiety, depression, and lower quality of life isn’t so surprising. While it’s likely that people with existing depression and anxiety may have more of a tendency to catastrophize, those without existing depressive systems may develop them as a result of catastrophization. Addressing the attitude toward the pain is a way to break the cycle. In children experiencing pain, this is one of the first recommended interventions for effective treatment (source).
When I realized I couldn’t move my neck, I was totally bummed. I used Arnica, applied a pain patch, and took Advil to no avail and I hated having to cancel my classes. But after feeling sorry for myself for about a day, I made a conscious mental shift. I wasn’t denying my pain, but I made a decision to assume it would get better and not make it a bigger deal than it currently was. I also made another important decision that was the second contributing factor to getting rid of my pain in a timely manner.
KEEP MOVING
Keep moving. When one part of our body hurts, we have a tendency to stop moving our whole body. But most of the time, our pain is localized and we can keep moving something. Continuing to move even while we’re experiencing pain does two things. First, it increases our confidence by creating a sense of self efficacy. Self efficacy is defined as “believing in one’s ability to carry out necessary actions to manage pain and to reduce the impact of pain on everyday activities” (source) and it’s shown to have a clear positive impact in reducing our pain experience. We feel more in control and less victimized by our pain (therefore, less likley to catastrophize, they’re all interdependent). When you pick up a box that you thought might be too heavy, and carry it all the way up to your apartment, you’re impressed with yourself, right? You experience that confidence doing daily tasks even without the presence of pain. The feeling can be even more empowering during the presence of pain. When I was experiencing neck pain, and I still managed to do some floor work for my hips, I was quite happy with myself. My sense of self efficacy rose and positively impacted my outlook on my pain and my entire pain experience—therefore reducing my actual pain.
Second, when we continue to move, we necessarily end up moving the painful body part, even if not a lot. If your right shoulder hurts, walking will still move your arm because the torso rotates when we walk and our arms connect to our torso. Moving the body part that hurts keeps us from stiffening it and stiffening the tissues around it. We create tension to protect the painful areas, but ironically, the more stiff and tense we become, the more likely we are to continue to experience pain and create relational pain in surrounding areas. So, I continued to move my neck in the ways that felt accessible. I wasn’t rolling my head around like a bowling ball, but I continued to turn it when and where I could. I used my eyes to activate muscles around the neck, and soon found myself being able to wash dishes and empty the dishwasher.
These two strategies—avoiding catastrophization and continuing to move—may not work in every situation. Sometimes, we want to feel sorry for ourselves and be coddled, I totally get that (something about skin cuts for me). And sometimes, we really are in way too much pain to move. But keep in mind that all of these factors are very intricately intertwined. Something as seemingly insignificant as a family member telling you “Don’t move! You’re going to make it worse!” may actually make you feel more helpless which will contribute to your pain experience, and the cycle begins. On the flip side, something as seemingly insignificant as getting yourself out of bed during a pain experience can actually be a big win. Cheer yourself on, and you’ll find the cycle gaining momentum in the other direction.
keep moving.
xoxo