Your Eyes, your body state, and your pain
I cut the tip of my left thumb one recent evening while chopping some vegetables. I wasn’t in need of a hospital visit, but it hurt and bled decently which made my evening uncomfortable, as well as my sleep since I tend to move around a lot at night.
The next morning, as I drank my morning coffee, I just felt off. My finger was hurting quite a bit, but more than that, it was extremely sensitive to touch so I was nervous to make movements that would exacerbate the pain. I found myself making decisions about how to navigate my morning based on what would be the path of least resistance for my finger. Unload the dishwasher? It seemed extra full, probably not. Take out the trash? It seemed extra heavy, it could wait. Getting dressed was effortful. Even in movements that had nothing to do with my finger, I felt like I was moving slower, more clumsily and heavily instead of confidently and swiftly through my environment. The injury was just the tip of my thumb, and on my left hand (I’m right handed), yet it was enough to make the world around me feel slightly cumbersome.
How we feel impacts how we see the world around us. If you place a glass of water some distance away from someone who is thirsty and someone who is not, the thirsty person will guess that the glass of water is closer to them than the non thirsty person. Distances literally look farther and hills look steeper to people who have low energy and are not physically fit—as in, they will guess that the distance between A and B is longer whereas those with higher energy and who are more fit will guess the distance as shorter. These studies tell us that the state of our body can directly impact our immediate visual experience. In a more practical context, that means someone with chronic fatigue or who lives a mostly sedentary life will actually see the physical world around them as more challenging to navigate.
In turn, additional research shows that these perceptions of our environment directly affect our physiology. Our blood pressure rises in advance of doing something that we think is difficult to help us prepare for the task. Conversely, our blood pressure remains low if we’re about to do something we perceive as easy. If we’re on a stationary bike and the image on the screen is a steep hill, we’ll start working harder in response to what we’re seeing, even though the resistance on the bike didn’t change. The same thing will happen in reverse — if we see flat road on the screen, but the resistance on the bike increases, we’ll still be more likely only to work as hard as the flat road requires. Here’s an interesting piece going back to blood pressure — our blood pressure also remains low if we perceive something as too hard. So someone who has chronic fatigue or is unfit not only sees the world around them in a way that presents physical challenges, but physiologically responds in a way that keeps them from being motivated to try those physically challenging things within their environment. Consequently, the less one moves and physically interacts with the environment, the more tired one may feel. The cycle is common and can feel impossible to break.
We can apply this directly to pain. With my minor finger injury, I saw the environment as a more cumbersome place — imagine what it might feel like with chronic pain! If you experience low back pain, you might feel less physically fit and agile. That feeling about the state of your body will affect what you see: a box on the ground might look bulkier and heavier, or a set of stairs might look higher and steeper than it actually is. That isn’t very motivating to actually lift the box or climb the stairs —remember how quickly I ditched the idea of unloading the dishwasher and taking out the trash? And if you do end up lifting the box or climbing the stairs, it’s most likely going to feel harder (because perceptions and expectations go hand in hand and expectations have a profoundly large effect on outcome) and all of this isn’t going to be very motivating to repeat.
I will offer a shameless plug here: Having professional support — someone alongside you who can encourage you to safely try moving in new and challenging ways — can be a key element to breaking the cycle. I have clients say, “I didn’t think I could do that!” all the time. The moment you experience doing something you didn’t think you could do, you get a major hit of dopamine, a neurotransmitter involved with reward that makes you feel good. The feeling of reward manifests as empowerment, and consequently, you become motivated to feel that way again. In the research, what I call empowerment is actually called self efficacy — the belief that you have the capacity to influence your outcomes. Empowerment/self efficacy changes how you feel about your body (it also changes how intensely you feel pain), which therefore can affect your visual perception of the world around you. So now you have three positive shifts: a successful movement experience, motivation to repeat the experience, and literally a new way of seeing the environment around you. All three shifts may offer the chance for new engagement with your surroundings in a way that feeds into feeling even more empowered, and the cycle then reverses itself in a positive direction. Pain scientists Moseley and Harvie sum it up best in their newest education book Pain and Perception:
“By re-engaging with a preciously painful activity in a new way, in a new environment or with new people, it is possible to reduce the influence of negative expectations and sometimes create new positive expectations. And by finding the right level of activity that avoids big flare-ups but still promotes your body’s inbuilt capacity to adapt, you can guide your body’s expectations away from pain and unnecessary protection.”
This is absolutely not a one shot fix, and it’s 100% a journey of steps back along with the steps forward. When you take a step forward, we take a moment to recognize and celebrate. When you take a step back, I remind you of your progress.
keep moving.
https://pubmed.ncbi.nlm.nih.gov/11817755/
http://www.sydneysymposium.unsw.edu.au/2013/chapters/BalcetisSSSP2013.pdf
https://www.researchgate.net/profile/Guido-Gendolla/publication/292893391_Three_decades_of_research_on_motivational_intensity_theory_What_we_have_learned_about_effort_and_what_we_still_don%27t_know/links/58b3fe8045851503be9e284a/Three-decades-of-research-on-motivational-intensity-theory-What-we-have-learned-about-effort-and-what-we-still-dont-know.pdf
https://www.ted.com/talks/emily_balcetis_why_some_people_find_exercise_harder_than_others
https://www.noigroup.com/product/pain-and-perception/