A Pain in the Knees
I recently experienced an amazing breakthrough with a client. Linda (not her real name) is in her early 70’s and started working with me because she was experiencing knee pain in both her knees that was limiting her function in her everyday life. I love working with Linda because she’s very open minded and receptive to a lot of the mind-body concepts I introduce in relation to pain (clients who have a long history of practicing yoga as Linda does are always easier to communicate with on these topics).
Over the course of our almost six months together, we’ve strengthened her lower body as well as her upper body, we’ve addressed hip mobility as well as shoulder mobility, and we’ve talked at length about things like the relationship between pain and damage, and how to increase function amidst pain
Last month she opened our session with a declaration. She said, “I was talking to my husband and have decided that I’m going to start calling it chronic discomfort instead of chronic pain.” The inside me was jumping up and down and cheering while the outside me calmly asked her to expand on her thought process before congratulating the huge shift in perspective.
You might be thinking, chronic discomfort? That sounds terrible! Sure, feeling uncomfortable isn’t ideal when comparing it to feeling perfect (who feels perfect??). But it opens up a whole new world when comparing it to feeling pain, and here’s why:
We are more likely to continue to do things with our body even if they feel uncomfortable. We are less likely to continue to do those same things when they feel painful.
The word pain registers differently in our brain than the word discomfort. As living human beings, our brains and bodies are assessing our safety 100% of the time. If we start getting too many incoming signals that we may not be safe, whether it’s from a dark walk in the woods, a poorly adorned dentist’s office, or a scratch on our leg, our brain will send us alert signals to get us out of the “unsafe” situation. The word pain contributes to this sense of danger / lack of safety / need for protection. Constantly using the word pain in the context of someone who has chronic pain may be a contributor to their actual pain experience (it could be a .05% contribution or a 20% contribution but it’s still a contribution)
People almost always associate pain with damage in their body. This concept is the dinosaur of pain and rehab science that has yet to become extinct. Pain can be correlated with damage but we know for absolute certain that it is not necessarily so. People can have tissue damage and have no symptoms, and people can have no tissue damage and lots of symptoms. Furthermore, pain is not caused by tissue damage. Pain is an output of the brain, just like a feeling (like feeling sad or happy). This output is a product of millions (literally) of contributing inputs (like the word pain!). People who believe their chronic pain is a product of the damage in their [insert any body part], commonly also come to this incorrect conclusion: moving in ways that are painful must in turn be worsening the damage. Changing the term from chronic pain to chronic discomfort more easily releases someone from that belief. When we do something that’s uncomfortable, we’re not usually thinking that we’re hurting or damaging ourselves. It’s just . . . uncomfortable, and oftentimes we keep doing the thing. Using the word discomfort instead of pain empowered Linda to feel confident in doing more physical activity without the fear of worsening her situation.
Here’s the kicker. We didn’t “fix” Linda’s knees. The arthritis and meniscal tear present in her knees 6 months ago is almost certainly still there now. I also will venture to say from my conversations with her that many of the sensations she experienced previously still exist. She still sometimes feels stiff, and she still feels twinges when doing certain things. While they might have become less frequent, the sensations didn’t disappear. However, she decided to label the sensations differently based on her functional capacity. Through our work together, she felt she was able to do more even though the sensations in her knees were sometimes still there. This increased functional capacity cascaded into feeling confident in herself and her abilities and a better outlook about her situation — both of which then cascaded into the idea of naming her situation differently.
The cool part is that nothing is a one way street with pain physiology. The adjusted label to “chronic discomfort” can positively influence her situation in a cycle of positive reinforcement. Take a look at my very rudimentary drawing below.
Can you draw a cycle for your pain experience? What can you learn from it? What one thing could change that would change the whole trajectory of the cycle?
Keep moving.