Our body is wired to detect danger and protect itself from serious harm. Pain is a built-in
alarm to alert us of dangerous situations. Our pain system does a relatively good job
at alerting us when there is an acute injury, like a burn, a bone fracture or appendicitis.
However, pain is not a good thermometer of how much harm there is in the body.
In some situations, the brain will not stop alerting the person of danger,
even when the injury has already healed. And hurt will be interpreted as harm.
Well, but you may be thinking, is there any problem with that?
Yes, because if you feel pain and you think that the pain is a thermometer
that something is being harmed in your body, you don’t do the things that promote healing.
Actually, you will be doing exactly the opposite. So, let’s talk about hurt versus harm today.
Before I continue, let me remind you that this video is not intended to provide medical advice.
If you have a condition that causes pain, please talk to your doctor.
This video is only for educational purposes.
If there is an emergency, call an ambulance or go to the nearest emergency department.
If your doctor told you that the injury, the disease or the condition that started
this pain is already healed, then why do you still have pain? Well, any feeling of pain is just that,
a sensation. It does not mean that when it hurts there something harming your body.
If you have persistent pain anywhere in your body, don’t try to diagnose yourself. Get a medical
opinion and a proper diagnosis. Your doctor or your therapist will confirm
that there is no ongoing injury. So, if this is your case, you should be happy,
you can be reassured that there is nothing harming your body.
Of course, pain is unpleasant, it is annoying and tiring. I understand that,
and I am not telling you that you need to have the pleasure of feeling pain.
No, but the problem is that people who fear pain because they think there is harm to their body,
avoid activities that actually promote healing. And the main modality
that promotes healing and avoids the transition from acute to chronic pain is movement.
Watch my other video about the difference between acute and chronic pain.
Movement. Fear of movement
is very common among my patients. This is what we call kinesiophobia. It is a phobia of movement.
They avoid exercising or using that body part. There is a questionnaire that I use
with my patients, it is called the TAMPA Scale for kinesiophobia. The higher the
scores the more fear of movement the patient has. Here are examples of some questions:
I’m afraid that I might injure myself if I exercise
My body is telling me that I have something dangerously wrong
Pain always means I have injured my body
No one should have to exercise when he/she is in pain
There is a lot of research showing that among people with the same type of injury,
those who have higher levels of kinesiophobia tend to suffer higher pain levels, have more disability
and worse quality of life. Younger women tend to have higher scores than older women.
When we screen our patients for kinesiophobia and address these beliefs during rehabilitation,
the patients recover faster and achieve a much better quality of life.
When patient fears movement, they tend to become more hypervigilant and avoid activity which will
lead to more muscle weakness, poor balance, poor coordination and endurance. They will have more
disability and depression. Then, the person feels worse and this cycle just perpetuates itself.
When the person loses the fear of movement,
they confront activity, they engage in normal daily activities, and recover much faster.
Pacing When you understand that hurt does not mean
harm, you get too excited and want to do a lot of activities that you were avoiding. Like gardening
in the morning, cleaning the house in the afternoon, and grocery shopping in the evening.
Maybe you need to pace yourself. There is no need to rush.
Pacing means that you will respect your limits.
You can break down an activity into small steps. You can rest and take it easy.
Taking breaks improves your overall performance and speeds up your rehabilitation.
Have you heard the story of the two woodcutters? They were in a competition to see who would cut
more trees in a day. One was an older woodcutter with many years of experience, the other was
a young and stronger man, but without the same experience. After one hour of chopping trees, the
older man stopped to rest and invited the younger man to do the same. The younger replied “No Way,
I don’t need to stop”. The older man kept taking breaks every hour. At the end of the day,
the younger man was astonished to find out that the older man had cut many more trees than him,
and he went to ask the old man what his secret was.
The older man replied, “Every time I stopped to rest I sharpened my axe”.
So, the secret is to find balance. Do not be afraid of movement that you
will be paralyzed by fear of harming yourself. But respect your own limits and pace yourself.
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