Todd Hargrove continues to be one of the most credible writers on musculoskeletal pain science in the world. Check out his new article – here
Out of the 7 strategies mentioned, which are the top two? 1. Rest 2. Strengthening.
It’s hard to believe that musculoskeletal pain science can be reduced into such simple terms, because of all the noise out there.
“Here’s the bottom line: for many kinds of common pains, you will not find a treatment that works better on average than simply strengthening the muscles around the painful area, in a way that doesn’t aggravate the pain.”
A little knowledge can be a dangerous thing…
“All I do know is pain is a confusing complex and worrying condition and poorly associated with structure.”
Todd Hargrove on the important topic of the inefficacy of orthopedic surgery –
FROM THE IASP (Internation Association for the Study of Pain)
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Note: The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain, and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. This definition avoids tying pain to the stimulus. Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause.
Another great blog by Todd Hargrove. The main point of this blog boils down to a careful suggestion, which is that MOVEMENT-based therapy is superior to education-based therapy, for chronic pain.
“But pain is unfortunately sometimes more like the checkerboard illusion – immune to logic. People often have pain in areas where there is no damage, and sometimes in areas where there aren’t even body parts! Having conscious knowledge about these facts sometimes cannot affect perception. In terms of modules, we could say that the pain module is just not very interested in hearing corrective information from the cognitive modules. It was designed to be strategically ignorant about their conclusions. This is frustrating, but I think an interesting theoretical way to look at the problem of pain having “a mind of its own.” If the pain module won’t “listen” to the more cognitive modules, which modules might be better at speaking its “language?” The movement modules would be first on my list.”
“Or it’s possible that exercise just really does aggravate some cases of fibromyalgia.
And yet fibromyalgia is among the most likely of chronic pain conditions to benefit from exercise if you do it right. But what’s right? No one knows for sure, of course, but here are some evidence-inspired tips:
- Moderation, of course: either stick to the Goldlilocks zone, or only leave it for relatively short bursts. The conventional wisdom is regular moderate exercise, never too much or too little, but I think that’s a bit too simplistic. You may want to exercise intensely because it’s fun, for instance, but that must be balanced with more frequent and generous recovery opportunities than you needed back in the pre-fibromyalgia days.
- Timing is everything: as every fibromyalgia patient knows, there are good days and bad days. It’s important to minimize exercise on the bad days, and equally important not to pounce on the opportunity to get back to it on the good days.4950
- Aerobic or lifting weights? It doesn’t really matter — they both seem to work.51 Do what pleases you…
- Make it fun, make it happy. That may sound trite, but exercise may work for fibromyalgia not because of its familiar biological effects, but as a desensitization tool, a brain-changer,52 a way to demonstrate to nervous systems that the world is a “safe and good place.”53 This effect would also go a long way to explaining why one form of exercise seems to work well for one patient, and not at all for another: because its success depends at least partly on how we feel about a workout. “
One possible cause of chronic pain?
“Fitness: Undoubtedly critical! Regular moderate exercise really is the closest thing we have to a miracle drug or a fountain of youth. The older you get, the more you should avoid the extremes: too much and too little are likely both a problem.
Do you even lift? You should! Weight lifting specifically is linked to a lower risk of metabolic syndrome.24 It’s a more well-rounded and efficient workout than most people realize.25
Anti-inflammatory nutrition: It’s also possible to some extent to eat an “anti-inflammatory” diet — which isn’t as impressive as it sounds. It basically just means a healthy diet, particularly one that doesn’t give our system major blood sugar regulation challenges.”
Todd Hargrove is able to describe in simple enough terms, how movement can decrease pain through adaptations in your brain and nerves:
We experience pain in relation to movement when the nervous system perceives that the movement is threatening to the body. Like other perceptions, the perception of threat is an interpretation that is subject to change based on a wide variety of information. A program for graded exposure can offer the nervous system new information about a movement that might cause a change in perception. If you can find a way to perform a currently painful movement at a low enough intensity that it does not hurt, you are sending the nervous system feedback that the movement is safe. If you do this repeatedly, perhaps the nervous system will start to disassociate the movement from the pain. This is the same rationale underlying many treatments for anxiety and phobias.
Strength/Resistance Training: increases mobility, cognitive benefits, increases cardiovascular health, increases strength
The science behind strength training is taught in superb fashion in “Body By Science” by Doug McGuff. Even if you’re not interested in a so-called “12-minute a week” program, the teachings about exercise in this book are invaluable.
FYI: More info on strength training: it leads to the maintenance of functional ability, the prevention of osteoporosis, sarcopenia, lower-back pain and other disabilities, a reduction in insulin-resistance, diabetes, heart disease, cancer, falls, fractures, disabilities, the cardiovascular demands of exercise, depression, an improvement in metabolic rate, glucose metabolism, blood pressure, body fat and central adiposity, blood-lipid profiles, gastrointestinal transit time, cognitive function, and quality of life, and an increase in muscle and connective tissue cross-sectional area, strength, power, endurance, hypertrophy, flexibility, joint stability, posture, mood, and self-esteem.