Ask a PT: Should I avoid doing things that hurt?

When was the last time you stubbed your toe? I stub mine all the time, and I can tell you exactly what it feels like: an almost overwhelming rush of pain that radiates from my toe up through my entire body, and then fades as quickly as it came on. I’d say I’m pretty good at riding that wave of pain (although you wouldn’t always know it from the stream of curses that comes out of my mouth!)

When I’m struggling with back pain, I don’t do so well. I feel the urge to prevent it, and find myself avoiding things that I know will get my back into those positions that are going to make the pain worse. I’ve perfected this weird move for getting out of bed when I have pain - propping my arm up on the pillow and launching myself sideways so I don’t put pressure on the part of my back that hurts.

If you have ever suffered from musculoskeletal (MSK) pain, this might sound familiar. You might understand the urge to avoid movements that cause pain or make it worse. This is natural: pain is the brain’s defense mechanism. We evolved it to deal with acute injuries like a broken leg or a tiger bite. When we feel pain from an acute injury, our brain is telling our body, ‘stop right this minute, or you’ll do more damage.’ This works wonders when you have a broken leg or a tiger bite. But when you’re dealing with chronic back pain, avoiding the movements that cause the pain can make the pain worse over time. The problem is, the brain doesn’t always know the difference, and if we keep avoiding pain, we teach it to recognize all pain as bad. The more you avoid the pain, the weaker your body becomes, making it more likely you’ll feel pain. This is how pain becomes chronic.

The culprit in this game of mental mix-and-match: fear.

Fear will reliably turn small injuries into chronic pain that escalates for decades. Here’s how it happens.

When faced with pain of any kind, we have two options: face it or avoid it. When you face the pain (like in my toe-stubbing example above), you get on the right track for recovery. When you avoid it, you tell your brain ‘this feeling is scary’ and you’ll start to move your body in unnatural ways to avoid feeling it again. The longer you avoid the feeling, the scarier it will become, and over time, your brain will start to think that what you’re feeling isn’t just a little bruising in your back, it’s more like a broken leg or a tiger bite.

The wild thing is, the pain reaction can continue even after the thing that caused you the pain in the first place has healed, because you have created a new pathway in your brain that is easy for the signals to travel down.

The good news is there’s a way out of this conundrum.

Both the body and brain are plastic - you can train them out of their bad habits with a little knowledge and persistence and get your pain under control, for good. Here’s how:

Understand what’s causing you pain

First and foremost, you need to understand the cause of the pain. This process is often more about understanding what’s not wrong with you than understanding what is. The reality is, the cause of most MSK pain is treatable - there is a less than 1% chance that your pain is caused by a serious underlying problem. This is true no matter how fierce your pain is. Your physical therapist’s first job is to find the true source of your pain. They’re trained to find out whether the pain you feel in your shoulder is coming from your shoulder or referring from somewhere else, and to recognize when the pain might be caused by something more serious, like a neurological issue, an autoimmune condition or cancer.

Once you understand what’s causing your pain, part of your brain will realize that you don’t need to be afraid. This is great progress - our next task is to work on the other part that’s still afraid of pain.

Feel the pain and face it

The next step is to face the pain. It won’t be easy, but like many things in life, it’ll be worth it. Don’t be discouraged if you don’t get it right the first time. You’ll have to try it many times for it to become a habit, but the more you practice, the better you’ll get.

Next time you encounter the pain, your job will be to feel it. Really feel it. Don’t judge your pain or yourself - replace that judgement with a heavy dose of curiosity. Where is the center of it? Where does it move to? How does it feel in your body? Is it hot? Cold? Tingly? Stay with the pain until it subsides, and observe how it leaves your body. Does it come on suddenly and leave as quickly as it came? Or does it fade more slowly? What does that feel like?

Being curious about your pain will help you accept it as part of your life, an important step in your journey to overcoming it. This practice is possible to do alone, but having a PT to support you through this process is really helpful. Cognitive Behavioral Therapy (CBT) and mindfulness-based practices can be helpful, too (and that is why we integrated CBT into all of our programs).

Move, move, move

There is one thing that’s been proven time and time again to work for easing MSK pain… movement. Our bodies were born to move. Movement gets our blood pumping, strengthens our muscles and releases natural painkillers from the pharmacy in our brain. It’s important when you’re in pain to move in the right way.

You’ll need to get your body into the positions that will help you heal, and make sure you don’t do anything that will hurt you further. It’s a fine balance, and one that physical therapists are trained to perfect. A skilled PT will work with you to build a plan that has just the right amount of work for you to get better, and help you push past your limits safely.

SWORD PTs create programs that change and evolve as our members get better, breaking down those impossible tasks into the micro-movements that help you build strength safely and do the things you’ve been afraid to do (like sit up straight in bed).

When you’re working with a PT-designed exercise program, you might be surprised that some of the movements cause you a bit of pain - this is OK! You have to move past the pain. Your PT can help you get to the other side.

Ready to start your journey to a pain-free life?

If you want to make your pain a thing of the past and are looking for a physical therapist to guide you on your journey, SWORD can help. We combine licensed physical therapists with wearable technology to bring you high-quality physical therapy that you can do from the comfort of home, on your own schedule.

Our members have reported a 70% decrease in pain, making them 64% less likely to consider surgery and 36% less likely to resort to medication. They’ve discovered that they have the power to overcome their pain, with their trusty physical therapist at their side.

I know that you can do it too!

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About the author: Megan Hill, PT, DPT

Megan Hill, Doctor of Physical Therapy, is a licensed physical therapist focused on musculoskeletal rehab and chronic pain management. She dropped her plans to go to law school for physical therapy after a knee injury from the Chicago Marathon left her in need of rehab, and she hasn’t looked back since. She’s on a mission to empower people to manage their health through exercise, education and coaching, rather than relying on passive approaches.

Megan earned a Doctor of Physical Therapy degree from the University of Illinois at Chicago (UIC). She also holds a Bachelor of Arts degree in psychology from Duke University and is a certified running coach.

Megan lives in Denver, Colorado, where she spends every spare second running, biking, hiking, sailing and stand up paddleboarding with her husband, Layton, and dog, Ollie.