This post is inspired by a great woman we recently started working with. She took advantage of our free “Discovery Session” to see if we might be able to help her with her hip flexor pain, which developed gradually about a year ago.
We ran her through an assessment that involved numerous easy movements and light palpation to her painful hip. The result of the session was great! We were able to help her understand the deeper drivers to her pain, and laid out a definitive plan for how we can help.
However, she emailed us the morning after saying,
“I just wanted to check with you - last night and this morning my hip was and is bothering me. More pain than usual. In the spot that you pressed that was tender. Where my hip flexor is. Is that because of some of the things we were doing yesterday at the assessment? I think that's pretty typical - but just wanted to check in and make sure.”
It is NOT typical for our clients to be in pain after an assessment or treatment.
We’re here to help you get out of pain…not put you in it.
All of the movements we take people through in our assessments are very novel, and any palpation we do is typically gentle.
But the fact that this woman experienced increased pain from such a small amount of movement and touch brings up a really important topic with regards to rehab.
HOW LONG WILL IT TAKE FOR ME TO GET BETTER??
That’s one of the main questions we get from people seeking our help, and (without meeting or assessing you) the answer, though cliché, is…”it depends”.
There are a multitude of factors that go into how quickly we recover. One of the biggest, and most overlooked, is the beliefs we hold about our pain.
PAIN ≠ DAMAGE
Our medical culture has engrained in us the idea that pain is 1:1 correlated with damage. That one structural problem is the source of all of our discomfort. If we “fix” the damage, our pain will go away. Oppositely, if we feel more pain, the damage must be getting worse.
Nothing could be farther from the truth! Bodily damage and degree of pain are often found to be poorly correlated at best.
In fact, bad breathing patterns are probably better correlated to low back pain than bulging/herniated discs or arthritis.
PAIN = PERCEPTION OF THREAT
At the end of the day, pain is a construct of the brain. Your body receives a stimulus, the brain processes all of the information it has available to it, and determines if that input is threatening. If it decides that it is, you experience pain, so you can remove yourself from the threat.
Pain is meant to be protective.
Have you ever heard about people who can’t feel pain? Their life expectancy is something like 30 years…because if their body is put under threat (i.e. they put their hand on a burning hot stove, or step on a rusty nail), they have no means of recognizing it.
Now structural damage/tissue injury is one significant input that your brain processes when it determines whether something is painful or not.
If you severely sprain your ankle and it swells up bad, you’re going to feel it. Likewise, if faulty movement patterns cause your hip to pinch every time you squat down, you’ll likely develop discomfort in the front of your hip over time too.
But, the way we experience pain is heavily influenced by our beliefs about.
NO TWO PEOPLE PERCEIVE PAIN THE SAME
If you’re a runner and have hip pain, and your best friend had a stress fracture in her hip last year, your brain is going to process whatever you have going on in your hip a lot differently than the college football player whose teammate had hip pain and was back on the field in two days.
If you’re parents put a band-aid on every “boo-boo” as a child, your brain is going to process injury much differently than your neighbor who would break their leg and their parents would tell them “rub dirt on it”.
Pain is perception.
The lady mentioned above was told by an orthopedic surgeon that she strained her hip flexor and tore the fascia in the front of her hip.
If your reading this and are not in an orthopedic medical profession, do you even know what “hip flexor strain” or “fascia” really means? You’re brain just registers “big words that sound threatening”.
So what the hell do you think goes through her head at a subconscious level when I push on her hip??
It takes close to 1000 lbs of force to deform fascia 1%. The light touch I applied during her assessment was close to the least threatening input I could apply. Yet, she felt it the next day.
What do you think she's really feeling? A severe injury in her hip, or her brain overreacting to a safe stimulus? You better bet your bottom dollar on the latter.
So not only are we going to have to address the movement issues that are causing her hip to be irritated at a structural level, but we’re also going to have to address her beliefs and misconceptions about her pain.
The outcome ultimately will be no different. She’ll do great and we’ll help her get back to doing what she loves. But her process in rehab is going to be a bit different (probably a little slower) than someone with the same injury with more positive beliefs about their pain.
Again, pain is perception…NOT damage. Don’t let it intimidate you, and I promise your recovery will be much shorter.