If you’ve been here long enough, you’ve heard us talk about “the cycle” of pain and injury that people fall into. It’s much more common than you think, and in a majority of my evaluations I hear people say something like “I’ve had this shoulder pain on and off for 5-10 years, but recently the episodes are getting closer and closer together and it seems like it won’t calm down all the way.”
They’re essentially describing the body’s inflammatory process that happens when we do something that our body isn’t capable of handling (yet). At first when this happens, most people will rest or take a break and let that inflammation or pain calm down. On the graph below, you’ll see the horizontal black line in the middle that represents our threshold of when we start feeling pain. When we do something to our body that spikes a response that goes above that line, our brain perceives pain. This is protective, and it can be good. It’s our body saying “Hey, that was too much for me to handle.” After all, the inflammation process is our body’s way of repairing and healing. This is a natural and healthy process. Our bodies are amazing in this way.
However, as you can see on the lower graph, if we have repetitive insults on the system over time, we have multiple spikes in inflammation over time – our body’s nervous system gets so sensitive that recovery in the spikes have a hard time getting below the threshold of feeling pain. This can lead to more of the “chronic pain” feeling over time, and it can overly sensitize us to things that don’t normally cause issues.
Why Do Repeated Inflammatory Spikes Occur?
Repeated inflammation often happens when an injury or stress doesn’t have enough time to heal properly before being re-exposed to further strain, or we do nothing to intervene, and we keep putting the same stimulus on it expecting a different result. Some common reasons for repeated inflammatory spikes include:
Repetitive Stress or it Being Under-Trained: Engaging in the same activity over and over without adequate rest or appropriate build up time of capacity (such as sports, heavy lifting, running volume, or even time spent on yard work) can continually trigger inflammation.
Improper Rehabilitation: Sometimes, patients return to physical activity or work too soon after an injury or where they do too much OR too little to regain capacity to do what they love.
Unresolved Movement Patterns: Faults in movement patterns (walking, squatting, running) that go uncorrected can cause certain areas of the body to bear excessive load, triggering inflammation repeatedly.
Here’s The Kicker: during the “rehab” process or really in any sense of getting better at whatever you want to be better at, we want to flirt with that threshold line. Most decent physical therapy clinics can do the first part of rehabilitation well: calming inflammation down and getting you below the threshold line. What we do really well? Making actual long lasting changes. The ONLY way to do this is to increase our body’s capabilities to do what you want to do (run, garden, put heavy weight over your head, hike with your family). Just because your body can’t handle something right now, doesn’t mean it can’t ever. Our bodies are adaptable, we just have to give them the right formula for improving.
How Do We Improve the Body’s Capability?
Improve Movement Patterns: taking a deep dive into optimizing the way your body moves in order to take undue stress off of structures that shouldn’t be taking it and redirecting it.
Improve Strength: Improving muscle strength = Improving bone density and strength = It can handle more stress.
Challenge It: The only way to improve the body’s capacity is to challenge it. This is where most clinics get it wrong. We WANT to put healthy stress on tissues in order for them to grow, get stronger, and tolerate more demanding tasks.
This is something I educate clients on in their early plans of care. It is relatively easy to get someone’s symptoms to calm down. Once they ARE calmed down, the real work starts. We must build it back up and get past our “baseline”, and to do that we have to challenge the system. This is what I call “flirting with the line” of inflammation. Our goal is to get close to the line, but not go into the pain zone and stay there for long. This is where the real change is made, and it’s how our body becomes resilient to what we want to do. This is hard to do, and every single human that walks through the door is different.
There is no cookie cutter approach to this, and this is why so many people struggle to rehab their own injuries. This is why it’s so important to get help to stay the course, even when we experience a flare up during the process. You are not back at ground zero. You are not starting over. It’s part of the process. This is the art of what we do daily, and this truly is where having a team surrounding you is so important.
If you’re ready to break the cycle and push past your limits, whatever they may be, we’re ready to empower you and walk alongside you in this freeing journey.
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