Dealing with pain: 8 things to do about it today

Why does it still hurt? The answer … It's complex.

We get it, you were hoping for another magic bullet. Unfortunately, we’ve been doing this too long to know that no such bullet exists. The good news is that complex means there are lots of different things at play when it comes to feeling pain and so we have many different avenues to explore to help us deal with it. Also, complex doesn’t always mean complicated, often simple solutions are all you need.

People usually come to us with long-term pain and discomfort. This pain has likely been going on for several months or even years. The pain has not subsided as predicted and prevents them from participating in and enjoying their favourite sports and activities, sometimes not allowing them to continue at all. Not to mention interfering with day-to-day life! 

They are usually told about a damaged body part, being out of alignment or having muscles misfiring. This then results in trying a bunch of stuff to ‘fix it’ … 

  • Painkillers
  • Massage 
  • Stretching and/or low level rehab exercises
  • Seeing a chiropractor, osteopath or physiotherapist (maybe two or three)
  • Maybe a cortisol injection
  • Sometimes even surgery

Often these give relief for a while but have little to no lasting improvements. 

The pains and niggles continue to linger or flare up on a regular basis and the confusion, frustration and loss of hope and confidence in the body becomes very real.

If this sounds like you, we get it, and you are not alone in your confusion and frustration. You’ve tried doing the right stuff and it still hurts! SO, WHAT NOW!?! It’s often at this point you’ll potentially feel like giving up.

Before you resign yourself to living with this forever, give us 5 minutes of your time and see if this blog can help you.

We at aps take a broader view of things. This helps us to get a better understanding of your pain and find better solutions for recovery. We can create a comprehensive plan to help you to do the things you need to do and enjoy the activities you love with more freedom and confidence.

Step 1. Rule out serious stuff

The first step is ruling out serious stuff. This can sound scary but keep in mind the serious stuff is generally:

  1. Pretty obvious, such as:
    • Severe pain
    • Non-movement related pain
    • Pain resulting from trauma (a high fall etc)
  2. pretty rare, for example only about 1-2% of low back pain falls in the really serious category. 
  3. Likely already ruled out if you’ve been around the houses.

If you’re in any doubts, go get it checked out. A well-trained rehab professional doing a comprehensive assessment can do a good job of figuring this out. If they are in doubt, they will refer you on to, or collaborate with, a medical professional. 

Step 2. Embrace the idea that Pain is Multidimensional

‘You are not a car. You are an Ecosystem’ (Greg Lehman)

It’s never just a “weak core or glutes”, “poor posture” or an issue with your tissues. These things might be relevant, or they might not be very important at all. Research continues to show us damage & dysfunction correlates very poorly with if & how we experience pain and levels of disability.  

The body is important in pain, it’s just not everything. Tissues get irritable if they can’t handle the physical stress placed on them. Yet this irritability isn’t just about the biological state or strength of the body. Other factors can amplify or dial down a pain experience with or without tissue damage or what’s often called dysfunction.

This is why we say pain is multidimensional. 

Here’s a look at some of the key factors we explore that could be contributing to pain. We focus on these because they are often areas where we can create change:

How do I move forward? The answer is … you have lots of options!

The path forward generally consists of 8 key parts. Together they create a comprehensive, collaborative, and progressive rehab plan relevant to the person and their goals that helps them to build up and get back to doing what they love.

1. Assessing to get a better sense of the pain problem. 

Assessing is the best form of guessing. Gathering information, through talking, physical assessments, and experimenting with movement helps narrow down the pain problem to set realistic expectations for how long things might take, inform us of where to start and best ways to build up. This includes things like what exercises could be a good fit and which big picture areas might be worth exploring. 

2. Addressing any unhelpful beliefs, making more sense of pain and utilising mental performance.

Beliefs are important. They shape our attitudes and behaviours towards pain, and unhelpful myths or misconceptions can be a block to recovery. These can be things like “avoid moving your back a certain way” or “you must wait ‘this long’ before doing anything with your shoulder or knee”. Clearing them up and upgrading to more positive messaging, that’s evidence based, can be massively helpful in:

  • Creating more optimistic outlooks and expectations.
  • Making sense of pain and feeling in control.
  • Feeling it’s safe to move, to load, to live.
  • Understanding that physical stress is a force for good in painful problems. 
  • Restoring trust in your body 

Exploring mental strategies can also be incredibly beneficial. Examples include cultivating a growth mindset, setting goals, and focusing on process rather than outcome.

These things can help us stay calm in challenging situations and when we become overwhelmed. It can also help us refocus and build routines that are essential for success in the recovery process. 

3. Resuming and dosing the goal activity, aka doing your “thing”, is a big part of the fixing! 

Can I do my sport / activity while in pain? Am I going to make it worse? Do I have to get to a certain level of strength or movement ability before I can play again?

This is a contentious area that maybe gets over-thought. At some point, whatever the goal task is, it MUST be part of the recovery. So, the answer is probably yes. 

How you go about it is highly individual and always a dynamic process. Sometimes it’s helpful to back off, take a short break and let things calm down. Other times (probably more often than not) doing the specific task might be the best thing… there’s a thought! 

The ability to tolerate, adapt and build up is one of the amazing traits of being human. Research shows us it’s less about fixing things to be able to do activities and more about facilitating tolerance to handle gradually increasing levels of the activity. The questions are what shape does doing my thing take, how do I get a clear sense of how much is ok right now, and how do I know when and how to progress or regress? Managing the dose with a gradual build up is key!

Here’s a basic framework: 

  • If irritability / pain is high – It’s probably helpful to back off, take a short break and let things calm down.
  • If irritability / pain is moderate – It’s probably helpful to be engaging with your activity / sport but modify it in some way. This could be doing it at a lower intensity or volume or avoiding aspects of it that cause irritability and pain levels to rise. This is very often a MISSING piece of the rehab puzzle. Dose is key and seeing how you respond informs what to do next.  
  • If irritability is low / pain is ok – It’s probably helpful to be doing your activity / sport, while still allowing your responses to inform you as to how fast to progress. 

Of course, like all good frameworks there will be exceptions where you might want to restore things such as strength, mobility, or motor control first.

For most sporty/active people with a pain problem we would hedge our bets on a comprehensive approach that includes some mobility and resistance exercises, as well as dosing your activity appropriately and making it a central piece of the rehab plan.

4. Working on the bit that hurts (local exercise) 

This one is obvious, but if something hurts, at some point we’ve got to start getting it moving and handling load. It could mean building more capacity or tolerance, but equally important is improving confidence, showing that your knee, back, shoulder etc, is strong and still capable of doing things. 

5. Working on the stuff near the bit that hurts (upstream & downstream exercise)

Research and experience consistently show us that focusing on the stuff around the painful area helps, we just don’t need to get bogged down in figuring out exactly why it helps or the minutiae of best exercises. 

  • If the knee hurts, work on the ankle, hip and core.
  • If the shoulder hurts, work on the arm, shoulder blades / torso and opposite leg (kinetic chains are useful).
  • If the lower back hurts, work on the hips and the upper back / torso. 

As always, we want to work on these areas comprehensively. Get them moving, learn good motor control and then move past conventional “low level” rehab by progressively building up load and capacity.

6. Explore ways to calm stuff down.

Feeling like you have some control and ways to soothe your pain and discomfort, to either re-engage with avoided movements or just continue to move in day-to-day activities, is an incredibly empowering skill to possess.  

There are lots of options out there that help us soothe our pain, and all of us are going to turn to them at points. Often these are things such as ice, medication, bed rest, alcohol, or other distractions.

Whilst all of these do a reasonable job of soothing pain levels, most don’t have any long-term benefits or a progressive path of getting you back to where you want to be. This usually ends in a loop of going through flare ups and often needing more and more of the soothing mechanism before repeating again.

At aps we lean towards things that not only give you control to reduce your pain levels, but also offer physical benefits and lead us down the path of getting back to our thing. 

This includes strategies such as:

  • Breathing 
  • Soft tissue work e.g foam rolling 
  • Mobility exercises
  • Motor control exercises
  • Exercise/activity adaption

The last one on the list is a big part of our approach. If we can keep you active, whilst reducing pain levels, by tweaking what you’re doing, this is win-win! These modifications tend to focus on things such as loading in different ways, regressing the activity, and sometimes simply confronting feared or painful movements in a controlled way. 

We are biassed towards the techniques that help you take control and give all the secondary benefits of getting moving. Examples of exercise modification could be:

  • Loading in a different way – Swapping a deadlift for a hip bridge
  • Modifying the lift or technique – Trying different variations of deadlift or different variations of lifting (challenging the idea of neutral spine for example).
  • Poking into the pain to build tolerance and desensitise the pain (dose is key here) – Deadlifting still, but maybe tweaking load, tempo, or volume to find a good start point for building tolerance.
7. Getting a bit healthier, managing stress better.

Pain is always multidimensional, but it’s hard to know exactly what needs to change. This broad catch all category can often be filled with hidden gems that help with recovery. Here it’s best to work on what seems relevant to you or obvious low hanging fruit (e.g. I consistently get less than 6hrs sleep and life has been really full on).

It is also worth considering how much ‘rehab stress’ you can handle right now. There are many strategies available. However, some can be too demanding, like having to complete 10 exercises each day while managing a busy schedule. Often less is more when it comes to rehab.

8. Being consistent. 

Consistency is key and trumps perfection every time. Find a rehab, movement and life schedule that works for you, and that has some level of flexibility in it. This will help keep you going when life gets in the way, which it always will at some point. Making use of routines (especially morning and evening ones) to develop supportive habits can also be a game changer for making things efficient and staying consistent.

How long will it take? The answer is …

Unfortunately, there is rarely a clear-cut answer to how long pain rehab will take as not all pains are created equal. As we’ve talked about throughout the blog, pain is complex. Everyone’s start point and end points are different, so it becomes difficult to give out exact time frames for recovery. 

In our experience, with the ideas in this blog applied well you can see big improvements in 3-6 months.

Our best advice is to be patient, give it time, and don’t give up.

Pain management requires focusing on signs of progress and being mindful of what your body is telling you. This is key to successful pain management. If your pain is reducing that is obviously progress, but so is:

  • Having the same amount of pain less often.
  • Having the same, or even a bit more pain, but doing more.
  • Having flare ups that don’t last as long.
  • Having to do less to manage or soothe your pain.
  • Feeling more confident about movement regardless of pain levels.

While you’re on your pain or sports rehab journey you can use your bodies feedback to help guide some decisions:

  • What are my pain and sensitivity levels the day after I’ve done something?
  • How does my pain respond to certain movements, thoughts, emotions or behaviours?
  • In terms of things such as sleep, activity levels and confidence in my body, am I gradually progressing or deteriorating?

These questions can help us navigate our journey and becoming more in tune with them often helps speed up the process. As does focusing on little steppingstones of progress rather than an arbitrary mark on a calendar.

Things to keep in mind:

  1. Different people have different start points, challenges, and end points. For some it might be a bit quicker and for others a bit longer.  
  2. Progress happens in circles & waves. Backsteps and flare ups are inevitable and expected. Learning to navigate them with minimal setbacks or concerns is an important part of the rehab process
  3. Nearly everything gets better in time. The human body is amazing at adapting.
  4. For the rare times with things that don’t or can’t get better, we simply focus on making life bigger. Here we can work around your pain and look for ways to build your strength, capacity, energy, mindset and confidence. This helps you to work towards an active life, doing more of the things you love.

Can I do my thing while in pain?

Am I going to make it worse?

Do I have to stop?

Will this get better?

What should I do? 

If you’ve made it through this blog, we hope the concept of our multidimensional approach will:

  • Give you some answers to these kinds of questions.
  • Create at least one or two options you hadn’t considered that you could start experimenting with.
  • Hopefully nudge you to a bit more of an optimistic outlook, even if it might seem slightly daunting and confusing. 

Remember, rehab can be complex, but complex challenges can have simple solutions. 

How a plant works is incredibly complex, yet we simply give it water and sunlight and it does all the cool stuff. Often, we just need to find the right mixture of things for you so your body can do cool stuff too.

Do you need help, reassurance, and guidance?
We are here to help you find a path to live and play again with more freedom and confidence.