Neuroplasticity of MUSCLE, JOINT and spine pain

 

September 13, 2016  /  anne brennan

Reposted

Pain science is moving  away from explaining all pain as damage or fault or wear and tear  in bones or ligaments or discs or joints. 

Theories of pain can make for lively debate.  

In bold are pre-world war II beliefs.  

*All  muscle or joint pain must mean  an injury. 

YET:  There is  no evidence that pain is due to an ongoing fault or injury.  The worst pain imaginable   occurs without injury or disease; such as a prolonged calf cramp or a migraine.

Injuries are   rare unless very young or elderly or playing contact sport.

Injuries can cause pain but not all pain is an injury.

* What we can see on x-ray and radiology explains pain.

YET: Australian Medical guidelines say X-rays or scans should, only, be used to eliminate more serious causes of pain, such as a fracture not to diagnose joint and muscle pain.There is no reliable evidence that torn cartilage, or damaged ligaments and tendons, narrowed or slipped discs or ‘worn out’ bones seen on radiology cause pains nor can be treated, so why search them out? 

 *X-rays and scans help  work out the best treatment.    X-rays help detect and guide treatment for fractures YET: Once healed, x-rays do not guide treatment or explain ongoing pain. Within three to six weeks after early healing has commenced  the problem is not the fracture but the reaction to the  injury. Treatment should then focus on these reactions. It should  ease pain, recover full movement and strength and regain (or gain balance) and deal with the triggers for current pain. 

* Any new   or different or sharp pain is a new injury/problem.

YET: Every time the brain experiences sprains and strains, (muscle and joint pain),  it changes and intensifies how it next experiences them. Because there are so many ways to endanger the body, the system constantly adapts and learns to be more proactive to prevent injury. Old pain spots become the early canaries in the cage reminding the consciousness either to move more or move less. If ignored they either intensify the warnings or start an ache. Memory systems are involved. Pain is different  every time it is experienced even within the  same person. This is  completely different to   sight or hearing or even skin pain.   These don’t change no matter how often the same thing is seen or heard. 

*Joint and muscle pain is like touch or skin pain: a message to the brain revealing what and where the problem is. 

YET: Skin and muscle pain are entirely different. Skin pain helps us to locate and protect damage  by telling us to remove a splinter or get away form the fire. In contrast muscle and joint pain  changes behaviours    to protect and heal limb/spines because we can't or won't do this ourselves.    We would grind our bodies to dust if pain did not stop us.

Where and how we feel pain in joints and muscles   is not a  guide as to what is going on. The body 'ups' its alarm system (pain) and turns on its  brakes  (stiffness)  if     pain is  ignored. It sensitizes  muscles,joints and skin so that they hurt more easily. This a normal feature of its protective and healing system.   

 * Pain starts  in joints and joint structures such as ligaments and discs.    This appears logical:  joints 'feel' stiff,  inflammation settles in and around joints, and joint/spine  surgery can help  severe pain.

YET: despite millions of dollars spent on research  there is no evidence to  prove this theory. Radiology experts have been saying  for years that what is seen on x-rays in  joints has  no bearing on  joint pain. Instead:  it appears  that long overlooked muscles around joints  can create the  perception of joint pain   when they contract,  as part of a  neuroplastic sensitisation process. If the body starts to act as if there is an injury so creates joint inflammation.  This secondary effect must also be dealt with.

* Pain is all in the head/mind or psychological.   The term ‘in the head/mind’ is technically right:  any perception, such as  the colour blue, or angina or asthma, or the sight of a snake , is ‘in the head.’ But this does not mean they are imagined.   There is no evidence that pain   is caused by  a psychological or emotional  or psychosomatic problem.It is a real physical response the same as feeling angina.

* Rest helps pain.  Many drop out of sport due to an injury,  rest it up to let it 'heal'  then  go back to play  only to have it re-injure.

YET Because there is usually nothing to heal: rest  can lock in the problem.  Instead: ease back then build up.

* ‘No pain no gain’.  YET: Pushing through some forms of pain and ignoring its message is unhelpful.  If it hurts to sit (or stand) for hours, or descend stairs  then these  should be avoided until  full  strength and endurance to stillness is retrained.  I will explain which pain should be pushed through and which shouldn’t and why   in more detail later.

* Pinched or irritated nerves cause neuropathic pain:  This popular theory   is also unproven.   Nerves   transmit    nociceptive (risk) signals that can result in pain. Nerves get better at their job with practice but they don’t produce pain.   A pinched or blocked  nerve stops transmitting pain and other messages.   Saying that blocked nerves create  more pain messages is like saying a broken phone  wire creates more telephone calls.

* Pain is inevitable with age.  As in: ‘I’m getting old this is to be expected.’    YET: The good news is that occurrences of sharp pain probably peaks between 20-40. That is: if   we ‘listen’ to our bodies, do the hard yards, exercise properly and apply common sense principles there should be less pain with age (see blog) 

* Things wear out with use. YET: the reverse is true. Use it or lose it.  Joints wear in not out. Studies  show that    walking  and   weight bearing exercise makes   joints healthier with age. Joints wear in not out and how they wear in depends on how they are used. Used them at odd angles (for example wearing ill fitting shoes or slumping) they will change. This doesn’t cause pain but eventually the muscles that support and stabilize bones and joints can’t work properly at odd angles and this causes pain.

* Every type of pain is unique  depending on how or  which tissue it originates from. This is  a yes and a no. Every type of pain/weakness  should be treated with an individualized rehabilitation program.

YET: the research is telling us that there are far more commonalities in joint and muscle pain, (and with their treatments), than differences.  Current research silos researched according to where pan is felt not why pain is felt . This is why joint and muscle pain is such a huge problem and the science and research is so far behind all other forms of medicine.