Things Are Not Always As They Seem: Rethinking Pain And Why You Should Keep Training
Wow! A throwback. I wrote this in 2016 as a wee 24 year old. Nonetheless, figured it'd be exciting to re-share. Enjoy!
What better way to draw readers into my first blog than to hit you all with a super cliche title that appeals to the ancient wisdom given by the Greek philosopher Plato. Yes, one way to seem very, incredibly, ultra-master-guru smart is to quote someone who was mega smart 2400 years ago - When the Earth was still flat and togas were a fashion statement - Mission accomplished self, you are now on your way to philosophical super stardom.
While “woo-ish” in nature, there does seem to be some merit in this simple statement. Whether you’re talking about politics or giving a medical diagnosis, there is always complexity in simplicity. A professional athlete makes extraordinary tasks seem mundane; a good clinician makes a life saving diagnosis look attainable to anyone one with a keyboard and internet connection. Making the complex simple is a notable and highly sought attribute for people who are close to a mastery level of accomplishment.
Although, what happens when extreme complexity is bypassed in the name of simplicity? What happens when a community rallies around the most simplistic answers and clings on with the gusto of a true-believer? What happens when the underlying biological and chemical foundations are not understood within that life saving diagnosis? What happens when the athlete has her level of mastery attributed to simple talent and luck? These are dangerous missteps on the bumpy path to understanding how goals are accomplished. Simplicity without understanding the preexisting complexities of a subject is a dangerous walk on a very narrow tightrope.
To highlight an area where harm can be done from an overly simplistic viewpoint we should look at the trusty postural-structural-biomechanical model of injury and pain.
Yes, even in ‘The Sciences‘ simplicity can be dutifully disguised under the rouse of academic research and approved thesis’. Unfortunately bias can easily find its home within a community where critical and skeptical thought should be at the forefront (1). One can ponder that if you have devoted your whole life to pursuing and proving a particular hypothesis it would be very disheartening to see a lifetime of work become eroded by the unforgiving process of scientific correction, but that is not how science works. It does not care about your feelings, it only wants to see progress.
This model presumes that injury and pain often have primary contributors that stem from a biomechanical process. Your shoulder hurts because the soft muscle of the upper shoulder is impinged upon and being eroded away by the hard bony structures of the shoulder. A clinician may tell you that if you continue to move your shoulder in this way that your muscle will rupture and you will need surgery to reattach the muscle and shave away the bony structure, “You should never play water polo again if you want to avoid surgery”.
Another common example is the Pandora’s Box of low back pain. The biomechanical model will tell you that you may have a vertebrae that has “slipped” out of place and is applying pressure to your spinal cord. This can bring about catastrophic thoughts of a hard and jagged bony structure ripping into your spinal cord, “You have a herniated disk and should not mountain bike anymore”. Not fear though! A rupture of your spinal cord can only cause you to never walk again. With your central nervous system on high alert from the doom imposed upon you by your clinician and the images concocted in your head you forfeit the activities you love, but for the greater good…. Right?
With a preliminary hypothesis and blossoming supporting evidence for pursuing surgical interventions via the biomechanical model, you now have a new treatment and a new field of study; score one for science! Unfortunately as the years pass and human understanding of the body increases in complexity, the pre-existing viewpoint starts being eroded by the ebb and flow of scientific research.
Research starts showing that people with "slipped discs" on MRI’s just so happen to not have pain. In fact a large majority of people have a natural degeneration in the vertebrae of the spine ‘Spondylosis’ as shown on MRI , with zero detriments to their health. Also known as being asymptomatic. (2)(3) . With exercise therapy, shoulder muscle tears from impingement are successfully rehabilitated without being surgically reattached (4).
This is preposterous, the MRI shows that the muscle is gone or the disc herniated; how can there be function? Well it turns out that even though an MRI shows a structure is out of alignment or being impinged upon, the conclusion that pain is caused by the structure is woefully inept at explaining said pain (5).
In fact, as Lorimer Mosely points out, your back pain might be stemming from a neurological based theory called Central Sensitization that is contributed to not only by biomechanics, but psychological and sociological factors as well (6). The evidence hints that ultimately the brain and its complex physiological system of checks and balances is in charge. This points out that maybe we should be changing from the simplistic biomechanical model - MRI shows injury: Injury needs to be fixed - and instead adopting to the more complex biological-psychological-sociological model of injury and disease.
The bigger picture I am eluding to is that within life there are complex and multifaceted decisions you will need to make on a daily basis. It seems there is significant emphasis on my generation to follow our passions and to let simplistically visceral decisions guide our journeys.
“Follow your heart” is the mantra of my peers, and I would beg you to reconsider. Now that humans are in a time where we can pursue self development and not just survival, I implore you to instead: follow your brain. Thinking situations through from all angles, critical thinking, is a biological tool that separates us from our animal relatives and should not be taken for granted. A developed capacity to see a situation from all different angles will almost guarantee that you will always see things as they are, not just as they seem.
References:
1)http://retractionwatch.com/2015/10/13/much-of-preclinical-research-into-one-cancer-drug-is-flawed-says-report/
2)American Journal of Neuroradiology http://www.ajnr.org/content/36/4/811 Definition of terms – AJNR “Nomenclature and Classification of Lumbar Disc Pathology” http://www.asnr.org/spine_nomenclature/discussion.shtml
3)http://www.cpdo.net/Lederman_The_fall_of_the_postural-structural-biomechanical_model.pdf
4)1 – Arthroscopy to atraumatic degenerative tear of the rotator cuff http://www.ncbi.nlm.nih.gov/pubmed/26189808 http://www.ncbi.nlm.nih.gov/pubmed/24395315 2 – Arthroscopy for knee osteoarthritis and degenerative meniscal injury http://www.ncbi.nlm.nih.gov/pubmed/12110735?dopt=Abstract http://www.ncbi.nlm.nih.gov/pubmed/23506518 3 ACL Reconstruction for recreational athletes without risk sports http://www.nejm.org/doi/full/10.1056/NEJMoa0907797… 4- Arthrodesis for discogenic low back pain http://www.ncbi.nlm.nih.gov/pubmed/24346052 http://www.ncbi.nlm.nih.gov/pubmed/25467996 5- Arthroscopy for femuropatelar pain http://www.biomedcentral.com/1741-7015/5/38/abstract 6- Surgical decompression for lumbar degenerative stenosis http://www.ncbi.nlm.nih.gov/pubmed/25844995 7- Shoulder impact syndrome http://www.ncbi.nlm.nih.gov/pubmed/23989383 8- Chronic tendinopathy and acute Achilles tendon rupture http://www.ncbi.nlm.nih.gov/pubmed/23006143 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509775/ 9- Cervical radiculopathy: two years of follow-up http://www.ncbi.nlm.nih.gov/pubmed/23407407 http://www.ncbi.nlm.nih.gov/pubmed/23778373 10- Proximal humerus fracture: two years follow-up http://jama.jamanetwork.com/article.aspx?articleid=2190987
5) https://www.painscience.com/articles/structuralism.php
6)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750819/
