The art, practice and science of Feldenkrais®
Director: Robert J. Burgess BEd, PT, PhD, Feldenkrais Practitioner

the behaviour of pain



  1. introduction
  2. no pain no gain
  3. the behaviour of pain
  4. exercise that hurts
  5. pain, diagnosis and pathology
  6. pain after exercise….good and bad pain
  7. the chronology of chronic pain
  8. changing pain
  9. don't run away
  10. rejoice, acknowledge and celebrate
  11. vigorous exercise- from pain to pleasure
  12. stiffness and pain
  13. body mind issues
  14. a word about Feldenkrais
  15. my own pain
  16. summary
  17. responses

1. introduction

Chronic pain is not a thing to be cured but a difficulty to be resolved by process. What follows here is not a scientific or medical definition of pain. What follows is a description of the behaviour of chronic pain as it may present and change during the course of time and during the course of recovery. The presentation and behaviour of pain may lead to a diagnosis but there is also much that can be learnt and used to describe and provide information about progress and status in your process to be out of chronic pain.
The area, severity and type of pain tell a story. The behaviour of pain over time provides clues to progress. Attitude to pain and response to pain affect pain preservation versus recovery from pain. Does the presence of pain mean that there is something wrong or perhaps that you are doing something wrong? Chronic pain changes from week to week and month to month- what does this mean and how can you use this information? What about new pain and treatment pain? So much is available to you to describe and provide information for progress and about progress from the presentation and behaviour of pain. What follows is a description of a formalisation in written words what I have observed and explored with clients in their progress and process with chronic musculoskeletal pain.

The chronic pain presented here is pain from muscles and joints or other soft tissues that have developed spontaneously or from an injury without full recovery or ever worsening status. Pain has been present for some time (at least 3 to 6 months) and has been unresponsive or minimally responsive to medical treatment. A diagnosis is clearly formulated from medical attention or at least a formal non diagnosis has been reached, ie the doctors don’t know what it is. Examples include chronic back pain, knee pain, shoulder pain. All the kinds of chronic muscle and joint aches you seek attention for from doctors, physical therapists, chiropractors and the like. The pain may be minimally or maximally impacting your life. You may even have had surgery. All treatments to date may have failed or made you worse. The presentation and behaviour of pains you are continuing to suffer may be described below and possibly, you may make some sense of the following and find some aid to better understanding and management of your problem.

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2. no pain no gain


Well maybe not. There is a time to push and there is a time to take it easy. I recall one client with chronic back pain who loved to swim. She would begin swimming, push through her initial pain and then continue to finish her laps. She then suffered for 2 days with an extreme exacerbation of her pain and even though this occurred every time she swam, she never put two and two together. She never made the connection between her swimming and pushing through the pain to her suffering. Even when I suggested there may be a link between pushing through her pain and the after affects she could not believe it could be possible. One of the greatest hurdles is to observe and process your own attitudes and bodily responses. This was an extreme case of misuse and doing too much. Most people do too little. Many stop doing everything until the pain has gone or they have seen a professional. Total rest. Not uncommon medical advice. Each represents the extreme end of the scale of exercising when in pain. Too much, too little and too cautious.

-doing too much
The swimmer needed to not push through the pain. She was not attuned to listening to her body. She only listened to her head saying I must swim my laps. She was trying to train when she needed to take it easy and stay within what was comfortable. Swim a length rest. Swim a length rest. If it hurts slow down, do less, re-arrange. Am I sore? Can I do more? Am I tiring? Is the pain becoming worse? Always sensing your response and status and never blindly pushing to an imposed number of repetitions or time. If you are exercising and pain becomes more constant, stop. This is a big sign to quit for now and try later. To exercise, ignore or push through pain is mostly bad. You will pay for it. You will pay the next day and you will pay in the long term recovery potential. If you have a little pain and suffer only minor pain for 30 minutes to half a day then maybe this is tolerable. Of course the ideal response to exercise is too feel good, not to feel pain. Right? Who wants to have pain? If you exercise and suffer extreme pain for one to two days then this is bad. You are contributing to worsening your problem. Your attitude to push and be in pain is reinforced and your process away from pain has been given a blow. Do less and soon you will be back doing more than before with no pain. Simple. Listen to your body. Begin to trust your sense of what feels right or wrong. Experiment. Get it wrong and adjust. Don’t blindly push because of an attitude (your or what someone told you to do). Try and fail. Try and succeed. Become your own expert.
There is another category of doing too much that relates to exercising generally. Athletes can do too much. One of the errors when you feel good, feel strong and powerful is too do too much. You will be sore and flat and drained the next day. Even if you have no pain syndrome to begin with. Feeling good is great, enjoy it, don’t abuse it.

-doing too little
Total rest. Quit all exercising until the pain is gone. NO. NO. NO. Definitely not. For most musculoskeketal pains it is better to find a way to keep doing everything in small comfortable doses. Again to push and do everything is bad. To stop everything is also bad. Do a little of everything especially as the pain does ease. Research on recovery following back pain has shown that people recover quicker and return to full work sooner if they continue to go to work in what ever limited capacity they can manage as soon as possible. Complete bed rest for three days delays the recovery and return to normal work load. Five days of complete rest delays recovery even more. Again it is not to blindly push and it is not to completely rest. Rest is not total but controlled limited activity. Find out what you can do and keep going, keep moving. The judgement for what and how much is the immediate and delayed response. If it is easy it is OK. A little pain is OK. Adjust. Stop if it hurts. Try again. If the pain is worsening and you can’t bear it, go home, lie down. Do a little more if you feel OK, but beware of doing too much when you feel good. It is like the swimmer pushing through pain and actually into pain. Sure if you have a serious injury then pathology definitely determines some of what you can and can’t do. But again this will be tempered by how it feels. If you are straining or in pain you are hurting yourself. Sometimes in the clinic we push people. More later.

-waiting for advice
Other times people will not start anything until they have the go ahead from a professional. They stop all activity for fear of messing things up. Usually these people are more than ready to get going moving and exercising. Given the go ahead with some good guidelines they do fine. In fact once they start to exercise and return normal activities their pain improves immeasurably. Perhaps it is a sound methodology to wait for professional advice but you don’t have to wait. You can begin some small things on your own. Trust and experiment with your own sense of what is right. But make sure you do obtain professional consultation.
-waiting for all the pain to go
You can’t wait for all the pain to go away before a return to activity. It does not work that way. An amount of your recovery and resolution of pain results from a return to your activities of life and recreation. It can and does happen that way but mostly it is not a cut and dry difference between being in pain and doing nothing and not being in pain and doing everything. Recovery is a process. A big part of recovery and treatment is the process of a gradual return to activity. There are exercises and there is exercising at the clinic and at the home. There are specific exercises you may be shown to do at the clinic or home by a professional and then is general exercising to do. Walking, riding a bike, swimming or a return to your recreational activity in some modified way.
This is especially true for chronic pain. Because you developed chronic pain partly by closing doors and ceasing to exercise and limiting your full participation in life’s activities, the process of recovery necessarily requires a return to exercising to end pain.
Don’t wait. One extreme example often seen in medical clinics is when there is imposed rest for some period of time. After a fracture when a limb is placed in a plaster or a serious ligament strain and the person is told to rest completely for two weeks and then see their doctor if pain persists. At one end of a spectrum of behaviour, one person in this state does absolutely nothing and in fact almost ignores the injured part all together. There is a mental neglect. The other person moves around and in the plaster and the imposed rest. Nothing extreme just little movements. They find ways to be doing everything in life, so once the plaster is off or the imposed rest has ceased they are more than ready to go. The muscles work instantly and joint range of motion returns easily and they return to full function very quickly. The other person with the exact same problem comes out of the plaster and the foot looks like it has been in the plaster for 100 years. The person has no ability to contract their muscles or move their joints. And there is pain. There is much more work to be done to get this person back to full function. Instead of 2 to 4 weeks it may be 2 to 4 months. Worse, if this state is not well attended and the person continues to neglect and give in to the difficulty of getting moving and over coming pain they regress. Yes they get worse. More pain and more inability to move. The worse case scenario is they develop what is called RSD- Reflex Sympathetic Dystrophy. Very bad. Don’t allow this to happen. But it just like the process of developing chronic pain. An amount of pain and difficulty cause you to give up, to stop moving or trying. Closing doors.

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3. the behaviour of pain


The type and area and behavior of pain tells a story. Constant pain is worse than sharp pain present only on movement. A large area of pain is worse than small area. Left sided pain is usually worse than right sided pain. More central pain is better than peripheral pain. Medial knee pain is better than lateral knee pain. Medial ankle pain is worse than lateral ankle pain. Pain on the very top of the shoulder is easier to treat than pain to the front or side of the shoulder. Pain to the side of the trunk is better than pain close to the spine.
There are several ways to gauge the level of pain that a person is suffering. A common simple method of scoring pain is the pain scale. People are asked to quantify their pain on a scale from one to ten. Ten being the worst possible pain and zero no pain. As well as using the zero to ten pain scale for how severe the pain might be, constant pain versus intermittent pain is another scale for pain. Constant pain, for me, is at the worst end of the “nastiness of pain” spectrum. Intermittent pain is less nasty. Obviously, the two scales overlap and correlate. That is a ten on the pain scale may well be a constant. A one on the pain scale is not usually a constant pain though it can be. A constant mild dull ache does occur. I use several scales and defining factors to gain an assessment of the “nastiness of pain”. By nasty I mean how bad is the pain, how much does it affect and limit your life and how difficult will it be to take away pain. A constant shoulder pain that a person scores as a ten out of ten that wakes a person during the night and does not allow them to sleep and limits all activities during the day, is a nasty pain. The person with a score of ten for shoulder pain after the do a day’s work has less nasty pain even though they both scored a ten. There are questionnaires used in research to estimate the pain and level of function of a person with chronic pain.

From my training in Australian Physiotherapy there is a way of defining pain for determining how much treatment you could do in a session with a person in pain. It is called “irritability of pain”. As well as its intended use, I find that this definition for pain behaviour correlates well with the potential for recovery, ie how long it will take, how much recovery is possible and how difficult the process will be. There are three questions for determining irritability:
1. How much activity to cause pain?
2. How much pain is produced?
3. How long does the pain last?

So the person who walks for 10 yards (how much activity to cause pain) and has extreme pain (how much pain) that lasts for 5 days (how long does the pain last), has a very high irritability and will likely take some considerable work to recover and may have limited potential for complete recovery in one period. Even the best and most appropriate treatment and management will take time and evolve through several stages of recovery. The person who runs 10 miles and has a mild soreness for half a day has low irritability and will have a better chance of full recovery provided the right treatment can be found to deal with the problem. The irritability scale is a most useful scale for determining chronic pain recovery potential. Is your pain irritable or non irritable? If your pain is highly irritable then you can not expect too of anything you try alone or with your therapist/practitioner. If you have low irritability and your are not getting anywhere, then you made need to try an alternative approach.
The process of easing constant pain will involve a lessening of the amount of pain though still constant. It will also involve the person being able to do more for the same pain. A shift will occur from constant to intermittent pain. A shift will occur in the behaviour and area of the pain. Finally, it may just be a feeling of stiffness. This kind of process for recovery from a constant chronic pain is very common. Hence it is useful to know that this may occur for whatever reason. I have my theories but for now is important to be able to qualify where you are at along the scale of nastiness of pain and what you can expect your process to be. Whatever your diagnosis the behaviour and nastiness of pain is a major determining factor in your process of recovery. Two people with the exact same diagnosis can have completely different recovery processes.

Pain that can’t be palpated and reproduced is easier to affect than pain that can reproduced. So if your therapist can’t find and reproduce your pain your are in a better state than if he can. You are more likely to recover quicker, if the right treatment can be found.
Pain on the left side of the body is more difficult than pain on the right. Pain that shifts from left to right because of your treatment process is usually a good sign. You are coming down on the nastiness of pain scale and up on the ability to function normally scale. Pain shifting to the left may well mean than the system is shifting into a worse state.

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4. exercise that hurts

One of the best exercises is the one that hurts. One of the worst things to do is stop an exercise that hurts. Huh??
Let me explain. If an exercise hurts, stop, of course. But don’t never do it again. The exact same exercise that hurts is your way out of pain. Master the exercise, find a way to do it without pain and you have success. Then there is one more thing in life that you can do that does not hurt. This is the process of recovery from chronic pain. You don’t fix chronic pain you learn how to move to avoid it.

If an exercise hurts then stop, briefly at least. Start again slower and smaller and find a way to do the exercise without pain. Do half the motion. Do the reverse motion. Go slowly. Change the orientation. Do it in another position. Find a similar easier exercise. Two things can happen. One, you suddenly are able to do the exercise easier an without pain. Rejoice and celebrate in your power to help yourself to greater function. Two, it may still be painful. Leave it for now. Find something else to work but don’t give up on exercise all together or your therapist. Most exercises are not bad; it is just how you’re doing them. Remember, pain can be approached as a consequence of function. Learn to move easier and better and the pain goes. Become your own champion in dealing with your problem. Problem solve, experiment, be your own therapist and utilise your professional as a consultant.

To stop the exercise and never do it again closes doors. This is the process for worsening chronic pain. Yes this is our most chronic pain ever gets to be chronic. People stop doing things because it hurts, whether it was an exercise the therapist showed them or tying shoe laces. Gradually more and more tasks become impossible so eventually everything hurts and you can do nothing. So at the same time that pain is bad and you want to avoid pain in exercise, you also want to meet the challenge of an exercise that hurts and master it.
Pain is a funny thing. We are conditioned in our thinking by pain and our medicine. In musculoskeletal pain syndromes most often the part that hurts is not the problem.

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5. pain, diagnosis and pathology

In medicine we diagnose. We need to know what the problem is. What is causing the pain? What is wrong? This is a powerful, appropriate and well established model for dealing for musculoskeletal pain, including chronic musculoskeletal pain. Yet, chronic musculoskeletal pain exists as chronic because our medical model can’t solve it! You need this model and must utilise this model but it has limitations to resolving your problem. In the Feldenkrais model and what could also called the movement diagnosis model, the question is what am I doing wrong? What can I do differently to lessen effort and pain. Chronic pain may be a pain you’re developed from injury or damage but it continues to exist because there is something you do to maintain it or even created it in the first place. The two models, of what is wrong and what am I doing wrong are totally compatible and parallel. It is not alternative medicine. It is more of the same picture.
Both worlds are valid and I use both simultaneously all the time. So someone has a torn rotator cuff muscle in the shoulder and sure they need treatment to the injured structure. Sure they need strengthening. But they also need ways to improve how the shoulder is functioning in the system. Improving arm and trunk coordination can ease strain at the shoulder. This takes pressure off the structure allows better healing and contributes potently to prevention of chronicity or recurrence, far greater than just local management ever can alone. There is always something in the way the arm and trunk are being used, organised or coordinated that can be improved to ease the effort and strain in moving. Baseballers don’t pitch with their shoulder, they use all of their body including legs and trunk and arms to project the ball. Up to 50% of ball speed comes from the leg and trunk action. There is a linkage and interaction between the two models. They are no mutually exclusive but mutually inclusive. At times more emphasis and awareness of the pathology is required, at other times with pathology understood, movement issues are primary.

The focus in medicine at times is tunnelled and ignores some obvious functional aspects of human movement. We in medicine are yet to be formally exposed through research to this movement diagnosis and the movement learning Feldenkrais model for management of chronic musculoskeletal pain.
Currently in orthopaedic medicine we try to directly affect the pain and pathology. There is only one thing wrong with the pain and pathology model, we use it as the only determinant for assessment and treatment. There is nothing wrong with the pain and pathology model, it just needs us to include normal human movement- the entire musculo-skeletal system organized by the CNS. Re-organize, re-construct, re-coordinate movement and learn to move with greater awareness and ease and pain disappears. It is only by experience I make these declarations, however, the concept motor learning is not new, it has never been applied to affect function and pain in orthopaedic medicine.
It is not possible to completely rehabilitate without some functional aspects being attended to. Many musculoskeletal problems, in fact, can be managed well with a mostly functional approach. Changing movement patterns, restoring coordinated smooth action, choreographing skeletal and muscular use for ease all improve function and appease pain syndromes. Pain is secondary to function as well as the result of pathology for most musculoskeletal problems. When some has suspected rotator cuff strain and pain disappears because the person learnt to coordinate their arm and trunk better, it becomes easier to accept this functional model. Improve function and pain goes as a consequence. Even with significant pathology, learning to move well takes the strain away from the painful area appeases the pathology and minimizes pain.

You don’t always need to know what the pain is. Don’t try to diagnose or be diagnosed for every little pain that your chronic syndrome presents with. This is chasing pain and ensuring the preservation and continued chronicity of your pain. Again have the two baskets or parallel columns of information and process- let the medical diagnosis model stand along side your movement diagnosis model. New pain means what? What is wrong or what am I doing wrong? Who do I go see to find out what is wrong or what do I do different to ease pain? This is especially true if your are in a program and improving. Trust the process your are in and expect process or changing pain.

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6. pain after exercise.....good and bad pain

If you exercise and push and pain develops that later becomes intense then you have done too much. This is bad pain.
Sometime you may not have pushed and may not have felt pain but still there is pain later. Sometimes this can be good pain. Doing something new. Using your muscles and bones in a new way can be new to the system. Not only that but the new experience also may challenge the resting tone and length and posture of muscles. A body experiencing chronic pain has a set tone, length and posture to muscles. The new experience may then ask the muscles to change their resting tone, length, posture. This can be painful. Some muscles associated with chronic pain are shortened some are lengthened. The shortened muscles are holding on to an image of stance and function that is excessive in tone. They don’t need to be that short but have become that way at rest and during function.
Requiring an habitually shortened muscle to lengthen at rest and change it regular behaviour during movement can be a painful adjustment. The old habit says stay short the new experience says it is OK to be longer. The conflict and the lengthening can be painful. Continued experiences that encourage a lengthened posture allow the muscle to adopt the new length. Associated pain will change. The body has a new organization and easier less stressful attitude. The pain associated with this process is good pain.

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7. the chronology of chronic pain

Changing chronic musculoskeletal pain is a process not a thing.
The premise for the origin and development of chronic pain will set an image for therapy. If you look at a chronic pain like an old car in need of renovation then you can immediately see a course for progress. Step by step in a particular order the car is repaired and ready for use. At any stage there will still be a need for further renovation and only a partial function. Another analogy is the Archaeological concept. At one time a city or object is above ground. The course of time may bury this structure with layer upon layer of earth. Over time these layers compress, deform, become stone and hide and cover what lay beneath. A return to full exposure of the city or objects necessarily follows a reverse chronology. Layers of earth are removed exposing the different times and status of exposure or un-exposure.
In the same way a car may gradually decline and become in need of renovation, a person may develop chronic pain. And in the same way an object become buried and lost beneath the earth so does decreasing function and chronic pain develop. Many people with chronic pain have seen their pain change over the years. And gradually with the changing pain and years their function too has changed.
Particularly, I see a clear expression of this with people with RSI. Repetitive strain injury. Somewhere in the beginning it begin as fatigue. Then more fatigue then some pain then more pain. Then instead of just the fingers it went into the wrist and forearm.
Then it moved to the shoulder and neck. Once upon a time they could work for several hours before needing rest because of fatigue. Then it becomes five minutes before bringing on pain that lasts for the rest of the day. Then they went to the doctor! This kind of process is 6 to 24 months. There is no medicine on this earth nor will there ever be that allows this person a magic overnight fix and back to full work.

The process of worsening function and increasing pain requires a tool to reverse the status. People who begin to attend to their body and learn better function begin to have less pain and can do more. Many times I have observed that the course of improvement follows a chronological reversal of how they got here in the first place. Hence one day, typically a person with improving function and pain from a chronic problem come in and say
“what have you done to me, the pain is just the same as when it first began!”
“I smile” and hail “hallelujah”. So you are back where you started. This is a good thing.
People are often surprised and dismayed at their progress back to where they started, but that is just where they are at, where it first started. Next is beyond this state and a return to where there was no pain.

So progression may mean new or even old pain becoming apparent for a period of time. This is usually a good sign. Good pain is distinguishable because of the evidence surrounding it of less severity of pain, less disabling pain, able to do more and move better. This new pain is then good pain. Process pain. This is to be rejoiced, celebrated and acknowledged for the best effect and to ensure that the next stage for improvement is ready to take place.

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8. changing pain

Pain changes. Be aware of that. Alas pain does not always totally magically and completely disappear. Sometimes but not always. Most often there is a process. Pain changes in its severity, area and behaviour before it finally disappears all together. New pain or a new area of pain or new behaviour of pain does not mean your pain is getting worse. If you have less pain, can move better and do more then it is just a part of your process. You are actually getting better.
The classic well documented example is the centralization of back pain. Typically a person who has low back and leg pain will find that the pain radiates less down the leg. Gradually it radiates less and less down the leg and becomes only back pain. In this state the person will be more comfortable and be able to do more.
For example, also, in my experience, another kind of centralization or lesser pain. A person with low back pain may begin to improve and have less pain, move better and do more in life. The exercises are easier. This person may then present, to their extreme dismay, with thoracic or scapula pain. “What have you done to me?” “I now hurt in my upper back”. “Your treatment is making me worse”. “The exercises are causing a new problem”. No, no and no. Let me explain.

As you exercise and improve your function, the back, the whole back is moving better. You have increased your level of skill and control of the your spine. But this leads you to the next level. It is often that low back pain has accompanying stiffness in the thorax. In fact the stiffness in the thorax increases the stresses on the low back contributing the painful syndrome in the first place. As a spine begins to function better and a stiff thorax is loosened there can be pain in that area. These muscles and joints that have not been moving but are being asked to move. This can be painful. Why? When the low back was hurting the thorax was stiff and unchallenged. Muscle and joints were being held and shortened. The letting go of this habit of holding can be painful. From being chronically shortened and doing one thing, holding on, there is now the task of being able to shorten and lengthen and move in more ways. Not easy to drop the holding. Think of lowering a heavy object down onto a table. There can be effort and even pain in the arm muscles. I only imagine it to be something like that.

The new pain will be less nasty, it will be sharper and smaller, it will be momentary rather than constant and it will be less disrupting to life. This is good pain in the sense that it represents a shift to a better organization of the spine.

The archaeology concept for chronic and motor control is useful. A city or object is buried deeper and deeper as the years go by. To find the city or object there is digging through different layers of earth to finally reach the goal. It is the same here. Low back pain does not happen as one thing. It can be a process of stiffening in the spine that eventually leads to pain. The return to normal pain free function involves a process.

In this function model, pain is a consequence of function. It is a thing you are doing wrong rather that what is wrong. Sliding down the scale of function correlates to increasing nastiness of pain. Improving function back towards normal involves different potential pain at each stage of recovery according to how the system is working. The task is to remember pain and function go hand in hand either way round the circle.

So frequently, as I work with someone with a chronic pain problem and they begin to make real changes the pain will shift and function will change. Changing pain is good pain. The factors to identify is that the new pain is less nasty, you are moving better, have less pain and can do more. Persist and you feel be freer still.
Changing pain is good pain.

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9. don't run away

Changing pain can be scary. New movement , new organization, less pain, more ability to do and a new pain can all be too much. Be warned that success in your process can present this way. To be warned and prepared is most relieving.
“You said it would happen and it did”. “It is concerning but I trust and have faith”.
With changing pain many people will stop the exercise and even desist with their therapist and run away to their doctor stating he made me worse. Bad choice. Maybe the therapy is just too painful and too rough. Sure desist and find someone else. But if it changing pain for the better, find a way to persist. Talk with your therapist.

So if there is new pain there are several options to cause and action. Maybe it is changing pain and you become a little scared you may feel a need to run away. Maybe this is changing pain and good and you need to persist. Maybe you are not ready for the changes that are occurring or maybe it is going too fast. Maybe you need to stay in pain. Maybe the current therapy is not for you.
Talk to your therapist and decide a course of action. Avoid running away. Avoid running to your doctor first, run to your therapist first, then decide if you still need to consult your doctor.
Changing pain can be too much. Run away if need be but you will need to return one day. Try to find a way to stay in the process.

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10. rejoice, acknowledge and celebrate

Any little improvement is to be rejoiced, celebrated and acknowledged. Just like a little kid with school work or learning a task or sport, acknowledgement is a powerful reinforcement to continue. In the face of progress to remind yourself that there is still pain and you can’t do so and so is negative behaviour and ensures limited or no progress. The next stage for progress will be inhibited and slowed.

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11. vigorous exercise- from pain to pleasure

Usually the last third or last 25% of your recovery from a chronically painful condition is dependent on a more full return to exercise and normal activities. There is no cure that resolves the pain 100% and then you return to life. You return to life to complete the recovery process. In fact if treatment is used to gain the last 10-20% of full recovery from chronic pain, the treatment process may in fact contribute to maintaining a chronic problem.
In this case late in the process it may be necessary to push with more vigorous exercise. There is no pain just the fear of pain. Now it is good to push, to exercise hard and feel your body being strong and capable. It is time to realise that there is no pain, no limitation. Now is the final stage of going beyond the fear and memory of pain and returning to normal functioning in life. Remind yourself and the nervous system of pleasure and not pain. This is of course different for each individual and exercise level.

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12. stiffness and pain

Stiffness is better than pain. Often the final stage of a painful syndrome is a period of stiffness without pain. Very common. There are several aspects of stiffness to be aware of on relation to pain. First, a little about the concept of stiffness. The prevailing image of stiffness is usually scar tissue of some sort in a joint or muscle that needs to be stretched. A structural image of stiffness. In biomechanics and neuroscience, systems defined as being organised with an amount of stiffness or impedance. Like in electronics there is current and impedance. Current is the flow of electricity and impedance is a measure of the resistance of a structure to current. All structures have an amount of impedance, some more than others. Copper has low impedance. Resistors resist the flow of current. Capacitors store electricity and have high impedance.

So to in biomechanical structures the system functions with some amount of impedance or resistance or stiffness. The action of muscles contracting and moving a joint involves some amount of impedance or stiffness. When people have a stroke muscles tense more creating more impedance to movement. The amount of impedance and hence the amount of ease to a movement is controlled by the nervous system.

In chronic pain there is often stiffness of this kind. Impedance or resistance to movement because of tense habits of motor control. This is primary and precedes and determines structural stiffness. If a person tenses or holds one part of themselves during movement, eg raising the shoulders when using the arms, resistance is created around the shoulders and upper back. Chronic holding or impedance will feel like a true structural stiffness and in time may even be structurally stiff. The joint being used fully develops contractures in the soft tissues surrounding the joint. Stretches for muscles and joints are a commonly method for reducing stiffness in these joints. Input to the nervous system to reduce tension and therefore impedance can also affect stiffness.

This is why massage works. It reduces muscle tone. Learning greater skill also will lower the amount of effort and impedance to movement. So there are at least two, possibilities for affecting stiffness.

Stretching or reducing impedance. Stretching for chronic pain has limitations. Input for the nervous system through exercises for learning and awareness of how things move is a major process for reducing impedance, ie Feldenkrais.

How many people with chronic pain experience difficult with movement not just because of pain but because of heaviness, fatigue, effort?. The heaviness to movement of a limb is related to impedance and coordination between the limb and trunk. Another word about stiffness.

Sitting. Sitting on chairs is an unavoidable modern man habit. Nature or God did not determine for this system to sit. Whatever, sitting for long periods is like silt settling in a quiet lake. First silt, then mud, then clay and finally stone. All of these images for the kind of stiffness or impedance (ie both functional and structural) that is possible in the motor system are useful approximations for the variety, amount and difficulty for changing the kind of stiffness.

Pain associated with stone like stiffness is tough stuff. Pain associated with silt like stiffness occurs with acute injuries. Very easily and simply affected. Stiffness of the stone nature will follow a process through clay and mud and silt to become fluid again. It will be slow and very tough initially and gradually progressively easier. Pain along the way will change appropriately. It is possible to have very small almost imperceptible stiffness that is stone like that will have the nastiness associated pain. Still there is stiffness and still there is a need for mobility and learning around that holding.

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13. body mind issues

If you have read all the way to this point then it is clear that the chronic musculoskeletal pain your are suffering from is not a thing to be cured by medicine by a difficulty for you to on and work with. Your attitudes and beliefs about pain will have been challenged. You may even begin to see that there is something you are doing to cause or maintain pain. One of the simplest and extreme examples is the person who has shoulder pain and they demonstrate how and where they have pain when moving the shoulder. So for example they may raise their to the side to a point where it hurts, they cringe and crumble with the pain. Unfortunately for them this is the one and only movement they ever perform- the painful one. They don’t gently raise the shoulder part way or in other directions. They raise it straight to the point where it hurts and push. It is like having bruise and hitting it continually with hammer to then say;
“See I have a bruise and it just won’t go away, it is always there no matter what I do”.
But all they ever do is hit it with a hammer.
The swimmer from page one could merely swim a little to find soon that her swimming would take away her pain.

A similar person, usually a man does exercises but treats movement and his body like a wrench that he torques. Using a wrench usually requires tightening a nut on thread to a specified torque to make sure the nuts stay in place. This is not a good image for exercise. Imagine always and only taking a movement to the end of range and pushing and holding it there and tightening it up like a wrench on nut and bolt. This does not transfer to use in life. Better to practice running the nut up and down the thread and feeling the full range of motion including perhaps some torque at the end.

Attitude towards movement affects function.

A classic example is men. Men in industry. Big men. Men who identify themselves as strong and need to do strong things. They lift heavy things as a show of strength. Usually they take a deep breath stiffen their chest and lift things that are too heavy. The stiffening chest makes the trunk rigid and brittle. One day they develop back pain and it gets worse and they can’t do what provides identity for them. This is depressing to them.
You can’t do what you can’t do. Don’t try to do what you can’t do. You can’t go back to doing exactly what it was in exactly the same way that caused the problem in the first place.

Time to learn different expectations of your body and yourself. Maybe a new job all together is what is required rather than a modification of the old. Maybe learning and lifting technique can be enough. Or maybe a little of all those things. I recall a man in his early sixties who had washed trains as employment for 25 years. He developed chronic low back pain that prevented him from doing his work. He was proud and loved trains. His employer was smart (a rare thing generally). They gave him a clip board and made him inspect other people washing the trains.

I am always amazed at the mother with two young children by her side and clearly in the late stages of pregnancy that I see in the supermarket at the check out with a shopping cart full of groceries and two screaming kids to accommodate. She does it with ease and smile. Totally amazing. The same or similar person presents to the clinic with a chronic low back pain. One story and possible description for the pain is that this person has no self time. They are all family. There is no free time, no exercise time and little adult time. Both mums and dads suffer this cause of back pain. The process of recovery can be merely attending for some attention. The process of recovery can be a return to self time and exercise time. There was nothing wrong. The attitude and determination to apply oneself to a task without self time can be a cause for pain.
These examples a small attempt to open a door to the relationship between body and mind and function and pain. Every motor act and intention in life carries an particular coordination of the skeleton and an attitude. Be available to and listen to body and yourself. It is not all in your head, but like a car you are driving that continually crashes you may need to adjust something in your driving.

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14. a word about Feldenkrais

Feldenkrais is not medical treatment. It is not Physical Therapy. It can be applied as a tool in medicine and PT. It is method of learning. It is way to gain awareness about yourself through movement. At a simple level you learn to move with greater ease and grace and ease pain and feel good. At a more complex level you gain access to, insight to and a process for learning about your psyche. It is a method for approaching greater potency in the world. A process to realise your potential.
It can be applied with tremendous success and power to the medical setting and particularly as a method for dealing with chronic musculoskeletal pain. Used in this way a person with chronic musculoskeletal pain may makes gains with pain and movement ability but you may also be introduced to ease and grace and learning of and from movement. You will learn to love and appreciate yourself a little more, you will move with ease and no pain and you will feel lighter and more powerful in the world.

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15. my own pain

One fine summer’s morning playing cricket on a favourite field near the sea in the South Australian country town of Whyalla I experienced my first ever episode of back pain. I was 15. I was bowling my fast medium paced swing and cuts when I suddenly felt pain in the right lower back. Mild but sharp enough to say that it was pain. I continued. But I recall being surprised and fearful. Perhaps more uncertain than fearful. I had never had back pain before and had no idea of what to expect nor what to do or what might happen. No great effects in the immediate days following the event and no further episodes for some time. None that I recall specifically but low back pain was to become a regular part of sporting life for twenty years.

I had some minor weekly pain during my twenties playing football. Again minor but worsening every year. Next I recall back pain in my second season of professional football. I was not going to play because of back pain however once selected in the A grade I was not telling anyone about my back pain. It was Adelaide Oval and I recall walking around the ground under the grandstand towards the rooms. My mood then was one of apprehension and uncertainty. The back pain seemed to take away some of the anxiety or expectation about playing in a big game. I was preoccupied with the thought of my back limiting my performance. But it did not. I played well enough without repercussions that I can recall.

Then 2 years later back to amateur league and my back pain continued to worsen each year until I could hardly walk for several days after a game and I was missing a game to play the next game. That is I played every second game for the last half of the season. It worked well because we had a rest week during the finals. I played my best ever finals game in a losing team. “Best on ground” with 5 goals and several sensational marks. But not good enough. Don’t remember back pain just disappointment and tears.
Soon I had pain down my leg and numbness in my big toe. Numbness in the big toe whilst not limiting functionally was very scary. On the way to surgery. Nothing helped much. A heel raise, a chiropractic visit, physiotherapy and finally I invented my own stretches which helped the most until then. I did strong trunk rotational stretches in sitting. That helped the most. Why? I imagined because it was all connected. A stiff thorax made for more stress in the lumbar spine. I still believe this and I invented ways to stretch patients using a belt to hold them down and then twist their trunk. The initial concept of rotating a trunk on bench I doubt was mine. What I added was the direction of the stretch to be in the thorax and not low down in the lumbar spine.

But still pain. One day I heard myself complaining about the pain in my back. I heard myself complaining and said to myself I can’t do this anymore. I can’t get around all then time complaining about pain in my back. There had to be some way I could get on top of this problem. The constant complaining was constant complaining. So after that day I shut up and quietly went about the business of finding a solution without ever complaining about the pain again.

My wife, also a physiotherapist, in fact a paediatric physiotherapist, came home form a weekend conference where the there had been a presentation about the Feldenkrais Method. She simply said; “This stuff is for you”. Now she was and still is a woman of directness and clarity in her thoughts.

My first session of a Feldenkrais movement lesson from the book “Awareness Through Movement” by Moshe Feldenkrais produced the most dramatic change of all. Every lesson increased my function and took away pain.
What I learnt from my experience was; own your problem. As Feldenkrais said;
“The trouble in your body is your trouble”. So true. Whatever way your back became sore by injury or insidiously own it as if you created it. Own it as the primary choice for improvement like you would own your golf swing.

I learnt to be my own expert. I explored and followed my nose through several different therapies, stretches and back techniques. I became my own scientist and in the process using professional as consultants. I learnt that pain can become much worse. It can become much better. I learnt that pathology does not matter as much as function. A long argument for another time. Changing your back pain and musculoskeletal pain in general is a process and not a thing.

I still had little idea about the body-mind relationship. I was struck like a smack across the face the day I saw myself complaining about back pain. I heard myself complaining yet again. That had to stop. Do something about the problem, don’t just go on and on about it forever. There is no self potency in complaining. To become active your self about what’s needed is owning your problem. There is always success in this.

Over the years of learning more and more from Feldenkrais work, experimenting on myself and seeing hundreds of people with back pain I have learnt a method of approach for back pain and spinal conditions and pathology. There are some simple basics to changing pain and function that I use for myself and my clients/patients. Today, I feel I understand and have good control of my spine. It stiffens from time to time but I can basically do anything I like without pain. There is nothing I can’t do or will avoid doing for the life I lead and wish to lead. I can even play a little of the Australian Rules Football at age 46 with no pain. I am old, slow (so what’s new), I can’t play like I used, I don’t play weekly and I need to stay fit to compete without repercussions but I have no pain.

Well not all true. In the years 2000-2001 I was very determined in my intention to complete my PhD studies. I spent all day and all night and all weekend sitting at my desk typing away at the keys. A little stiff by the end of the day but no real pain; just stiffness pain. In March of 2001 after a solid 12-15 months of increased and determined study I played a game of football. Fine, a complete 4 times 20 minutes of football, no problem. After the game I had swim and a beer and then found that I could not rise from the chair in which I was seated without extreme pain and difficulty. I slept little that night and for the next week. It was excruciating to roll in bed and to get out of bed. I crawled to the bathroom through the night and went to work without socks for 2 days because I could not reach my feet. Even all the potent Feldenkrais exercises on the floor where only of minimal help. I was always able to lie down on the floor try a few varied movements and my back felt great. Not now. Even two full days at a Feldenkrais training impacted little on my pain and difficulty. I really had become de-conditioned, stiff and vulnerable to back pain. My official diagnosis for myself was a disc bulge/inflammation. Treatment helped but only a little. It was going to be a long process. I actually took some medication. I took an anti-inflammatory medication for several days. It seemed to help a little but I stopped it after 5 days. I think I was coping better and decided to go it alone. I took no time off instead I found a way to be at work and to do all that I could. I had a forward lean in the trunk and I moved slowly and cautiously but I fooled most people and managed somehow. It took 6 months to get back to my original level of flexibility and pain free function. The recovery was slow but steady. I was truly shocked at the onset and the progress. Me! A back pain expert of a sort completing a doctorate in physiotherapy with the topic of trunk motion and back pain and I suffer an extreme episode of low back pain. What a poor advertisement for myself but what an amazing learning opportunity again for me. I learnt that my lifestyle had again set up a state of vulnerability that brewed to a state of breaking point. The last straw on the camels back. I learnt again that back care/health/freedom/agility is not a thing but a process. I thought I would have been the last person to be so out of touch with myself and my body. I had pushed blindly and solidly and with great determination ignoring other needs. I don’t see it as a recurrence of pathology, I see it as a worsening of my physical conditioning and lack of attention to my body awareness and flexibility.

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16. summary

This is not the be all and end all of pain. I have presented no science. I prefer not to. I believe science is a little lost yet with chronic pain. The very best way out of chronic pain is learning, body awareness and exercise. Hence what I have presented are some notes for reference for your own process with your chronic pain issue. Nothing more or less. Take it or leave it. Remember there is much more than this brief description and many other experiences from other people.

My biggest hope is that one or two things in reading these pages will click for some of you and you will benefit from the learning.

Thanks and good luck.

robert burgess

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17. responses

Please make all replies to me by clicking here: robert@efeld.com

Feel free to offer your own individual experiences for presentation on this page.

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