~ Understanding Mechanical Pain ~
by Major Jason Silvernail U.S. Army
Many people with pain like yours are frustrated. Your pain probably came from nowhere in particular, has stayed with you for far too long, and isn’t related to any major trauma. If you did have an injury, the pain has stayed much longer than the time it took you to heal. You may have had X-rays or tests that showed nothing was wrong, or showed just ordinary degeneration associated with aging on your scans and tests. The medications prescribed by your doctors may not help much, if they help at all. The care providers you may have seen before might have difficulty explaining to you exactly what’s wrong. You may have tried resting it but it doesn’t seem to help. Prolonged positions like sitting, standing, or driving might increase your pain. You might be stiff and extra sore in the morning. You may feel that you have to keep moving and fidgeting to stay comfortable. The area might feel stiff and tight even if you haven’t exercised it. If the pain is in your spine, you may feel stiffness and crunching sounds in your spinal joints. If many of these things sound familiar, you might have mechanical pain.
How Does Pain Work?
The pain you are experiencing is due to nerve tissue in your body sending your brain a signal. This signal is received and your brain makes a decision about whether it will be painful or not. You see, pain doesn’t come from the body; it comes from your brain. Relieving and reducing your pain is mostly about reducing the signals going up to your brain. We are going to talk about how those signals get generated and what you can do about getting them to slow down, and eventually to stop.
There are two ways to stimulate the nerve tissue in the body: chemically and mechanically. We are going to talk about nerve tissue because it is the communication network of the body. Muscles, joints, bone, tendons, and ligaments don’t send signals to your brain, but they have nerve tissue all around them that is responsible for this communication. So really there’s no such thing as “bone pain” or “muscle pain”, there is only pain from stimulation of nerve tissue in the bone or muscle or whatever body part we’re talking about. When you have “muscle soreness” from a workout, it isn’t your muscles themselves that hurt, but the nerve tissue that lives in the muscle that is talking to you – muscle soreness is primarily a chemical irritation.
1. Chemical irritation is part of the inflammation process, and it’s the first way to stimulate nerve tissue. If you’ve ever had sunburn, a sprained ankle, or a cut on your finger, you know what chemical pain feels like. The pain is more or less constant no matter what position you are in, and you can relieve it with ice and with anti-inflammatory medications. People with this chemical pain respond well to anti-inflammatory medications and some rest – the body clears the chemicals irritating the tissue with time.
2. Mechanical irritation is the second way to stimulate nerve tissue – it is pressure or tension in the nerve tissue. Mechanical pain changes with position and movement, worsens with prolonged positions, and doesn’t respond very well to anti-inflammatory medications and time/rest.
Won’t an X-ray or MRI show this mechanical pain?
No. Mechanical pain is a problem with the way the tissue FEELS, not the way it LOOKS. It is not a structural problem (like a broken bone), it is a functional problem. If someone took your picture right now, they could tell you how you look, not how you feel. Scans you may have had were probably normal or showed normal aging changes. In medical studies, people with no pain have been found to have advanced arthritis in their joints and even herniated disks in the spine – so in the absence of a major injury like a broken bone the scans aren’t that important to helping diagnose and treat your pain. What you have is chronically irritated tissue, not broken or damaged tissue.
OK, I’ve Got Mechanical Pain. What Can I Do to Help It?
Well, as we said before, anti-inflammatory medications aren’t usually very helpful – this is tension and pressure, not inflammation. The solution for mechanical pain is movement; movement that relieves the tension in the system. No amount of medication or rest or time will help the problem. But if you’re reading this, you probably already know that part. Here’s something else you should know. When nerve tissue is under this strain, the small blood vessels that deliver blood to it are pinched. This reduces the blood flow to the tissue. Resolving this pain involves reducing the strain and restoring the normal blood flow. Without a regular blood supply, the tissue will remain irritated and painful. One way to think of mechanical pain is to think of someone twisting your finger – this is what the tension in your tissue is like. What we have to do is “untwist” it.
Is This Like a Pinched Nerve?
Well, mechanical pain is tension in nerve tissue. So, in one way, all mechanical pain is kind of like a pinched nerve. Usually, when people talk about pinched nerves they talk about one specific nerve that has been compressed – this nerve loses its ability to send signals well and there might be numbness, burning, weakness, or a loss of the normal “reflex hammer” response. While this does sometimes happen, most mechanical pain is not focused on one nerve; it is more widespread in the tissue in general. When the compression is focused to one particular spot, it’s usually easier to diagnose with a physical examination or testing. It also tends to be easier to treat. Unfortunately, most mechanical pain isn’t like this.
The Spider Web and Movement That Helps
Most people with mechanical pain problems have tension in the tissue that is not focused on one nerve, but is more widespread. The nerve tissue branches throughout the body like a spider web, sending and receiving signals from place to place in your body. Picture a spider web for a moment. If you pull on one strand, what happens? The whole web moves. The tension is distributed throughout the system. That’s why it’s sometimes hard to find the movement needed to restore the blood supply and ease the irritation. You may have tried stretching and exercising in the past and found they didn’t help – the spider web nature of the nervous tissue makes finding the right movements very hard sometimes.
The movement that helps your pain is the movement that eases the strain and restores the blood supply. Sometimes this movement can be introduced by your therapist with manual therapy techniques – sort of an “outside in” approach. But this is only a jump start to the system – you have to learn to untwist yourself from the “inside” out if you are going to feel better in the long term. Your therapist might prescribe or choreograph specific exercises that can help, or you may have been shown other kinds of movement therapy designed to reduce the tension. In any case, doing your therapy often is very important.
Pain Is Like Thirst
When your body is thirsty, your mouth feels dry and you know exactly what to do. You give your body what it needs. Thirst is your body’s request for water. Once you give your body what it asks for, the thirst goes away. You drink when you’re thirsty, and sometimes you drink a few times a day because you know that’s what your body needs. You don’t need to be told how much to drink, you let your body tell you that. The same thing is true of your pain and movement. You should see the pain as your body’s request for movement. When you have pain, you should do the movement therapy until you feel you’ve done enough - and also you should do the therapy a few times a day just because you know your body needs it. Don’t save up thepain during the day, thinking that “I’ll just do my exercises at night” – you wouldn’t save up your thirst like that, would you? You wouldn’t save up your thirst throughout the day and then drink a big jug of water at night to make up for it. Doing the therapy is just the same.
How Much Should I Do the Therapy and When Can I Expect to Get Better?
Don’t worry about exact numbers of repetitions – be more concerned with getting in touch with how your body feels, and responding to it to reduce the pain. That is how you can learn to fix the problem yourself – from the “inside out”. When you are doing movement therapy, you are moving sensitive tissue and it is hard to predict when you will get better. Some people get better faster than others, and it has nothing to do with your age, gender, weight, fitness level, or strength. It is about how quickly you can learn to feed your body the blood supply it needs and how sensitive your system is overall. Sometimes people have more pain initially when they start the therapy – this is rare and neither you nor your therapist can predict this.
Don’t be discouraged – remember only movement will resolve the pain, and if you continue the therapy you will improve – just take it one day at a time. Learning to get back in touch with your body and feed it what it needs sometimes takes practice.
~ By Jason Silvernail DPT