The uphill battle with getting rid of chronic pain (and how to at least start!)

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So you’ve just seen your physiotherapist and they’ve given you the advice, that in order to get rid of that niggling groin or chronic neck pain, you need to attend a certain number of treatment sessions, generally in parallel with some form of exercise based rehabilitation. Attending the treatment sessions, listening to the physiotherapist and having your back pummeled is the easy part, but when it comes to the part YOU have to do to get yourself better, this ain’t easy!

You might even find that you don’t even get that far. Your mother, brother, sister, uncle and every other member of your family had has enough of you complaining persistently in a peevish or irritating way about your niggling back pain or those headaches that keep racking up those sick days you’re taking at work. They convince you to book into the physiotherapist but you keep incandescently ignoring them. They might actually make an appointment for you, only for you to cancel it or not show up.

Why do we find this SO damn hard! Why does it seem such a big mountain to climb?!

Just know, you are not alone and the motivation to take action is an extremely difficult process!

Now, us physiotherapists generally know what we’re talking about. We deliver an evidence-based medicine and we try to teach you ways of looking after yourselves so you DON’T have to see us! For every client who walks (or doesn’t walk!) through our doors, we follow a treatment plan that we know has research behind it to back it up.

So why are people still unmotivated to change?

Before I give you the secret, a bit about me. Earlier this year, as a true Aussie would on Australia Day, I took my dogs for a walk around the block in bare feet, only to step on a gumnut. This started off a chronic, persistent case of plantar fasciitis and, for those of you who have experienced this common heel condition, I feel your empathy flowing through me right now.

I knew what to do. I knew exactly what to do. I knew the research and I knew this journey would involve a golf ball, resistance training every other day and also the reluctant binning of my flat fancy work shoes.

I was compliant for a bit. I got some great comments on some funky new sports shoes I began wearing to work, there were a few profanities in the house with rolling my foot over the golf ball and I had my favourite little step where I would perform my leg strengthening exercises. Three lots of 12, each leg, every second day. I was compliant for a bit. I felt great but didn’t maintain consistency. A night out in heels with a decent amount of gin and I was back to square one.

So why do we do this? Why do we (a) start but not maintain consistency or (b) not even start at all, even though we know it’s the thing that needs to be done to get us better?

Here’s the secret…

To start a new task, to change our habits or to finally put an end to that shoulder pain that’s been stopping you putting a bra on (so you’ve been bra-less for months), I like to use the analogy of a chemical reaction (I bet you didn’t think you’d be learning some chemistry today!).

As an example, we all know that hydrogen and oxygen react to form water. The little bonds between the hydrogen atoms need to break and the little bonds between the oxygen atoms need to break before the two can even react! This involves a huge amount of energy for the process to even begin! You can see in the diagram below, it takes a huge amount of energy to start the chemical process and not so much to keep it going. Just like starting those physio exercises.

 

So, why is it so hard? What actually happens in the brain to stop us taking action?

Our brain runs on autopilot to conserve energy. The more you perform a habit, the more it becomes deeply wired into your brain, in a little part at the back called the basal ganglia. A lot of the time, consciousness is not involved in your decision-making so the basal ganglia rules the roost!

When you first try to adopt a new behaviour, you have to enlist your prefrontal cortex, the thinking brain, and insert conscious effort, intention, and thought into the process. When you’ve performed the new routine enough times for connections to be made and strengthened in your brain, the behaviour will require less effort as it becomes the default pattern.

So, by making conscious effort, by using your prefrontal cortex to take action, any action, you’ll gradually start to change your habits and behaviours!

For example, if you begin to avoid positions that aggravate your knee pain, then this becomes autopilot. The brain habitually avoids certain positions from then on creating muscle imbalances, joint stiffness and muscle weaknesses, which can lead to pain and dysfunction later down the track. It’s important to work with your physiotherapist to safely learn how to get your knee into to those positions again until the brain registers them as “normal”. This will increase the chance of ticking off the bucket list item of learning how to breakdance!

 

 Top tips on taking action to get better

  •  Just start. You will NEVER EVER feel like it and there will NEVER be a right time. Try a couple of weeks of something, a week, a session or even half a session. Try one minute of an exercise and then the week after, two. We build a house brick by brick by brick… you get the gist! Also start to notice the excuses that keep coming up and work with a professional, colleague, friend or family member to “talk these out”.

 

  • Consistency is the key. Recent reviews of ALL of the exercise programs for Chronic and Acute low back pain (and other injuries but let’s start there) have suggested that it doesn’t really matter what type of exercise you do, just that you do it regularly. What this means is that there isn’t one type of ‘magical’ exercise that will cure all that ails you, and many different exercise types can be highly beneficial in the treatment and management of low back pain (and other issues). So don’t overwhelm yourself by booking in three personal training sessions a week for 12 weeks if it will shy you away from getting to your goal. Other people on the other hand may respond well to this (see the next point).

 

  • Find a reliable, accountability buddy. “When performance is measured, performance improves. When performance is measured and reported, the rate of improvement accelerates.” — Thomas S. Monson. If you can’t find a buddy, I know a few good physio’s!

 

  • Put yourself assiduously in conditions that encourage the new way. For example, try to be around people who are working towards a similar goal, train with a healthcare professional who understands your condition or if you’ve injured your knee playing soccer, try to maintain contact with your club as a coach/mentor so you can continue to feel part of the team and players can be your accountability buddies.

 

  • Try to observe when your motivation is high and try to take action then. Try then, to “push” that new action into a habit loop. In the morning, after a good caffeinated beverage, hit the gym before the palaver of work sets in. Try those yoga stretches after work and when the kids have gone to bed so nothing may distract you. Find the time of day that works for you and DON’T punish yourself for skipping a day!

 

Summary

If there’s one message you take away from this extended drivel, it is that changing your deeply entrenched habits invariably requires help, information, and real support from others and is extremely hard!

People who have recovered from injury have been through the boring, mundane, time-tested process that eventually brings about this recovery so, stop looking for “quick hacks” that bring faster results. Nowadays, social media doesn’t help, as we see people who are running on the soccer pitch after experiencing a 12 month injury. Social media just gives the final product and doesn’t show us all the hard work that went into the recovery process.

So, in order for a good habit to become sustainable and enjoyable, that part — the getting started — must not be sudden. It should be made increasingly automatic by getting that prefrontal cortex to change consistent, little habits to show the basal ganglia who is really in charge!

 

Written by Lauren May

Lauren is South Perth Physiotherapy’s Principal Physiotherapist and has a huge passion for looking into why people have “roadblocks” in taking action to push themselves to recover from chronic pain. As this is often a combination of physical, mental and emotional blocks, there can often be a complexity in reaching the answers.

 

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826769/

https://thebestbrainpossible.com/the-neuroscience-of-changing-your-behavior/

https://www.ncbi.nlm.nih.gov/pubmed/11920693

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