Your Brain – Smoke Dectector
Patient: “But it hurts when I sit or lay down… shouldn’t I feel better when I’m resting?!”
PT: Not exactly…
A common line of thinking among many PT patients is that rest will resolve pain. It’s counterintuitive to many individuals that discomfort and pain persist while resting. Let’s dive into this misconception and shed some light on the topic of rest as it relates to pain.
When it comes to pain that is musculoskeletal in nature, it’s common that the cause is overworking, stress, or strain on the muscles, tendons, ligaments, or bones. People often associate this with active movement: running, walking, or even something as simple as getting out of a chair. In reality, your body is working all the time. In fact, resting states (lying down or sitting in a chair) can be interpreted by your brain as potentially dangerous if you have overworked a muscle that is typically used for this activity. For this reason, many therapists focus on educating their clients to rest in anatomically safe postures. You might ask: what is an ideal posture? How can my resting posture be flawed? Therapists know that ideal posture is a position in which your body is working most efficiently and able to support itself with minimal effort.
In cases where an individual is experiencing pain while sitting or otherwise resting, it’s likely that the resting or seated posture causes stress on this area of the musculoskeletal system. The brain interprets this as a stressor and triggers a pain response in the physical body to alert the individual of the burden that area of the body is under. What most people don’t understand is that the body is sending them a message. Pain is a news bulletin from the brain that the position is not ideal and that a change is necessary to obtain comfort. If the individual ignores this signal, as many do, the pain will persist and the brain’s alarm system may become more sensitive. This becomes cyclical, causing a lower threshold for activity before pain comes on again. If a smoke alarm is going off in your house– do you take action to address it or let it ring and ring? More than likely, you look for a reason for the alarm. Sometimes the smoke alarm goes off when something is burning– this can be analogous to an active pain response. Other times, you are taking a shower and the steam sets it off– this is what can happen to our alarm systems they can become more sensitive to stimuli that are not dangerous– like resting postures that seem like they should be pain free.
Now that we have a clearer understanding of why rest isn’t always restful, let’s explore some solutions. A few things need to happen in order for a patient to improve tolerance for resting postures. The first is being aware of your brain’s alarm system and making adjustments to your position when pain occurs. The second is freeing up the tissue that has been overworking and experiencing strain. This is where the PT often utilizes a variety of techniques like myofascial release, instrument assisted soft tissue mobilization or cupping to name a few. The third is to support the tissue that has been overworking by re-educating inhibited muscles to turn back on and properly support the straining tissue. Finally, in some cases the fourth step is to provide the area straining with some support while the system is rebalancing. When these steps are taken with the assistance of a PT to properly assess the body and determine a treatment plan, most individuals experience a reduction in their resting pain. Like anything that is worthwhile doing this process takes time and commitment to the program outlined by your PT.
If you experience resting pain, it might be your body’s smoke detector going off. Give us a call! Our job is to evaluate you and to help devise a treatment plan to make sure your alarm system is running correctly. We look forward to working alongside you on a treatment plan that balances your body and support getting you back to the place where rest is restorative and enjoyable, not painful.
Disclosure: If you experience pain that wakes you up at night and you are unable to fall back asleep, this may be a sign of a more serious problem and is something that should be brought to the attention of your team of healthcare professionals.