Move More After Pain, Not Less.
It’s hard to be objective when you are the one in pain. I first hurt my neck when I was about 20, during my brief stint in judo while attending university (I’m 31 at the time of writing this). I had just joined a local class. Although at first I could hardly even manage the cart wheels and tumbles that made up our warm-ups, I was keen to get involved with some sort of regular recreational physical activity, and judo seemed pretty cool. After a few weeks, I started to get a grasp on the basics and was beginning to really enjoy myself. This was until my sparring partner, ‘Dan’, showed up one night. He was about 40, twice my size, a yellow belt proudly tied around his beer belly, and a cocksure attitude as if he were the present-day Bruce Lee of judo. I soon found myself bound belly down on the floor, my head pinned down under Dan’s arm, and my neck twisted freakishly far to the left. I tapped out. “You’re not tapping out already, are you?!” Dan replied, pushing slightly harder into my head. I tapped a few more times.
I couldn’t shoulder check in my car for a almost a month. There was a tight and achey band of pain running up from the inside of my left shoulder blade up to the back of my head. If I moved too quickly, it responded with a sharp jolt to remind me it was there. I was bitter about it all, too. I didn’t ever go back to judo. This was before physiotherapy school, and I didn’t really know what to do about my injury besides ice and stretching. The pain eventually subsided but would return from time to time over the years. Sometimes it came on if I sat too much at the computer. If I slipped up with my form in the gym it would flare up. Other times it seemed to come on with stress. Even once I started to work as a physiotherapist, I didn’t really practice what I preached to my patients when it bothered me. I really babied it, to be honest.
I was basically the perfect example of a chronic pain patient. I had poor coping mechanisms, carried a little bit of a victim complex (thanks, ‘Dan’), and I slouched like a pro on my couch when I got home at night, even though I knew it wasn’t a good position for my neck. Earlier this year following a perfect storm of aggravating factors it really flared up, and I found myself trying to get through patient assessments without letting on that I couldn’t even turn my own head. The pain was more intense this time and it took forever to go away. After massage, numerous spinal adjustments, dry needling and acupuncture, muscle stimulation, and half-assing through some of my go-to physiotherapy neck exercises, only k-tape seemed to give it some relief.
Finally, one day this summer I was walking to work with my backpack slung over my right shoulder. I had over-packed it that day– laptop, gym clothes, sneakers, lunch, and more– and it was too warm outside to have it strapped across both shoulders and pressed against my back (I didn’t want to show up at work sweaty, okay?). My right arm was getting tired and starting to burn from fatigue. “Don’t throw it across your left shoulder though, you might aggravate your neck.” Wait. What? Did I really just think that to myself? I was pretty much doing what I would tell a patient specifically not to do.
My pain was special though. It was different from everyone else, and I needed to protect it. Except it really wasn’t. I was completely oblivious to my own knowledge and clinical experience when it came to having a sore neck. I think most people are like this; we subconsciously think that our situation is unique and different from the common experiences of others. This is rarely true. How about we try to stop overthinking, take a step back and observe our thoughts a little? This is how we get real insight into what is going on and self-evaluate how we are choosing to respond to it. We often let fear take over without even realizing it. This is a common way in which chronic pain develops.
Most cases of chronic neck and back pain are the result of a negative feedback loop. You hurt something, over-protect it, baby it with passive therapies, and eventually do less. As we avoid our favorite activities and become less active in an effort to protect ourselves from re-injury the sore areas gets weaker, our nervous systems become more alert and sensitive, and we maybe feel a little sorry for ourselves. The pain gets easier to trigger, we respond to this with more negative coping, get hurt again, and so on. Most of us don’t realize we are even doing it. I didn’t, even as a physiotherapist. I’ve noticed these behaviors in my colleagues from time to time as well.
The reality is after injury we need to do more, not less. We really need to exercise the affected area and try to get it in better shape than it was before we hurt it. We should participate in activities that maximize strength, stability, and flexibility. Get over your fears of re-injury. I can’t tell you how many people have told me that they have given up deadlifting in the gym after hurting their backs, even when the mechanism was unrelated to the lift. When done correctly, the barbell deadlift is actually an effective exercise in low back pain rehabilitation1. I always encourage my gym-going patients to get back to deadlifts, squats, lunges, and the like as soon as possible. If they weren’t doing them to begin with, I encourage them to start.
Others have given up really rewarding recreational sports like ice hockey and skiing, or have modified their fitness routines into something much more conservative. Once the injury has healed, I would say get back out on the ice and play even harder. Hit the slopes again. Instead of slowing down, consider what you might be overlooking in your exercise programming and to focus on making targeted gains in your weak areas. No, you’re not getting that old. If you already consider yourself fit and active, well-rounded, and feel like you’ve tried everything to no avail, find a health professional with experience in chronic pain management, and let them give you their unbiased and objective point of view on your presentation. Be open to their advice and to making lifestyle changes. Be willing to move more and to try something new.
The reality is after injury we need to do more, not less.
My neck pain is finally starting to go away after a several months of discomfort. I only notice it from time to time now. Although its hasn’t been warm here in Calgary for weeks (if not months), I don’t hesitate to toss my bag over my left shoulder. I am pushing my limits with weights in the gym while being extra mindful of form, tempo, and my overall programming. I have no issue with putting a barbell across my back, even on days when my neck feels a little tight. In yoga, I push into mild discomfort with my twists, and strengthen my neck against gravity in postures such as triangle, extended side angle, and side plank to name a few. I slouch less on the couch when I stop working for the night. Most of the time at least. That said, I think that I’m still a little bitter towards Dan. Maybe I need to work on that.
Mark Austin | BKin MScPT ACMT