If you’ve ever had chronic pain before, you get it.
Pain can be very blinding. You feel it, and it’s all you think about!
“Oh no, what did I do NOW?!” You might have had those thoughts if you felt a pain come out of no where.
Pain can be scary, but really it’s not the pain that’s scary, it’s all of the things we associate with pain that are scary to us.
“Did I injure myself? Is there tissue damage? Am I going to be unable to do ______? Will I have to stop doing things I love?”
We can easily spiral down these rabbit holes.
However, that same exact pain, when given confirmation that there’s nothing serious going on, suddenly doesn’t feel as bad. Crazy, right?
We use 4 words to describe sensations we are feeling, and this is the exact education our clients go through:
Insult, Irritation, Pain, and Injury.
Let's define them.
Insult: the subconscious response to a stimulus. As you're reading this on your phone (let's pretend you are if you aren't), if you're holding your phone in your hand, it's insulting the skin on your hand. You don't even notice it. If you were to read an article long enough, eventually, you'd adjust your hand or maybe switch hands. That's when insult becomes irritation.
Irritation: the conscious response to a stimulus. You notice it now. The word irritation has a negative connotation, but it's not necessarily a bad thing. We need some level of irritation to drive adaptation (or change). If holding your phone in your hand was only an insult, and not irritation, you'd be stuck in that position forever, and not notice the need to move. It drives change, which when we are talking about healing tissues, is incredibly important. It's also important for survival in more literal terms. If we use holding a cell phone as an example, we understand that being in a certain position for too long isn't beneficial and is getting a little uncomfortable, so we shift, but there's no fear or uncertainty around it. We understand exactly what's going on. When we don't understand it, that's when it starts to creep into pain.
Pain: a negative emotional response to irritation, made worse by fear or uncertainty. Let's go back to the cell phone example for a moment. We can all imagine exactly what our hand would feel like (maybe you're feeling it already as you read this) from holding our phone in one hand for a long period of time. Now, let's remove the cell phone from the equation and remove holding your hand in that position. Nothing about the level of irritation is different, but now we have no idea what we are feeling it. What's changed in your emotional state? Now there's concern, confusion, uncertainty. Did I do something to my arm? Why is it hurting? All the questions of the rabbit hole we talked about in the beginning because we don't understand why its happening or where it came from even if it is the exact same level of discomfort. It may even magnify itself to a point where you're afraid to use your arm, and now we have an injury.
Injury: The decision to stop. Simply put, and injury is when you decide you can't do something anymore. Back to our arm example, if you like to garden, you're now deciding you can't use that arm to dig and plant. Or if you like to play tennis, you're not using that arm anymore.
When talking about Insult, Irritation, Pain, and Injury, we use a rating scale with our clients from 1-10.
Insult would be a 0 because you don't even notice it.
Irritation would be anywhere from a 1-4.
Pain would be somewhere from a 5-8.
Injury is typically 8-10.
So how does this translate into movement and getting out of pain?
When exercising or moving, here are the rules we educate our clients on how to follow when they are looking to move pain free:
Rule #1: On the pain scale of 1-10, irritation must stay at a 4 or less while doing a specific movement. This is what we would consider an acceptable range of irritation. If we look back to our pain scale from 1-10, once we hit a 5, now we are talking about pain and that is more irritation than we want. If we think of shoulder pain and pressing overhead, lifting your arm up overhead without any load is a 5/10, we are not going to continue that movement or consider adding load because the tissues are already irritated at a level where it doesn't make sense to add any more irritation.
Rule #2: As you're doing a movement, the pain rating either stays the same as before you started OR it gets better. Example: before doing an exercise, you rate your shoulder pain at a 3/10. As you're doing the exercises, it must stay at a 3/10 or get better. If that's the case, then we can continue on with what we are doing because we are on the right track. If we go back to our definition of irritation, there's still some irritation (it's not a 0/10), but the tissues are adapting to the stimulus because it's staying the same or better with an added outside stimulus (which is what we want!).
If pain starts to get worse, something has to change. Maybe it's the range of motion (instead of straight overhead, maybe its a more forward angle), maybe it's the load (amount of weight), maybe it's the movement altogether (maybe this movement isn't ideal for today). Example: Let's use our shoulder again. Before starting the exercise (pressing overhead), you rated your shoulder at a 3/10. As you're doing reps of the movement, it starts to creep to a 4. Even though its still a 4 or less out of 10, we need to change something, because now all we are doing is causing more irritation to the tissues, and they aren't adapting. Either the load is too much at the moment, the range is to great, or the movement is not ideal at this point in time (or all three).
Rule #3: When the movement stops, the irritation should stop. If you had no irritation before pressing overhead or some irritation, and as you were pressing, you started to feel irritation get worse, as soon as you stop pressing, the irritation should stop or return the level it was prior. If it lingers or gets worse, either the range of motion, load, or movement need to change.
Rule #4: 24-48 hours after the movement/workout is complete, there should be no focal pain. Focal pain means you can point with one finger to a specific area of discomfort. Using our shoulder example, let's say we did overhead pressing, and it stayed at a 3/10 or less during the movement and 48 hours later, you can point with one finger to an area of pain, we need to change something. Note we aren't talking about muscle soreness or even general discomfort, this is referring to worsened pain in a very specific area.
If you need help with this, with certainty and peace of mind that what you’re doing is moving you in the right direction to get out of pain, and you aren't causing more damage, please reach out! We'd love to see if we are a good fit to help!