By Alicia Gyetvai
I know firsthand the toll that chronic pain takes. The afflicted thinks about it all the time. After a back injury in 2018, I found myself mired in a web of diagnostics, physical therapy, alternative therapies, etc. By 7 months post-injury my pain had gone from bad to much worse, I was frozen in fear about movement, wearing an SI Joint belt for months, doing injection therapies, and being advised on all the things I could and could not do to improve my situation and heal. My symptoms kept getting worse and spreading and I found myself more and more debilitated by pain and fear. Me, a seasoned Pilates teacher with a background as a competitive gymnast and a ballet dancer, afraid to move. Hello, shame…
And then I heard about Curable Health. An app geared towards chronic conditions! It offered researched alternatives to the pathology-saturated biomedical model that only identifies mechanical or anatomical causes for chronic pain. Taking the spotlight off “damage” alone started to change my brain.
Curable’s approach led me down the road of learning about neuroplastic/ chronic/ persistent pain and how my nervous system might actually be the culprit in my worsening condition. This led me to take workshops led by doctors, psychologists, and movement specialists on the subject. It took me years to really imbibe this approach after being so steeped in the more biomedical or musculoskeletal model for chronic pain where pain equals damage. This intellectual journey led me to a more embodied journey which led me to finally heal.
What is Persistent Pain?
Persistent Pain, also known as chronic or neuroplastic pain, is pain (or symptoms) that arise out of injury or physical or emotional trauma that continues beyond the normal period it takes the body to recover. After an injury, brain circuits can become hypersensitive to prevent you from getting hurt again. That’s helpful while you’re recovering but once the injury is healed, chronic pain can persist because the brain is sending out false alarms, presuming danger when there is none.
It’s easy to get stuck in this hypersensitive phase. Pain is a very unreliable indicator of the condition of the body, but it is an extremely reliable indicator that the brain is perceiving danger.
“Pain is a multiple system output activated by the brain based on perceived threat.” Lorimer Mosely, Explain Pain.
It is important to acknowledge that there are persistent/chronic pain conditions that can be caused by physical problems in the body, such as tumors, infections, fractures, and autoimmune disorders. It is always advisable to get medical clearance that rules out other complex processes that may cause or contribute to persistent pain before embarking on persistent pain re-education.
Pain Does Not Equate to Harm or Damage
According to orthopedic surgeon Howard J. Luks, “Almost no one over 40 will have a “normal” MRI report of the shoulder, knee, spine, or hip. Many of the changes seen on an MRI are considered to be “age-appropriate” changes to some of the structures in these joints. Most of those changes will cause no pain, can be ignored, and will not impact your activities.”
If normal wear and tear often does not cause pain, and if acute injuries have a projected healing time with proper treatment and rest, there must be other factors involved when pain becomes persistent.
Connection with Emotional and Physical Pain
Emotional pain and physical pain appear in overlapping regions of the brain. This is seen in the part of the brain that represents sensations in the body. This circuitry is part of our nervous system, our body’s mission control. It governs us by constantly evaluating safety. Our nervous system may become maladaptive to stressors so that it does not accurately assess emotional and physical threats.
Our emotions contain information and assign value to things; they tell you what you want and what you don’t want. Persistent patterns like worry, pressure, and self-criticism can put our nervous system on high alert. As the neuroscientist Lisa Feldman Barreb writes in her book How Emotions are Made, “You may think that in everyday life the things you see and hear influence what you feel, but it’s mostly the other way around: What you feel alters your sight and hearing.” If one is afraid, their body perception is altered to perceive threat.
How Pilates Teachers Can Help Clients Cope with Persistent Pain
Pilates teachers are positioned well to help promote meaningful change on pain because it’s a safe, non-medical, more enjoyable environment with a lot of choices. For Pilates teachers, addressing movement patterns and promoting activity and essential skills toward uniform development are important components of chronic pain management.
- We can offer a compassionate pain re-education with holistic healthy (best of the best) movement and a more regulated nervous system.
- We’re helping to educate a whole person, not just a muscular/skeletal body. This is not exercise performance, it is how we deliver movement to people in pain.
My top pain science education recommendations to clients are Explain Pain by David Butler and Lorimer Mosely, the pdf download Recovery Strategies by Greg Lehman, and Lorimer Mosely’s Ted Talk, Why Things Hurt found on YouTube.
1. Using Graded Exposure in a Pilates Session To Unpair Pain and Fear
A concept called graded exposure is an integral component of pain science and pain re-education. Graded exposure offers people a way to unpair pain and fear and confront and get comfortable with things they are afraid of; teaching the brain that something one thinks is dangerous is safe. Movement avoidance can lead to disability, disuse, and further pain.
Nothing breeds success like success.
- When a client experiences themselves performing movements they’ve been afraid of, their success changes their brain.
- This makes it easier for them to face triggers and manage their response to those triggers. This inspires healthy resilience.
- Instead of feeling bullied by vulnerability, your client is empowered by their inner strength, turning pain into a journey of discovery and recovery rather than continued struggle.
2. Use Compassion Because Pain Experience is Always Real
No matter what the situation, the pain experienced is real.
Pain is the brain’s opinion of how much danger one is in and it takes time to change thinking patterns and neural pathways. It does not help a person in chronic pain to have their experience gaslit. They are experiencing real pain. We must offer compassion as we help to coach them towards more self-efficacy, without completely buying into their pain story.
3. Build Confidence to Get Out of Fear
Beliefs are a huge part of how we scrutinize our situations. We want to shift our clients’ beliefs and build confidence and get them out of fear. People project on their experience from experiences they’ve already had. Being protective feeds into feelings of fragility. Instead of focusing on vulnerabilities, focus on resilience to fortify physical, emotional, and psychological strengths, which will help them to see that their fear thoughts are not the truth. I often ask a chronic pain client, “What would you do if you weren’t afraid?” Most people know fear plays a role but they haven’t defined how it’s holding them back.
4. Promote Joy in Movement and Everyday Activities
A lot of times, spotlighting pain triggers more pain. Pain is the body’s way of messaging you; it doesn’t have any more room to compensate. It’s essential to find ways to dial down stressors and dial up joy.
How do we help our clients attend to physical sensations mindfully without judgment, without fear, and communicate safety to the brain? Coach leaning into pleasant sensations like breath, scents, environment, etc. Have them focus on their physical wins. Encourage them to pursue activities (in a graded way) they enjoyed before the pain took over their lives. We want to give messages of safety in the face of uncertainty. To recover from painful traumas, people need to live through experiences that contradict what happened to them earlier. Living life with joy despite symptoms is a great first step to living life with fewer symptoms.
Resources
- Butler, D., & Moseley, L. (2013). Explain Pain (second ed.). Adelaide: Noi Group Publications
- Lehman, G. Recovery Strategies – Your Pain Guidebook.
- Barrett, L. How Emotions are Made: The Secret Life of The Brain. (2018) Reprint Edition. Mariner Books
- Luks, H. You Cannot Unsee Your MRI Report.
- Curable Health App.
- Lorimer Mosely Ted Talk Why Things Hurt.
About the Author
Alicia Gyetvai owns and operates PilatesBodies, a Classical Pilates Studio in Santa Fe, NM. Classical Pilates Studio, Santa Fe | PilatesBodiesSantaFe.com Alicia graduated from The Pilates Center in 2001 and has continued education through TPC as well as Movement Science Made Simple and Core Dynamics Pilates. Alicia is a host advisor to The Pilates Center, allowing her to mentor students through TPC’s rigorous teacher training program. She recently gained certification as a Persistent Pain Educator through the Embodied Business Institute.