Pain is a complex experience. There are biological, psychological, and social aspects that all contribute to a painful experience. Pain, although often seen as a nascence, is actually a good thing because it let’s us know that there is an injury or a potential injury. In this article, we will discuss how pain changes movement and what the effect of this is.
The presence of pain will cause the brain to alter movement patterns in order to protect the injured tissue or to avoid an injury. The use of pain to avoid an injury is an important characteristic because this means that your tissue don’t need to be damaged to experience pain. The brain can either increase or decrease the activity of various muscles to protect an area from further injuries. These changes in muscle activity due to pain are not always predictable or stereotypical for an injury. Therefore, your body may react differently to the same recurrent injury (low back pain for example) and will also vary between different individuals with the same injury.
Because pain is a protective mechanism, the altered movement strategy to pain provides short term benefits for the injured tissues. The altered movement can decrease the load of the injured tissue by decreasing muscle activation or it can provide stability to the area by increasing muscle activation. In evolutionary terms, this was great for allowing you to run away from the lion that was chasing you for lunch.
Once healing of the tissues has occurred, the movement pattern should be restored to the previous pattern. However, sometimes the brain doesn’t revert the movement pattern to the original pattern, resulting in the short-term altered movement strategy to replace the original movement pattern. This will cause abnormal loads on tissues, decreased movement in joints and muscles, and decreased variability in movements. These altered movement patterns will eventually have deleterious effects on your tissues.
The altered load on the tissues can cause some tissues to be overloaded and some to be underloaded. Ever injure one area and then shortly after another area begins to hurt? Well, the altered movement can place different stresses on different parts of your body, which can lead to muscle damage in that area. The mobility and stability of your body can also be altered because your muscles are functioning differently than what their intended purpose is.
Reduced movement is well accepted with pain. I don’t think I need to elaborate on that. But there is a cost to reduced movement that you might not be aware of. Let’s take the ankle as an example. After an ankle sprain, there is reduced movement at the ankle joint which means that the ankle can’t absorb the forces like it normally does. This means that the lack of force absorption at the ankle leads to increase force absorption at the knee, hip, or low back.
Decreased variability can lead to overuse and therefore injury to muscles. Normally, the muscle has multiple pathways to function which prevents overuse injuries from occurring. When there is a decrease in pathway options, this leads to fatigue and possible muscle failure. Think of a highway with multiple lanes, then closing all but one lane. Now there is increased traffic on that one lane, which leads to accelerated wear and tear on that lane. As a result, the lane will be overused compared to the other lanes and will fail before the over lanes.
Since the absence of pain doesn’t mean that the proper movement pattern is restored, it is important to have a movement assessment to identify the altered movement pattern and how to restore it. The two movement assessments used at our clinic and in many sports medicine clinics are the Functional Movement Screen (FMS) or Selective Functional Movement Assessment (SFMA). These movement assessments assess the quality of your movement against acceptable patterns, which allows practitioners to grade the risk of future injury.
In conclusion, pain is a protective mechanism to limit injury and further injury. While altered movement patterns provide short-term benefits, altered movements can have consequences later on. It is therefore important to restore the movement patterns as soon as possible after an injury. Have your movement patterns evaluated by someone certified in FMS or SFMA to decrease your risk of future injury.