A Neurological Outlook on Pain and Performance – Pt 1

Why does your body stop functioning with chronic injury?

 What does the body do in response to pain? How does pain/nociception change movement? Over time, what happens to the body with the compensations that occur? Physiotherapist Ken Moy shares a neurological outlook on pain and performance.

The brain is the all-powerful organ of the body, governing every minute chemical process, interpreting all sensory information from a plethora of different receptors, planning and initiating every motor output, and ensuring every autonomic function, functions (Frackowiak et al.). All these processes happen with the sole purpose to keep us alive – prioritizing the ability to breath and allowing us to keep moving.

But what happens if these processes are disrupted?

Through injury (acute or chronic), work, sport, or stress related, the body and brain will naturally and instinctively make sacrifices for our priorities to be met, resulting in compensatory movement strategies.

Although not necessarily a negative process, running on an inefficient loop puts the body at risk, causing energy loss and reduction in function/performance over time. 

Have you ever experienced spontaneous musculoskeletal pain, seemingly unrelated to previous injury or with any obvious cause? Or lingering pain that just doesn’t seem to go away with long bouts of treatment and therapeutic exercise? Your function improves, but it is just not quite your normal. Sometimes, the lowest hanging fruit in treatment could be exactly what you need, but other times just does not solve the complete picture – something which I’ve experienced myself. 

What happens in your brain with chronic pain

The complexity is that chronic pain occurs in the brain, via an increase in sensitization of signalling of the nervous system and receptors (Moseley and Butler). Kind of like a faulty car alarm going off with every gust of wind, these receptors continue to send danger signals to the brain despite no likely structural damage. With this, comes a reflexive protective pattern causing structures to go into “protection mode”; some muscles can be overworking and others not doing enough therefore causing change in movement pattern. This natural and automatic response can potentially be debilitating and long-lasting. Luckily, this can change through a process called neuroplasticity, and it all starts with sending the right signals back up – through the receptors of the joints, tendons, ligaments, skin, etc. 

How neuroplasticity can guide treatment plans

I believe that treatment should be provided with this idea as its foundational basis.

• Assessments can be performed to observe how your brain protects and finds its stability within the body, driven by neurological input.
• Manual therapy techniques can be applied, likely away from the site of pain (also likely NOT where the source of the issue is); a step that can be a major piece of the puzzle used to provide the correct input to the brain by stimulating such receptors. With the understanding that sensory information is vital for a change in motor response, pain compensatory strategies can be broken.
• Specifically tailored exercise program could then be used to re-enforce the new positive sensory and motor loop, creating a more efficient, stronger, and positively adaptable movement pattern.
• Lastly, education around areas of priority for self-care can be instilled within the context of a new understanding of how your body is operating, allowing you to strive for independence.
  This is the basic blueprint of treatment; very much an exploratory process combined with testing and retesting of neurological input/output.
  An analogy that I like to use is that the mind has a map of the body. In a perfect world, every piece of this map is clear. When a compensatory strategy is repeatedly used, certain parts of this map become blurry, therefore disallowing the body to effectively “access” particular muscle groups to contract or stabilize. Translating this back into function, other structures need to take its place to help do that precise role. Ultimately, it’s about the brain requiring the correct signal from the body to break this compensatory strategy. Your body already knows what to do and has the tools to do it; but sometimes, it just needs a little nudge.  If previous treatment hasn’t been providing you with the results you were hoping for, maybe it could be time to try something different.