Thoughts on pain, nociception, and sensation

I have been in the fitness industry for 18 years. I watch as pendulums swing regularly. It’s good—there is a desire of fitness and movement professionals to provide information to clients that helps them get stronger, feel more empowered, and get out of pain.

Random fact about me: throughout my 20s, I had chronic pain issues. I was wound tight, strong in a small range of motion, and busy trying to absorb all of the information about personal training I could. I ended up with inflammation in my elbows, a swollen left knee, and shoulders that felt like they belonged to an 80 year old.

So, at 24, I decided the solution was to start yoga. Yoga, it seemed, would make my body feel better by restoring some flexibility, something my young mind told me I needed.

At the time, plyometrics and stability ball workouts were all of the rage. Standing on BOSUs to improve balance and using stability balls for everything was encouraged, and creating situations for people to challenge their balance was sure to activate the deep abdominal muscles.. So were transverse abdominis isolation exercises using things like blood pressure cuffs and every variation of plank possible. Low back pain, we were told, was caused by a weak transverse abdominis, and squatting with your knees moving past your ankles was sure to cause your menisci to implode, causing permanent damage. Fitness and anything centered around the mind/body were completely separate disciplines. Yogis didn’t lift and personal trainers stretched, but didn’t do anything resembling Surya Namaskar A.

So, I began my yoga journey, but I still lifted weights because my professors said one of the most critical times for building a foundation for bone density is in your twenties (I was an exercise physiology major. My Even though I understood you could build bone density throughout your life, when professors use terms like, “critical time” and you’re a rule follower, you faithfully build your bone density using load, even though your yoga teachers tell you that is going to cause irreparable tightness).

Yoga made me feel marginally better, but it wasn’t the magic cure I thought it would be. Plus, even though I was good at focusing on me and the mat, I couldn’t help but notice how my lack of flexibility prevented me from progressing. My body was firmly stuck, no matter how many teachers tried to push me forward in forward bend, or how many days I practiced on my own.

I began studying alternate, “fringe” modalities, frustrated with both my nagging pain issues which ebbed and flowed throughout my twenties and the fact that, still, I felt something was missing. I also went back to graduate school so I could clarify a few things. I thought I wanted to specialize in working with runners, not realizing runners at the time lifted weights as often as yogis lifted weights. It worked out, though, because I became fascinated by gait mechanics and motor control.

I started to figure things out in my own practice. All of this self exploration led the elimination of my chronic pain, an improvement in flexibility, and clients who were also feeling better. It would still be a few years before I was able to put everything fully together, but I was on the right path.

Nociception is sensation caused by nociceptors, unspecialized nerve cell endings that send information to the brain. They act on fast or slow nerve pathways, depending on the type of axons the nociceptors as associated with (think of axons like the highways carrying the nociceptor information as rapidly as possible up the spinal cord).

If you pick up a steaming hot pan you drop it before you realize the pan is burning you. You can thank your mechanothermal nociceptors for letting you know the temperature of your skin is dangerously high and there is potential harm. Your motor nervous system respond by spontaneously dropping the pan.

Pain is defined as a somatic sensation. It’s complex, a myriad of sensory, emotional, and cognitive experience. Nociception generally occurs when there is an extreme change in pressure or temperature that could be potentially harmful and/or toxic molecules and inflammatory mediators.

Let’s say you’re camping and your five year old wanders off, falling into a deep ditch. She hits her head and may have broken her leg. You hear her screaming, and while you are rushing down to get her, you gash your hand on a broken branch. The laceration is deep, but you need to get to your five year old. Do you feel pain?

Probably not in the moment. Stress can suppress the sensation of pain so you can make it through and survive whatever the situation is.

Conversely, anticipation can exacerbate pain. Have you ever reached for something and experienced a twinge, only to reach for the same thing a moment later and have no pain? Why did your nervous system anticipate pain in this situation? Maybe you had something else on your mind that was stressing you out, or maybe you were a little worried about how reaching would affect your shoulder because it’s been achy. Or maybe you were tired, or maybe you don’t normally reach at that angle, so you weren’t quite sure if the new position was okay. Whatever the reason, your nervous system anticipated the movement as being potentially harmful, even though it didn’t pose a threat to the musculoskeletal system.

We all have habitual movement patterns that get us through the day. I don’t have to think about which hand I use to brush my teeth (though it’s fun to try and brush your teeth with the opposite hand once in a while). This saves me time and makes me efficient at tooth brushing, freeing up energy for other things, like pondering nociception and learning Parkour. Habits create efficiency, which is a good thing.

Sometimes, our habits create sensitization. In the above scenario, reaching the arm towards an object caused a twinge, so hypothetical you waited a second and tried it again. There is a pretty good chance hypothetical you changed something slightly about how you were performing the movement, whether it was reaching at a slightly different angle or using less muscular tension or more muscular tension, or less bend in the elbow. One way to look at pain that is caused by a specific movement is it’s a teacher to let us know we should try doing something differently.

But what if when you reached it caused a dull ache in your elbow that you ignored? And every time you reached you felt this dull ache, but you kept reaching anyway because life required you to reach? And what if you were to spend an entire day paying attention to how you reach and you noticed you reached for everything by tensing your fingers and never fully extending the elbow? Is it possible your options for reaching have become so narrow you have created the perfect situation for irritation, whether it’s of the tissues or the nervous system?

A few months ago, I noticed a dull ache in my right lateral hip while I was sleeping. Like all good practitioners who become complacent about practicing what they preach, I ignored it. Soon, it morphed into a sensation of tightness through the front of my left thigh that was sort of electrical feeling, more like nerve sensation than muscle sensation.

I viewed it all curiously, and while it didn’t impact my life or my movement practice in any way, the sensations were annoyances. It didn’t occur to me to check in and see if I had developed a habit that was creating movement patterns that were sensitized, or ponder whether my current work pace was creating a hyper-vigilant loop, rooted in too much doing and not enough time being “off.”

In October, I thought it would be a good idea to add either writing or filming to my lunch breaks. By the time March rolled around, I was using every free moment between clients to write or film, and after work time was becoming consumed with added responsibilities that come along with a busy in person practice and a desire to grow professionally in a different way. Maybe, just maybe, I was embodying my hyper-vigilance and perfectionism, tendencies I am acutely aware of and spend a lot of time fighting.

A New York Times article came out earlier this year that told the story of a 71 year old woman who was born with a rare genetic mutation that prevents her feeling pain. She also has extremely low levels of anxiety. She scored zero out of twenty-one on an anxiety-disorder questionnaire and doesn’t remember every feeling depressed or scared. Perhaps anxiety and pain are related, suggesting our thoughts become our physical selves, or maybe our physical selves become our thoughts.

In late Match, I began filming a course on the pelvis. Two days after I began filming, I noticed the sensations in both hips had significantly decreased. The last weekend in March, I went to a workshop based largely in somatic techniques and centered around the pelvis. I suddenly realized in the midst of the workshop I had been clenching my glutes. All of the time. The tension I was carrying in my life and the pressure I was putting on myself were translating into my body.

The sensations completely decreased after the workshop. Periodically throughout the day, I still feel myself defaulting to tightening and clenching. When this happens, l relax and observe, my emotional self resisting, as though relaxation isn’t okay.

Currently, the prevailing thought making rounds in the movement and therapy worlds is if there is pain, you should load it. While this works well for people who aren’t strong and who need more strength, for those who are already loading the area and there is still sensation, finding an alternative solution through changing position or down-regulating the system may be a better solution.

A client came in recently who has been working with me once a week for almost five years. He lifts regularly on his own. He also has a high stress job and spends a lot of time working—I have never known him to take a vacation. He had tweaked his knee but, he told me, he was able to get rid of the discomfort if he subtly shifted his position. While it could be argued that shifting position shifts load (and I would agree that this is true), it also creates a connection with you and your body. How are you moving in this movement right now? Is it serving you or could you change something about it to make it more comfortable?

Earlier that same week, another client texted me to let me know her chronic pain had become less chronic. When she felt it come on, she breathed, shifted positions, and waited to see if it would pass. More often than not, it did.

Prior to seeing me she had tried working with various trainers. Her pain continued to get worse, until it was a deafening scream in her right upper gluteal region. MRIs revealed nothing, and she felt frustration with herself and a disconnect from her body. A combination of modalities, including improving kinesthetic awareness, learning how to perform movements in ways that didn’t hurt, and learning she had the power to change her experience through subtle, gentle shifts created a connection between her and her body; strength training in a pain free way reminded her she is strong. She needed strength, but that alone wasn’t breaking the pain cycle.

While there is absolutely value in creating strength and a sense of resilience, if you are loading your tissues and that isn’t working, don’t be afraid to try a different approach. We all have different definitions of what pain feels like, and everyone’s threshold for sensitivity is unique. Was what I experiencing in my hips pain? Probably to some, but I didn’t view it that way. However, what I experienced in my twenties was definitely what I would define as pain. I am, hopefully, a different person than I was fifteen years ago, so it’s possible just the act of growing up has changed my perspective on how I view sensation.

Enabling people to feel holding patterns and encouraging subtle shifts creates a sense of freedom; instead of feeling like the body controls the experience you, actually, have far more power than you realize. My sensations disappeared when I took the time to slow down and actually feel how I was holding myself. An old proverb says, “if you listen to your body when it whispers, you won’t have to hear it scream.” Getting stronger is one important piece to feeling better, but I don’t think it’s the only piece.

Swiss balls have come back into vogue; so has balancing on uneven surfaces. I have no doubt the pendulum will swing again, hopefully equally emphasizing the value of strength as well as the ability to feel.