Movement is a fundamental aspect of human life, shaping our interactions with the world and people around us. When we are not experiencing pain, we move without hesitation, without restriction or fear. We cruise through our day with full confidence, not thinking of the incredible interaction between brain and body that plans, coordinates and executes everything we achieve during the day, both conscious and subconscious. However, when pain becomes a player in this symphony, our bodies respond by adapting movement patterns. It’s something that humans are very, very good at – changing the way we move to avoid pain. While this can initially be protective, if these changes are retained, they may become more harmful than helpful.
This blog will cover the following points on movement and pain:
How and why does movement change in response to injury?
Say you have a minor ankle sprain - your ankle hurts to walk normally. Our immediate reaction is to change the way your foot hits the ground, so it doesn’t hurt as much. We don’t limp because it hurts, we limp so it hurts less!
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You still achieve your goal of getting from A to B, maybe not as quickly, but you get there. As the pain subsides (healing) you hopefully resume a normal walking pattern and there is no more to it.
A bad ankle sprain may result in a bigger limp or some time on crutches, or even a walker boot. The physical pain and psychological effects can make it harder to regain your normal walking pattern. With more severe injuries or incomplete rehabilitation, you may also be left with some movement restrictions, weaknesses or reduced awareness of where your ankle is in space (proprioception). Sometime later you may still have a slight alteration in the way you walk, because of the original ankle sprain, the retained habit of protecting your ankle and/or any residual restrictions.
Now you may start to experience hip pain, as your hip has become overloaded because you offloaded your ankle. You didn’t even know you were overloading your hip, but your hip did! To help your hip pain, we have to alter the loads at the hip, so we have to go back and change the altered movement pattern at the ankle. (The ankle bone’s connected to the shin bone etc etc)
The Neurological Symphony: (or tug-of-war!!)
The relationship between pain and movement is complex, involving a delicate interplay of physiological, psychological, and neurological factors. The nervous system serves as the conductor in our body's symphony of movement. When pain enters the scene, it often disrupts this harmonious flow, triggering a cascade of responses. The brain, aiming to protect us from further harm, initiates changes in motor control (the way the brain controls movement) to limit the perceived threat. This alteration is primarily a survival mechanism, but it can lead to maladaptive movement patterns over time, i.e., patterns that are not so helpful.
Let’s simplify our symphony to a linear analogy – a tug-o-war team with 5 players in the team pulling hard and working towards the team goal of pulling the other team over. Player 5 gets sore and decreases their contribution. The only way to potentially achieve the desired outcome is that players 1-4 have to increase their force, but then they start to get tired more quickly. The only way to help 1-4 is if player 5 starts contributing again. (right now you’re thinking about that guy at the office who just doesn’t pull their weight right?)
So, a slight limp may cause some problems at the hip or knee sometime after the original injury and there are other common examples of adaptive movement changes that can significantly reduce your ability to function and enjoy life to the fullest.
Chronic back, neck or shoulder pain may lead to a vicious cycle where altered movement patterns actually contribute to the maintenance and exacerbation of pain. We might restrict how much we bend our back but still work out how to put our pants on or wash our feet! This often involves asking the hips and knees to contribute more (and growing longer arms!). Because the adaptive movement was so successful in avoiding pain when you injured your back, you hold onto that adaptation after it is needed. The tissue has healed. There is no need to maintain the altered movement, but it was so bad when it did hurt, that you just don’t want to go back there.
A thorough clinical assessment including comparison of side-to-side range of movement, strength, co-ordination, stability and muscle recruitment patterns (using ultrasound technology) may be necessary to create a treatment plan which will help you reduce pain and ideally resume normal everyday and sporting movements and activities.
My brain actually changes? What’s this got to do with my pain?
Multiple studies on musicians, dancers, sportspeople and other elite performers show physical changes in parts of the brain that occur in response to long-term repetition of different activities. Parts of the brain get bigger and change chemically but likewise can reverse when the repeated activity stops. Norman Doidge’s 2007 book “The brain that changes itself” introduced the term ‘neuroplasticity’ to the non-scientific world. This best-seller text portrays remarkable stories of chemical and structural changes in the brain following injury and illness and either reversal or adaptation of brain activity to ‘allow’ the patient to regain physical function.
The brain can change with both helpful and not-so-helpful adaptations. With non-helpful changes, an analysis of how you got to where you are now, educating awareness of the movement changes, high-quality input (rehab exercises), suitable progressive loading and plenty of repetition can help you lose the fear of movement, regain more ideal movement and ultimately work towards moving freely again without pain. This process allows for the establishment of new neural connections, offering hope for positive change. Rehabilitation and therapeutic exercises that focus on retraining movement patterns can help break the cycle of pain-induced movement changes – but you have to do them well AND often!!
Pain limiting your movement?
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Why rehab might involve working on other areas of the body
Solving long term pain will often then involve rehabilitation exercises that may focus on areas away from your site of pain.
A holistic approach that considers the individual's specific needs and goals is crucial. Physiotherapists and others involved in patient care must work to address not only the physical aspects of pain but also understand the psychological factors, such as fear, some unhelpful beliefs and lack of confidence that may contribute to and perpetuate movement adaptations. (This is termed the biopsychosocial model) Patient education is a key component, empowering individuals to understand their pain and actively participate in their recovery.
Understanding pain is crucial to restoring freedom of movement
Pain was once thought to be a simple reflex to a stimulus – a pain signal went to the brain and there was a reaction to it. The contemporary understanding of pain is vastly more complex, but it is beyond the scope of this article to describe it. We do know it is critical to understand the complex nature of pain to enable the restoration of painfree movement. A great introduction to understanding pain can be found here in this video by esteemed neuroscientist and Physiotherapist Dr Lorimer Mosely.
The relationship between pain and movement is a complex symphony. If you are experiencing pain when you move, or you are avoiding movements or activities because of pain (or the fear of pain, or lack of confidence), we may need to explore when and why you started to move differently. While pain may initially prompt protective adaptations, understanding and addressing these changes are crucial for long-term well-being.
Is pain making it hard to move normally? Finding normal tasks more difficult? Visit us at PhysioTec, and let one of our physios assess you and provide you with a personalised program to help you get on-top of your pain, and back to doing the things you love!
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- Alsop T, Lehman E, Brauer S, Forbes R, Hanson CL, Healy G, Milton K, Reid H, Rosbergen I, Gomersall S. What should all health professionals know about movement behaviour change? An international Delphi-based consensus statement. Br J Sports Med. 2023 Nov;57(22):1419-1427. doi: 10.1136/bjsports-2023-106870. Epub 2023 Oct 4. PMID: 37793699.
- Kantak SS, Johnson T, Zarzycki R. Linking Pain and Motor Control: Conceptualization of Movement Deficits in Patients With Painful Conditions. Phys Ther. 2022 Apr 1;102(4):pzab289. doi: 10.1093/ptj/pzab289. PMID: 35079833.