Don't get me wrong - our job is to help you get pain free. Completely pain free, for as long as possible.
But to do this things might take a little while. Typically the longer you've been in pain the longer it takes to stabilise the factors that are causing it. And we've seen it time and time again, people getting disheartened that they're not progressing because the pain is still there. But you are making progress, its just not in the exact stages you want - like jumping straight from A to Z, there are some steps on the journey!
But you are making progress, its just not in the exact stages you want - like jumping straight from A to Z, there are some steps on the journey!
When you've been struggling with pain for a while, the process is the same. Pain isn't just from one factor, you need improvement in range of areas in order to get a noticeable improvement in pain. So, here's how to spot your progress on the way to getting pain free.
1. Intensity of pain
One of the first questions we ask you every time you come for a Sports Massage is how much does it hurt, normally on a scale of 0-10. Now a drop from 8 down to 7 out of 10 is still pretty painful - but a 10% improvement in something that's been hanging around for a while is a pretty good sign. Normally you've come because things have been staying the same, or getting worse. So if there's a drop in the level of pain, then something is working.
2. Area of pain
This can be one of the first things to improve. If pain has been around for a while there will normally be an area where the pain started, and this will typically be the last to go. But over time pain has a tendency to spread, or when its aggravated you feel the pain elsewhere. So, if the pain is starting to stay isolated to where the injury was, or where the initial site of pain was - this is a good sign! Chronic pain has a way of confusing the body, making your perception of pain change over time. Ideally it should just hurt where the injury is. So if the area of pain has reduced - again, whatever you are doing it working so keep it up!!
3. Frequency of pain
This one is pretty obvious - if you'd been getting headaches every day and they've dropped to once or twice a week, then you're getting better. Some issues still remain just as painful every time they occur, like migraines, but if the frequency is dropped significantly then you've learnt to stabilise the conditions around your 'good' days meaning you can have confidence that your treatment plan is working and that now is not the time to give up!
4. Recovery from pain
Another common thing we see is an improvement in your recovery from pain. So when you get an episode or flareup of symptoms instead of needing to take a few weeks off of training its only a few days, or even just a good night's sleep to recover. As above, don't get me wrong - we want an improvement in all of these areas relating to pain. But just because you're still experiencing symptoms doesn't mean the work you are doing isn't working.
5. Pain tolerance
This isn't that we teach you to be more hardcore and just ignore the pain! This means that you are able to do more before the pain is triggered. Very simply if you can run 5K and then your knee begins to hurt and before you used to run 500m then you've had an improvement. Now, of course, this could simply be due to rest - you haven't actually addressed any of the mechanical issues that were causing the issues you've just had time to heal the damaged tissues. So yea, you can run further before you feel it again. So we want to see a sustained improvement in what you can achieve before you get the same symptoms.
6. Predictability of pain
Now, for a simple injury you should be able to describe to me what movements, positions or circumstances cause your pain. This could be just that the pain is present every morning and eases throughout the day or that when you're getting out of the car you get a sharp pain in your hip. Chronic pain tends to be more complicated than this. Although there are certain movements or situations may be particularly triggering you'll have periods of time where it tends to hurt unpredictably. You don't know why it's hurting more often, you can't think of anything that triggered it or you thought you were working hard to avoid movements that were painful.
What can you do to improve your symptoms quicker?
Pain can be affected by so many things. I often talk to my patients about the difference between the mechanical damage and your pain threshold.
...you may have forgotten about maintaining your pain threshold. Loads of factors affect your pain threshold including lack of sleep, illness, diet, hangovers, stress, etc.
Now although you may be doing all things to reduce your mechanical pain; like foam rolling, stretching, strengthening, adjusting muscle imbalances, icing, taking anti-inflammatories, you may have forgotten about maintaining your pain threshold. Loads of factors affect your pain threshold including lack of sleep, illness, diet, hangovers, stress, etc.
Making your pain more predictable means two things; one you've managed to get a grip on the factors that affect the mechanical damage to the injury and second you've started to stabilise your pain threshold and manage your lifestyle better to improve your health. Both of these things are going to make it much much easier to eradicate your pain. Predictability of pain means that you can prepare for symptoms; big essay deadline coming up, you know to stock the fridge up with good food, religiously head to bed early and organise with your friend to head to the park for some short circuits sessions. As you certainly don't need that back pain flaring up and distracting you from the final dissertation for the year.
So yes - you want to be entirely pain free. But remember pain is a complex thing, give yourself credit if you are improving in at least some of these areas. It means you are on the right track!