Friday, February 12, 2010

(Why) Do we get Protective of our Pain?

When i was at my worst with chronic back pain, i was, i think, pretty durn open to hearing about approaches that promised redress. Better than weeping if i picked up a sock and actually didn't hurt - the rarity induced the tears, knowing this would be fleeting; wishing it weren't.

So i've been surprised when i get chatting with folks, and as they hear about what i do with respect to movement and health coaching, that they start to tell me about their various (often chronic) experiences with their own pain. After the usual "how's it going with your doctor" and "oh they're useless it's just drugs or surgery so i've seen [insert manual therapist here]."

If that's followed with "and how's that going for you?" the reply may vary. Sometimes it's - "oh i have this great therapist i see once a month or once a week and i feel great after those sessions"

And sometimes the follow up discussion is about, why do you think you need to keep going back? - just to explore what the beliefs are that have seemingly come to accept that this is their new fate: to be committed to perpetual treatment. Sometimes, they're open to other models.

An alternate reply is the constant seeker - i can relate - "oh well i try 'em all; i'm still looking for a better [insert therapist type here] i used to have a great one - i've heard [insert other therapy here] is good, so i'm thinking of trying that" Sometimes this leads to a discussion of what these therapies might have in common, such that the approach may be leaving the person wanting; that something might be getting overlooked in the focus on the site of pain rather than perhaps on interrelated movements. Maybe it's not the right model for the circumstances. I do wish someone had offered me that observation sooner than later.

I'm Happy with my Condition. But these two responses are as nothing to this other, rarer response. The, well, i like the therapy i have now for X. I'm not better, and i don't get too much worse, but it's ok." A few times i have asked "but don't you want to get to a place where you don't need to see Y for X? where X is just better?"

Often the response to such a query is surprisingly protective. I can see the person pulling back almost physically towards that area of specialness, getting it as far away from me as they politely can. Their words in reply to my query are generally awkward and non-specific, indicating they'd just rather change the subject - at least with me, at that time and place.

I realize now, since learning more about motivational interviewing, that my attempt at engagement while feeling incredulous could be better framed as "that's great. sounds like that management of flareups, adapting your workspaces, is working for you. if you learned of an approach that would likely diminish X, rather than manage it, would you explore it?"

Other circumstances, though, are similar. Someone told me recently that they suffer from a particular condition. I'd just seen some research looking at this from an alternative cause perspective, and so asked this person recently if they were aware of it, and that the results seemed promising. The person couldn't have been more luke warm to learning more. And i'm thinking what's up? don't you WANT to get well?

The Value of The Condition. And then it finally hit me, well, maybe not. And then i thought, duh. Physical limitations can be convenient; they can help deal with fears. One person i know is in a constant state about getting back to the Fat Kid stage (he's now skeletal) and happens to have irritable bowel syndrome (IBS) - a recent development, and we're talking a fellow in his late 20's. The biggie that can't get handled with IBS? Fat. Another person i know has "bad knees" and travels a lot, overeating poor food, but is quite content with being overweight - reflecting that for "her age" she's in good shape, don't i think. And with the knees, well, can't really go to the gym now.

That's cheap psychologizing on my part, isn't it? And i don't mean it as a judgement of any of these folks; more a revelation for me (i'm a bit slow sometimes). We likely all have things we use as ways to legitimize choices or limits we put on ourselves that work for ourselves as an optimal strategy, based on the best of our understanding. And i mean that: we're busy people. We only have so many cycles on a day to focus on learning new stuff.

So let's say my cheap psychologizing is right and that IBS person has the best tool they can imagine for maintaining the thin physique they wish. Health is not their priority; not ever getting fat again is. IBS is working. They have the protection of a Condition to justify their very restricted and to me frighteningly low cal way of eating.

Likewise, when my back was killing me, i admit to using it not to go to Event X as i couldn't stay on my feet that long (so true) but did i want to explore alternatives? Hmm.

How Might Our Approach Change? What this dim insight into our attraction some of us have to our own pain may mean is a question mark in terms of better designing delivery of proactive health care/support for well being.

It's a sort of the site of the pain isn't the source of the pain necessarily. To trainers, i might ask, how often do we when taking a history ask about how things are at home? How stressed at work? About general happiness? Generally for me, my focus is on past injuries, surgeries, current training, supplements/medication. I'm a coach, after all, not a doctor, right? Other state checks have only come up if an athlete tells me they've been having a hard time sleeping. But what if i asked "are you happy, stressed, getting enough sleep" or related up front?

I don't have to have the answers if they tell me they're really depressed, actually. But at least that's a sign to say, maybe consider a coach that can help navigate that path, too?

These aren't answers that are complete; its just to highlight that perhaps the way we do health, well being, as only treating an illness is not so useful, especially when that illness may be valued and protected in a person's world.

Still a bit muzzy about the point of all this, but maybe there's a bit of an ah ha in here. let me know what you think.


Chris said...

That is a really thoughtful post mc.

My back flared up again this week. The familiar tightening of the lower back, gripping and making me immobile. I was a mess.

I went through the R phase DVD trying to keep out of pain. I also had a massage which helped.

now i am just trying to keep mobile.

What caused it? I don't know. Stress and work and in a relationship to me seem more important than the workout the day before the spasms.

I am certainly open to new approaches!

dr. m.c. said...

Have you ever had a movement assessment/screen, Chris?


Chris said...

No. Do you recommend it?

dr. m.c. said...

Yes Chris i do.

Simple reason: if movement is funny anywhere, addressing movement often results in great side effects like improved function and reduced pain. Such assessments pull the focus up and out away from the site of pain to look at the animal more globally, and to assess movements per se rather than spots. I've experienced great benefit from this, and the folks i've had the pleasure to work with seem to benefit there too.

Assessments can be done in person or via the web.

If you want to shop around for price/location, there are a bunch of Z-health trainers in the UK now, including two who are also RKC's and CK-FMS cert'd.

list here

i also do video assessment consults for the more locationally constrained.


Unknown said...

Enjoyed your post.

I think it ties in with those "secondary benefits of illness" which I've heard of.

Loved your series of articles on the vibram 5 fingers - went out and bought a pair of kso's. Only time I don't wear them is in the snow.

take care,

dr. m.c. said...

thank you, Bonnie
so what are you wearing for your winter feet?

and how come the lads get kso trek flows, i'd like to know, which could be great for winter with a pair of sox.

thanks again


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