02 Jun Flare Ups: Understand them to avoid them
Triggers for pain are different for everyone, but, especially when it comes to back pain, I see some common themes.
A combination of fixed position + stress
For instance, sitting working at the computer or driving. With driving this is particularly obvious: you can’t change your position, and other drivers’ behaviour is a cause of stress to even the most sanguine of people!
Doing something you aren’t conditioned to, especially when it involves repetitive movements
Digging is a good example. If you are only working in the garden occasionally it’s actually a bit of a workout that you might not be conditioned to (see here about pacing yourself in the garden)
The random flare up!
E.g.” I bent over to tie my shoe laces and my back went into spasm.”
So how can I help myself avoid pain flare ups?
We usually attribute pain to the physical things we have done. Sometimes that is obviously the case – when we have got an injury. But you have probably noticed that stress can be a factor in how you feel.
Pain is not just your body, it is a combination of your body and brain, and the nervous system communicating between them (see here to learn more).
If you think of mind and body both contributing to the experience of pain, then you might see different patterns in what is causing your flare ups than the purely physical. This is the start of learning how to avoid them.
The random flare up usually gets blamed on physical causes.
If you lifted a relatively light box, and your back ‘went’, you might blame the lifting as the sole cause of the pain. But if you lift equally heavy weights regularly everyday why would you hurt yourself this time? Were you tired? Or a cold coming on? Or utterly fed up of work at the moment? This can make a little pull or twinge in the back you would have hardly noticed on another day seem much more significant. (this happens unconsciously by the way – we don’t get to choose whether we feel pain – although we can choose how we react to it). Why would just bending down to pick up something be catastrophically painful on this occasion when you do it tens of times every day with no trouble? There is something going on in the muscles or soft tissues, to be sure, but there must be more to it. This is the pain puzzle: what else is going on that has made this minor physical thing seem so alarming to your nervous system?
Working out your ‘pain puzzle’ can help you avoid pain flare ups
Pain is always individual, but to give you an example of how understanding your pain better can help you manage it and avoid flare ups, I’ll confess about situations where I still have to be mindful of my own pain management.
I had years of severe chronic pain, where sitting for more than a hour was torture. I have learnt through Alexander Technique to sit with little effort. I also shift position regularly to create variety of postures. This has allowed me to go from sitting as awful, to sitting with ease.
However, because of my long history of pain, my nervous system is still slightly on high alert compared to someone who has never had persistent pain.
If I had pain now after sitting for some hours, it would be easy for me to blame just the sitting itself as causing my pain. But…. I have attended all day lectures where I barely stood up all day, with no problem. I have been on long train journeys where a couple of strategic leg stretches was enough to keep me entirely comfortable. In those cases sitting wasn’t a problem.
If I am in front of my computer wrestling with getting a difficult concept across (this one?!), or trying to do something ‘creative’ (out of my comfort zone!) I can find a warning niggle of pain rearing its ugly head.
So, how do I respond to that and avoid the pain?
Of course there is still a little part of me that says ‘oh no!, pain!’ , because that is what pain is : an alarm signal that demands we pay attention (eventually at least…)
However, I know that this pain is nothing to do with any damage to my body, it is just my brain telling me that something is wrong. But what? I then go through a mental checklist:
1. Is this a simple case of being in a fixed position for too long?
Have I taken enough breaks during this task? Do I just need a 5 minute walk around or a 10 minute semi-supine?
2.Am I attending to how I’m sitting or am I getting too caught up in what I’m doing and getting tense?
If I just think more about how I’m working, does the pain ease? see here for tips on taking care of yourself when sitting.
3.Is this pain more about the stress or frustration this task is causing me than the sitting?
Should I stop for now? If I need to continue can I break it down into smaller tasks, or mix it up with more relaxing work? I might need more regular breaks when doing something I find stressful than when doing something more pleasurable or easy. During more stressful tasks I run regularly through my ‘emergency checklist’ (see here)
4.What else is going on?
Am I stressed out by other things in my life? Have I been really busy lately, or not slept well? These sorts of factors are a drain on your whole system that decreases your resilience. This can mean that little ‘complaints’ from your body are taken more seriously by your brain, so it produces the experience of pain more readily.
If I’m run down, that’s the time to prioritise self-care for a while. More on this in future blogs, but nurturing stuff can actually directly help pain. My go-to things are resting in semi-supine, walking in nature, and time with friends. You may have different things that help you.
Pay attention, but don’t panic!
If you start looking, you might find that your pain triggers are stress related or emotional as well as physical. There is usually a physical component to be sure, but if you think about what happened in the days or weeks before a flare up it may be more complex than you used to think. You won’t have the same triggers as me, as we are all different, but if you look for them you will probably find themes in what makes your pain worse (or better).
Your pain is telling you something and you shouldn’t just ignore it. That doesn’t mean that you should stop doing what causes you pain altogether, or worry every time pain is a bit worse. But this is information about your well-being – use it.
You will have to come up with your own ‘checklist’ for what’s behind a pain flare up (sometimes its mysterious though!), and have your own ‘selfcare’ list of things that avoid the pain and restore you.
I’ll be talking more about how selfcare helps pain and fatigue, and how to increase your capacity in future blogs.
What would go on your self care list?
Want help to work out your ‘pain puzzle’? Contact me