Is your job a ‘black flag’ for chronic pain?

In a previous life I was a vet.

When I broke my back as a student, my surgeon told me that I shouldn’t try to be vet.

Of course, I ignored him, I was 18 years old, and I had my 2nd year of vet school to get back to, thankyou very much.

I’m glad I didn’t listen, but I understand more now about why he warned me. He was waving the black flag.

Vets, and other health professionals have a ‘black flag’ for pain.

In the same way that red flags indicate a risk of a possible serious pathology, e.g. when you have back pain, a black flag indicates a risky occupation or social context for developing chronic pain.

Not that the problem will develop inevitably, just that someone assessing you for pain would need to bear your work in mind. Black Flags consider the aspects of the job that you have little or no control of.

The main job risk factors for vets are:

  • Physical aspects – awkward lifting, holding postures for long periods.
  •  Long hours
  •  Unpredictability
  • Stress of dealing with clients
  • +increasingly, dealing with public flak on social media too.

Does that sound like your job too?

All this won’t be a surprise to you. But what can be done about it?

The good news is that pain is more complex than we give it credit for. It’s more of a puzzle, or like an ecosystem than a simple biomechanical/medical thing.

Why is that good news?

Because it means that there are solutions out there for pain that you haven’t tried.

You know how complex your body/mind and nervous system are. Pain has multiple causes, a myriad of aggravating factors, and involves many physiological systems, with some emotional stuff to stir into the mix. So, it would be weird if an experience like chronic pain always responded to one simple input, like exercise or manipulation.

The solution doesn’t have to be complex, just that we need complex systems thinking, not this input = this output thinking. 

If pain is a complex puzzle then you just need to start working on changing some key puzzle pieces. Choose the right ones for you and this can have a cascading change through your system. This can potentially change you from a persistent pain state to a no pain state. But it’s not a simple button you can press.

Some of the key ‘pain puzzle’ pieces for vets and similar professions and how to change them:

Tools to cope with the physical demands of the job

  •  Strategic postural changes
  • Learning to use minimum muscular effort for the job in hand
  • Movement ‘sense’ – having a variety of movements available, being able to avoid aggravating movements that keep pain lingering (this is harder than you think – habit is strong!)
  • Having appropriate strength for what you need to do without having to spend lots of time in the gym (unless you enjoy it!).

Tools to cope with long hours/ demanding environment

  • Being able to reduce physical responses to stress throughout the day.
  • Being able to ‘wind down’ and properly relax ‘on demand’.
  • Addressing sleep.
  • Making time for fun/leisure.
  • Social support.
  • Movement/exercise, that is right for you, not just what is ‘supposed’ to fix pain.

If we all had tools to address all these issues, would stop the vet profession having a black flag?

Of course not. There are all the things that a practice needs to do to protect its staff. Moderating hours, mandatory rest breaks and protected admin time, culture factors like encouraging finishing on time, listening and responding to staff needs etc etc.

But I see people pursuing ways to ‘fix’ back, neck and other MSK pain that I know have a poor evidence base, and, more importantly, might actually be detrimental to their ability to recover from pain. Because they don’t understand what they need to help their pain.

For me, it turned out that my surgeon was right. I did get severe back pain a few years into my career. Not to say that my pain was inevitable, it really wasn’t. But without the right pre-emptive tactics and the understanding of why pain might be more likely to develop in my situation, I was clueless of how to deal with pain that did crop up.

Then, when I reached out for professional help, I didn’t get what I needed. I got structural ‘fixes’, manipulations, postural ‘corrections’ and endless Pilates when I was already strong. Alternative therapies were nicer, but also ineffective and were still accompanied by the same ignorant narratives about pain.

I got into a vicious descending cycle, which led to me dropping out of my profession.

But what could have happened differently if I’d had the right information and support?

Knowing what I know now, what do I wish I’d been told as that 18 year old with a newly fixed, but wonky spine?

Preferably by a smiley, good looking, stock photo type of physiotherapist….

1. Prevention of chronic pain  (as far as it is possible) looks very similar to general self care.
Exercising, reasonable diet, having some fun, keeping stress within manageable limits, and getting enough rest and sleep.

2. A structural issue doesn’t mean that pain is inevitable

Being told that is a massive nocebo, and clinicians should use their words with care, as they are powerful.

3. Having had a long period of pain in recovery from an injury is a risk factor in developing chronic pain

Because of factors to do with the nervous system. But again, nothing is inevitable.

4. How pain works

Most people don’t really understand it well, so choose someone who does if you reach out for help.

But mostly I wish someone had said:

4. Develop your own toolkit for pain

So it’s ready and waiting to nip any pain problem in the bud.

Then what about if pain starts to creep in?

Obviously you get checked out for any red flags, treated for any specific conditions, and if needed, get surgery or proper medical management. But more often than not, managing or recovering from pain is mostly about yourself, your support system, and changing your pain ‘ecosystem’ by using your toolkit.

If you go back to the list of tools needed above, you will see that mostly they are about soothing your nervous system from brain to tissues. 

You shouldn’t feel you have to do aggressive exercises or stretches, work endlessly on your core, pummel yourself, or get treatments like manipulations, especially if they wind up your pain. It’s about what works for you, not what you feel you ‘should’ do because it’s what is popular or common practice. Popularity and familiarity of methods have very little to do with their grounding in the evidence of what works for chronic pain.

You can’t avoid all pain as a strategy for recovery, but doing things that repeatedly make your pain significantly worse, especially in a background of high levels of pain and stress, are highly unlikely to be helping you, because that’s not soothing your nervous system, it’s aggravating it. If a professional is telling you to keep on winding up your pain in order to do ‘something’ to the tissues,  you should probably move on.

The tools you want to have are also mainly things you can do for yourself, rather than needing to be ‘fixed’, ‘adjusted’ or ‘treated’ by anyone else (at least long term). Self efficacy (with plenty of support) is what the evidence points to being most effective for most people long term.

If you have your tool kit ready to go,  and good habits already in place, then if pain does start to creep in, it doesn’t need to take over like it did for me.

What if pain has already taken over my life?

It’s harder to dig yourself out of a deeper hole for sure. You need to be more diligent, and get a lot more help. But big shifts can be made if you get the right input. I’m proof of that. 

No-one can know what your outcome in terms of pain recovery will be, as it is dependant on the underlying reason for your pain, and on your own personal complex pain puzzle. But working towards good pain management and pain recovery is full of win -wins for general wellbeing and resilience. so why not try?

And if you are working on the wrong things currently, it can actually make your life easier and simpler to move over to using the right tools, as well as increasing your chances of getting long term pain relief.

Would you like have a toolkit for pain?

Come and join me in my Facebook group – to get those tools in your tool kit, for the social support, empowering knowledge, movement re-education and a better approach to posture that makes your life easier.

Or contact me for a chat to see how I can help you.

Starting the 10th October I have a 5 day mini-challenge to introduce you to one of the tools I use – mindful movement. Mindful movement gives juicy new neurological info for your brain and nervous system to help soothe and ease pain. To join us click here.

This is not medical advice. If you have any concerns about new or ongoing pain, please consult a medical professional.


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