Understanding how pain affects our overall function on the one hand seems rather simple. Usually it goes something like, "If I do this it hurts. Hmm...don't do that." In fact most people would opt to just "wait" it out and allow time off to "fix" the problem. We'd like to talk about why this might not be the best way to recover from injury or persistent pain with the ultimate goal being to restore your function. We find that using metaphors can help folks understand more about their pain and how it may affect their function as well as overall quality of life.
Twin Peaks Model
Let's start by introducing the "Twin Peaks Model" proposed by Moseley and Butler (2013) in their book Explain Pain (see below). This model conceptualizes the differences between those folks living without pain and those living with pain. There are a couple of points you need to understand about this metaphor. First, the mountain peak heights are depicted as different heights signifying different amounts of function (intensity). Secondly, the height of each peak then relates to the difference in tissue tolerance a specific tissue . Notice those with persistent pain (on the right) have a tissue that can tolerate less (or tissue fitness) overall stress. There is also a wider gap between what a person's tissue will tolerate and when the body will mount a protective response. As we've discussed in other blog posts (here) the body has a number of ways it will protect itself when it senses danger. Two of the more well known ways include producing a pain response and changing how we move.
Thinking along those lines it is important to understand that with injury our tissue tolerance as well as our bodily protection changes to become less tolerant as well as more sensitive to a given stressor. More often than not, this stress is less than we may have grown accustom to prior to our pain or altered movement.
Stoplights & the Twin Peaks
So how does this relate to our activity level AND why would pushing through the pain or even resting to "wait it out" not be considered the optimal course of action? Benjamin Boyd (2023), in his book Bodily Relearning: Reteaching bodily protection responses through insight and movement, adds yet another layer to the Twin Peaks Model. This layer uses a stop light to shed some light on what it might look like to perform at a higher level (intensity). Below, a modified version of the one presented by Boyd is recreated for a person dealing with pain. Note the illustration is the right half of the Twin Peaks Model depicted above.
In this metaphorical illustration the levels of intensity (height of the mountain) are further divided into three zones: green, yellow, & red. Each zone reminiscent of the "rules of the road" so to speak where a green light is consistent with safely continuing along the same path. A yellow light signifying a time to proceed but with caution, while a red light means we might want to stop or we're likely putting ourselves in harm's way.
Traveling the Road to Recovery Through Movement
Ok so lets see how this relates to movement or activity when pain is involved. Consider for a moment that pain is a unique experience that is very complex and though some movements may increase pain others may not. In the green zone we perform movements or activities, no matter how low level, that we believe to be "safe" and do not typically promote a pain experience. Note this zone also takes into consideration when we rest. As we begin to perform higher level activities (whatever they may be; typically with greater physicality) we move into the yellow zone which consists of movements or activities that may result (increase the risk of) in a "flare up".
A flare up is denoted by the dotted line in the middle of the yellow zone. It's important to note that the "tipping point" is that point where our bodies would mount a protective response, such as pain or altered movement. Reaching a point of becoming "flared up" isn't necessarily a "bad" thing. In fact, as we recover from injury or persistent pain we will need to work to a point where we continually push that "flare up" limit to continue to make progress. However, if we continue to push the envelope, so to speak, into the red zone this will likely decrease the breadth of our green zone as well as the yellow zone, that is to say this would result in fewer activities we could perform before we'd move into the yellow zone with a greater likelihood of triggering a flare up more quickly. In fact, the more we pursue a "no pain, no gain" mentality the more likely our capacity to perform activities will suffer. We've all likely been guilty of doing too much too soon at some point in our lives and can related to this situation.
On the flip side, now let's talk about a scenario that will also likely result in a similar result. One that isn't so intuitive. In this scenario we decide to rest, not do anything with the goal to allow our problem to go away, or "fix" itself. This seems like a great idea, right? I mean this is what most people hear from their medical providers, "if it hurts, don't do it". Well with acute injuries in the first 24-48 hours this makes complete sense, but what about after that time frame or in those cases where we are dealing with persistent pain?
The reality is that if we "lay too low" long enough our new normal will become a lower level of activity that we might consider "safe" and we won't be able to perform at the same level we might have prior to or at the onset of our pain experience. This will result in reaching the point of a "flare up" at a much lower level of movement intensity than before. The take home is that we need to explore movements even in those cases of persistent pain. As we explore motion we begin maintaining or even rewiring those neural networks needed to move the amount of motion and movement intensity to higher levels with each successful exploration.
As with most things considered to be "good" for us, there is likely a balance between rest & activity that makes all the difference in the world when it comes to recovering from injury or from persistent pain. Unfortunately many have been led to believe, on either end of the activity-rest continuum, that if some is "good", a lot must be "better". This is not necessarily true. Not to mention what is considered to be "good" for some, may not be "good" for others. The key is to begin to exploring movements that you are able to do without too much in the way of a flare up. With each passing day continue to move into the yellow zone of activity, before long you will begin to see your capacity as well as your overall ability start to improve.
If you're struggling with a nagging injury or living with persistent pain AND you're not ready to throw in the towel we at 4th Corner would love to be in your Corner. Reach out today & let us help you navigate the peaks in your life. Get started today & schedule a free 15 minute injury screen or discovery session to find out more about how we might be able to help.
Until then stay intentionally AND habitually active!