Pain and Injury - A Perspective
My approach to pain and injury: there are three main entry points - 1) understanding the modern pain science, 2) learning about tissue adaptation, & 3) “Know Thyself”.
Modern Pain Science
Pain is not an input to the brain; it is an OUTPUT. (There is no such thing as a “pain receptor” in the body). Pain is a prediction of threat to the body based on many inputs. In addition, there is no 1 to 1 relationship between tissue damage and pain (you can have pain and no tissue damage, or tissue damage but no pain)
Tissue Adaptation
Why is connective tissue (tendon, ligament, cartilage, menisci, bone, fascia) the main tissue type in the body to get damaged? Because connective tissue is the scaffolding of the body that transmits forces. Forces carry energy, and energy can exceed the integrity of the structure transmitting it.
But connective tissue is highly adaptive - there is a cytoskeleton in all connective tissue cells that transmits the vibrations of force through the cell membrane into the nucleus, to induce changes in genetic expression. In connective tissue, this results in changes in the proportions & kinds of collagen, elastin, & proteoglycans manufactured by the cell for structural support.
Know Thyself
“Know Thyself” - use the knowledge of tissue adaptation in conjunction with self-observation. We update our approach as more evidence & information comes in. This is fundamentally experiential. A simple formulaic arrangement will not work, & we assume responsibility for our recovery.
We let the evolution of the functionality that was lost dictate what we pursue. A shoulder tear doesn’t just need some banded external rotation… it needs a plan potentially working with isokinetics, 360 degree angles of strain, high volume, low volume, scapular stabilization, quick eccentrics, elasticity, etc.
Over the years, I’ve prepared articles, a whitepaper, and presentations, evolving this perspective. Pain/injury is so convoluted that it can’t be reduced to a straightforward narrative. The next best thing is a map, designating various entry points into the territory.