Rules about Pain

I recently read a blog post which made some interesting points about back pain. The argument presented was that back pain is not caused by heavy lifting. If it was it would likely be much more of a problem than it is for elite rowers who are pulling a large amount of weight through their curved backs on a regular basis. Rather, the post argued, back pain is far more likely to be due to inactivity and muscle weakness, leading to an intolerance of normal patterns of movement and lifting which then trigger problems. This argument makes a lot of sense to me and fits with my own experience of working as a pain management specialist. Yet for years accepted practice in occupational health has been to teach us to limit the amount that we lift to almost derisory levels in order to protect our backs from injury and long term disability. Perhaps not surprisingly there is no evidence that this focus on manual handling training has led to any improvements in the levels of disability caused by back pain in recent years.

It's worrying that within our culture there is a widespread belief that lifting and bending can be damaging for our backs. This is a belief that may support what psychologists call 'experiential avoidance', a tendency to limit our experience in order to avoid a potentially unpleasant outcome. Unfortunately in the case of back pain it may well be the case that the avoidance of certain movement patterns itself puts us at increased risk through inactivity and muscle weakness.

It's understandable that we would want to avoid pain. The very purpose of pain is to alert us to potential problems and motivate us to take action to avoid them. Yet often, the 'rules' we start to follow which we hope will reduce our risk of developing or exacerbating problems cause more problems than they solve.

The consequences of avoidance can be as simple as muscle weakness caused by inactivity. Often though this is just the start. By following 'avoidance' rules we can end up putting limitations on ourselves that considerably narrow our horizons and leave us disconnected from the things that are important to us and the life we would have wanted to lead. This same process often massively increases our suffering, whether from physical, emotional pain or both. Yet it can be hard to spot when we are doing this, especially when our culture strongly supports the avoidance message and need to follow 'rules for good health'.

One way in which Mindfulness can help us to deal with pain is by allowing us to tune in to our experience of how things are, rather than judging how we think they should be. This can help us to genuinely respond to what we need, rather than using rules to try to minimise experiences that we don't want to have. Health recommendations can be helpful if considered as guidelines but may just become a form of experiential avoidance if held too rigidly. Perhaps the way to truly embrace good health is to be fully engaged in things that really matter to us, so we don't end up needing to compensate for a life less lived with unhealthy behaviours and choices.

#pain #painmanagement #mindfulness #ChrisPenlingt

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