Pain threshold is the level at which pain or dysfunction has to reach before it starts to bother us. Most people think of their pain threshold as being a fixed point. Which is why they are generally quite surprised at how much their pain is bothering them by the time they turn up at the chiropractic clinic. We hear a lot of phrases like “I have a high pain threshold”. The logical extension to this train of thought is; “if I have a high pain threshold but this pain is really bothering me then there must be something really wrong”.
The thing about pain is that there is no fixed point – we feel pain when our credible evidence of threat exceeds our credible evidence of safety. Lets use a sprained an ankle as an example. As you stumble your sense of balance is the first thing to sound an alarm. Feeling the sudden warning signals from the stretch receptors in your ligaments tendons and muscles is the next warning. You have to make a decision: is this a threat to me? At this point the brain uses context to draw most of its conclusions from and a little bit of sensory information from the offending ankle. This is because seconds after an accident the body’s inflammatory response has not had a chance to start so there is no extra nociception on top of the potential tissue damage. The brain uses what it knows, what it believes, how safe it feels and what it can see, hear, feel and taste in order to make an assessment of how much pain to give you immediately. It will keep reassessing the situation according to all these factors for hours, days, weeks or even months following the accident.
We all know someone who significantly overreacts even after a small bump
think professional footballers. These are people who often get labeled as having a low pain threshold. In fact what they have is a fairly active imagination followed by a finely tuned self protection mechanism. Its fine to overreact immediately following an accident, most likely it will protect from immediate danger of further injury. Its not healthy to continue to overreact once all the credible sources of threat have been ruled out – the ankle isn’t damaged, its not going to lead to significant loss of income or a shortened football career, there is an excellent chiro/physio ensuring a speedy return to the game having re-assured the owner of the ankle.
In the case of an ankle sprain society has very few unhealthy belief structures in place so most people recover very quickly. In the case of back sprain, unfortunately, society have a lot of very unhealthy belief structures in place. For example: expressions like “mind your back”, beliefs such as “you must rest a bad back”, ideas like “my back is fragile/unstable/ delicate”. All lead to the brain using a context of high risk when it comes to any twitch or twinge from the back. It will to continue to assess the dangers as high for a considerable period of time following an injury if the unhelpful beliefs stay in place.
Just normal joints
Remember that the joints in your back are just joints like any other. They are no more or less susceptible to strains and sprains. They will heal in exactly the same way. Movement will help maintain strength and function. Rest will result in weakness and prolonged healing time.
No fixed pain threshold
Sometimes it does really hurt following an injury this is to some extent related to tissue damage as this will cause your body to mount a very helpful inflammatory response which is painful. It is also related to your own belief system has led you to understand that you have done something potentially dangerous to yourself. The pain threshold is not fixed but influenced by our beliefs and fears – the more you believe that there is a problem the more you will feel it. This is our brains way of forcing us to pay attention and seek help, support and reassurance.
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