Feel or Block the Pain: That is the Question?

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Associative and dissociative attentional strategies for influencing performance have been researched for a numbers of years in the context of running. In particular the work ofMasters and Ogles (1998) highlighted that the idea of simply either focusing on or away from the pain was too simplistic. This concept was revisited by Heil and Podiog in a chapter on Pain and Performance in the Oxford Handbook of Sport and Performance Psychology (Murphy, 2012).

 

The authors claim pain management should be seen be seen as a skill set to be developed in the face of distractions such as pain perceptions and catastrophic worrying thereby engaging in informed decision making regarding the best course of action.

 

·      Association therefore refers to relevant performance cues such as pace, rate of perceived exertion, fatigue and pain.

 

·      Dissociation is the intentional use of distraction as a way of coping with the mental and physical demands of the sport including pain

 

Previous research has suggested that elite distance runners rely more heavily on associative techniques, constantly shifting attention to the demands of their running despite the pain. This has been challenged, suggesting that pain behaviour is subjective, varying by individual and therefore it follows that each person should devise different cognitive strategies to maximize performance.

 

Heil (1993) had previously identified a four dimensional strategy that addresses pain assessment, decision making, focusing and self-regulation.

 

1.    Associating to both pain and sport can be beneficial when pain signals proper technique. If, instead, you change movement patterns to avoid pain then possible compensatory injuries can result.

 

2.    Dissociating from both pain and sport during performance is problematic because focus is scarified for sake of pain management. Alternatively, this plan could be beneficial if applied during natural breaks from running as a way of gaining rest from pain or demands of sport.

 

3.    Dissociating from pain while associating to sports performance is appropriate when pain is understood as part of your training regime.

 

4.    Associating to pain and dissociating from sport is of value in the management of overuse and chronic injury. Because sport performance can fully absorb all your attentional resources, you may suppress your physical well being which ultimately will prove detrimental. Useful in breaks between activities to assess pain and to check against muscle guarding.

 

The above strategies should form part of your training regime dependent on your activities and injury / pain state. Simply blocking or focusing on your pain can be counterproductive therefore adapting a much more flexible approach with a greater understanding of what your body is trying to tell you will enable you to train harder and minimize the risk of injuries.

If you have any questions, please do not hesitate to contact me  

 

Paul is currently training for his first 10k as part of the Brighton Marathon

 

It hurts - should I be training

A number of you will possibly be in your final preparations for a half-marathon. Training can be hampered by the festive period along with the cold weather in January. Doubts began to creep in regarding the number of hours / miles achieved and those painful niggles can seem to be getting worse. Following on an excellent article by Tom Groom asking the question does stress slow down your running,  I want to explore how we cope with demands placed upon us along with how we deal with pain. As the diagram below shows, the human body needs stress. Too little (underload) there is no training effect and we become inactive. Too much and the body rapidly becomes exhausted causing anxiety possibly leading to panic and anger. If you continue to push yourself without realising/ denying the symptoms, there is a danger of physiological and psychological burn-out.

Therefore, in usefully loading the body in terms of training you will experience a certain amount of pain. This may be whilst performing or muscle tightness / soreness after. Whilst pain is often seen as seen as an integral part of the sport experience (no pain, no gain); it is the meaning you assigned to it that is crucial in affecting your thoughts and behaviours. Previous research Addison, Kremer and Bell (1998) have suggested a continuum of pain experienced by athletes. This is useful guide to evaluate how your body is coping with the training load and if you are possibly moving from fatigue to exhaustion

Fatigue and discomfort—normal or routine sensations associated with competition, training, and rehabilitation;

Positive training pain—nonthreatening, typically occurring during endurance activity, and believed to be under the your control;

Negative training pain—perceived as threatening and an indication that continued training is no longer beneficial;

Negative warning pain—similar to negative training pain, but more threatening, signaling the possibility of potential injury and therefore should prompt you to evaluate its cause and take appropriate action;

Negative acute pain—indicates injury and is perceived as intense and specific;

Numbness—the absence of sensation, interpreted as highly negative and typically a cause for concern.

As Tom’s article showed, increased stress has a detrimental effect in a number of ways. Pain can cause a very strong negative emotional reactions causing you increased distress which in turn, increases the pain. Depression and anxiety can also enhance pain perception possibly causing pain catastrophizing, which is a maladaptive cognitive coping strategy. This is characterized by an excessive focus on pain, possibly exaggerating the threat whilst minimizing your ability to cope. This has the effect of increasing further muscle tension and anxiety increasing further the sensitivity to the pain. This has a cognitive element in that it can reduce your ability to make correct decisions in response to the pain.

In terms of managing your reaction to negative pain, it is important you focus on your thoughts and behaviours. Muscular relaxation, goal setting, education regarding injury, following training plans, and adherence to prescribed exercise are positive choices that facilitate your rehabilitation and healing.  Fatigue, discomfort, and positive training pain should be expected during rehabilitation and ideally perceived as evidence that you are at the ideal levels of intensity to move you through to recovery. However if incorrectly interpreting negative pain, you may be at risk of treatment setbacks and re-injury.

Should you need any advice on pain management please do not hesitate to contact myself for a free 15 minute consultation or the staff at the Physio Rooms 

 

 

Cognitive Behavioural Therapy (CBT) and Pain

Advances in research have raised many questions about chronic pain but it appears the best approach is to move away from a simplistic idea of ‘this condition needs this treatment’, to an approach that takes in the bigger picture. The BioPsychoSocial Approach Rather than focussing solely on changes in the body that may not be relevant to symptoms more recent treatments consider a BioPsychoSocial approach. This includes biological changes related to pain, psychological factors and an individual’s social circumstances as shown in the picture below:
 


Using this approach we can create a better understanding of why pain continues and how to overcome it, leading to long term changes in symptoms. We want to give you the tools and knowledge to manage your pain and support you through the process. Research has previously identified a strong relationship linking pain with depression and anxiety, which can be more prevalent in the winter months. This can be exacerbated by ineffective coping such as pain anxiety and fear avoidance - not confronting what are the key issues. In particular, pain catastrophising (a tendency to magnify the pain experience) has been shown to play a part in the transition from acute to chronic issues. This can be particularly prevalent in people who worry, leading them to feel helpless when think about pain. Someone who has depressive tendencies may internalize with statements such as “It’s my fault” or “I will never get over this”. 

So what is a possible way forward. Alongside the physical therapy you receive , Cognitive Behavioral Therapy (CBT) can be used for Chronic Pain. Taking an active approach to take control and reengage with activities thereby increasing functionality rather than decreasing pain intensity. It is tailored to each patient based on the results of the initial assessment, patient presentation and their specific-goals. The approach is broken down into various stages to meet the desired outcome, whether it be return to full functionality or achieving a greater performance. 

The initial stage is psycho-educative with explanations of pain and setting of goals. There is also a discussion of acceptance versus control – for some patients becoming pain free maybe an elusive goal. For many who train and play sport on a regular basis, pain is just part of the process and it is the increase in functionality / performance that is the key issue. Activity scheduling is a key part where there is a reengaging with pleasant activities regardless of pain status, previously avoided due to fear of reinjury. This is in conjunction with cognitive restructuring to have a more positive approach that problems can be solved. The final stages involves physiological techniques to manage pain more successfully such as progressive muscle relaxation along with discussion of pain and social dynamics. This involves an investigation into how your injury is discussed by yourself / others and how this can be possibly reframed. 

If you feel this approach can help, contact me for a free 15 minute phone consultation.