For individuals’ living with chronic pain, the long-range forecast is often filled with metaphorical rain storms, treacherous winds and long, dark nights. When pain is present, the most noticeable characteristic of a client’s changing climate often revolves around biomechanical restrictions and movement limitations. Perhaps not so obvious (yet often just as burdensome) are the emotional and psychological factors involved with experiencing pain on a regular basis.
To create a truly unique, multidimensional strategy for individuals in pain, it is imperative that you expand beyond the optics of biomechanics and connective tissue principles alone. Let’s take a walk through the four seasons of chronic pain and examine how you can help your clients transition smoothly through each one.
The First Season - Winter (fear)
Winter is the first season of chronic pain, where the radical change in climate significantly impacts an individual’s emotional and psychological well-being. The predominant characteristic of this season is usually fear—fear of movement, fear of pain worsening, fear of the unknown. This fear can reach such heightened states that just the anticipation of pain is enough to steer an individual away from doing the things that matter the most. Imagine avoiding an activity because of the anticipation of pain, rather than in response to it.
When such avoidance behaviors manifest, it’s clear that trying to address chronic pain solely from a biomechanical perspective is an incomplete approach. The neuromatrix theory of pain proposes that the output of pain is regulated by afferent sensory mechanisms in conjunction with cognitive inputs (Melzack, 2001). These cognitive inputs have the capacity to upregulate and exacerbate states of anxiety, apprehension, depression, self-doubt; all of which fall into the category of psychological/emotional stressors.
It’s these stressors that contribute significantly to winter’s burdensome climate. To clients in pain, winter’s dark and ominous atmosphere can sometimes seem to endure indefinitely. Successfully helping clients transition out of winter requires an understanding of the difference between a client’s “external” and “internal” problems.
The Second Season - Spring (awareness)
The melting of snow, dissipating precipitation and the awakening from hibernation are all welcomed signs that winter is nearly over. To the health and exercise professional, guiding clients toward a more desirable climate requires an understanding of each client’s internal problem.
All clients in pain have two global problems. The “external problem” is the biomechanical or anatomical concerns each client reveals during their initial consultation. Consider, for example, the client who has been experiencing knee pain for years. The knee pain is the external problem. The “internal problem(s),” however, may be the areas in life that hold the most meaning to individuals negatively impacted by chronic pain. The internal problems are the emotional, psychological and social/environmental stressors that are unique to the individual.
For example, consider a husband and wife who spend meaningful time together each day walking their dog. However, in recent months the husband’s knee pain (external problem) has become so problematic that it’s preventing him from participating in the most meaningful aspect of his day, which is connecting with his wife via their evening walk (internal problem).
A client’s emotional transition from winter into spring begins with his or her health and exercise professional gaining awareness into the client’s internal problem(s). This awareness then provides an opportunity for both the coach and the client to begin scripting a new, more desirable narrative based on what the individual client values most.
The Third Season - Summer (possibility)
For any seed to blossom and reach its full potential, a conducive climate is required. To clients in pain, fear, anxiety, feelings of hopelessness and negative self-talk are the metaphorical weeds of cognition. If these weeds are ignored, they can uproot any forward progress. During the summer months, the seeds of possibility must be nurtured and the cognitive weeds must be pulled on a regular basis.
As with any journey, minor setbacks and moments of self-doubt are to be expected (particularly when chronic pain is present). Because of this, including clients in the process of constructing future-oriented, growth-focused possibilities becomes essential. The Yellow Brick Road refers to this process as a “Possibilities Paradigm” and it involves four steps, each designed to amplify and reinforce a clients’ emotional and psychological resiliency and well-being. When successful, these 4 steps can help stir hope and bring optimism back into each clients’ current and future outlook.
The Fourth Season - Fall (self-regulation)
The fourth and final season is a time when clients return to pain-free living. And while there are a host of factors influencing each individual’s pain-free transformation (biomechanics included), a client’s capacity to accurately assess and regulate his or her own emotional state (self-regulation) is a primary contributor in overcoming his or her internal problem(s).
Consider the experiential difference in self-regulation in the following two statements: “Oh no, I just threw my back out again!” vs. “My back tightened up, but I know it’s just my body protecting me.” These are two completely different emotional reactions, the former laced with fear and the latter signifying the perception of safety and protection.
Preventing clients from experiencing negative emotions is, of course, not possible. However, as health and exercise professionals, we can strive to cultivate a climate that enhances each client’s self-regulation competence and help them identify and overcome the emotional and psychological stressors that contribute to their pain. Importantly, you can begin this process with your client even before you have conducted his or her biomechanical evaluation.
Melzack, R. (2001). Pain and the neuromatrix in the brain. Journal of Dental Education, 65, 12, 1378-1382.