Pain does not equal damage!
All pain is real. I’m going to repeat that one – ALL PAIN IS REAL! However, this doesn’t mean that pain always equals damage. In fact, you can have pain even when there is no damage to your muscles, tendons, nerves or any other structure in your body. You may have damaged your tissues in the past, for example a broken bone, muscle tear or a disc bulge. These usually heal over time (generally 3-6 months but this can vary depending on the injury). Our pain system however is extremely complex and responds to factors other than just tissue damage. This is why, even when our initial injury has healed, we sometimes continue to feel pain. We’ll explore some of the reasons for this over the coming weeks, but today we are going to focus on tissue damage – and see that it’s not always to blame! While tissue damage can indeed contribute to pain, it is also possible to NOT have pain when there is tissue damage. For example, in scans of people WITHOUT pain, - 87% of people between the ages of 20-70 years have a disc bulge in their neck - 78% of middle-aged men have bursitis in their shoulder- 96% of 80-year-olds have disc degeneration- 43% of adults over the age of 40 have knee osteoarthritis. What this means is that tissue damage and pain don’t correlate well. This is because pain is more complex than just tissue damage. In fact, many of these changes are associated with the normal ageing process and can often happen without us even knowing about it. For example, you may start to experience some degeneration in your knee. You carry on with your life, none the wiser until one day, you start to experience pain in your knee. You may have done a bit of extra bending or lifting in the garden, had a really poor nights sleep or been under more stress than usual. You go and see your GP, who orders a scan. There is some degenerative changes detected in your scan. This then gets the blame for the pain you are experiencing. Does this sound familiar? It is important to note here again, that all pain is real! If there are two people who both have degeneration in their knee and one feels pain and the other does not, it does not mean that one person is wrong and the other is right! The pain an individual experiences is very real. The message here however is that we do not necessarily have to fix what has been found on a scan to be able to function again. Below is a great infographic that talks about what x-rays and scans really mean! Scan the QR code on the infographic or check out Pain Revolution for more details on what some of the common words you’ll see on a knee scan report really mean.
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Culvenor AG, Øiestad BE, Hart HF, et al (2019). Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British Journal of Sports Medicine 53:1268-1278. https://bjsm.bmj.com/content/53/20/1268
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Nakashima, H., Yukawa, Y., Suda, K., Yamagata, M., Ueta, T., & Kato, F. (2015). Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine, 40(6), 392–398. https://doi.org/10.1097/BRS.0000000000000775