Everybody Hurts

REM’s “Everybody Hurts” is one of those timeless songs from my childhood. Listening to it playing on my computer always evokes a feeling of emotional ache lined with hope. (cue waving lighters and cell phones) To take nothing away from such an iconic band of the 1980s and 90s, I’d like to reinterpret their message today and apply it to physical therapy and how we therapists understand and treat pain. (After all, this is a blog written by a physical therapist on behalf of her clinic.) So I ask that you extend me grace for the metaphorical leap I’m about to take. (Commence jumping now…)

We’ve all experienced physical pain of some sort–from a bruise or a stubbed toe all the way up to a rotator cuff tendon tear or herniated disc. At times it lasts for a couple of minutes, but some people struggle with pain all day, every day. Sometimes we can identify the cause, but other times the reason for our pain may seem nebulous and unclear. This confusion can add to stress/anxiety/depression/feelings of hopelessness that so often coincide pain, especially chronic pain.  But what exactly is “pain” and why does it occur? Whole week-long seminars and advanced degrees are based on understanding and explaining it, but I’m going to try to focus on pain as it pertains to my job.

First, a little physiology lesson: The nervous system is basically the roadway for the body; all communication between body parts happens because of the signals transmitted via nerves. A specific kind of signal carried from nerves in the body to the brain is interpreted as pain.  For the sake of time and hopefully lessening confusion, I want to divide pain into two basic categories: mechanical and chemical.

Mechanical
Let me explain this with an example: Grab your left ring finger with your right hand and slowly bend it backwards. At some point you’ll start to feel some discomfort and then pain. Continue to hold it in this spot and the pain will continue (although it might change in location or quality). Push the finger back further and the pain will intensify. Release the finger and as it returns to its normal resting position the pain will decrease and eventually disappear. Mechanical forces cause pain when they deliver a load or strain to a tissue beyond what that tissue can typically withstand. If the load approaches but doesn’t exceed the tissue’s capability for recovery, while there is pain, there is no tissue damage (like what happened when you bent your finger backward). If the load is excessive, however, the tissue is traumatized (ex: bruise, strain, sprain, tear, dislocation, etc)–which leads to our next type of pain…

Chemical
Cell or tissue damage initiates the inflammatory response and also results in the release of specific chemical irritants, which continue to accumulate in the traumatized area. When the concentration of these chemicals reaches a specific level they “irritate” the nerve receptors, which trigger the release of that specific signal our brain interprets as pain. (Side note: Certain inflammatory and infectious diseases and some chronic degenerative conditions can also produce chemical pain, but for our purposes, let’s just say that the majority of chemical pain is caused by trauma or damage to the tissue.) The buildup of these chemical substances over time can explain why we may experience a trauma (ex: a car accident) and might not feel pain until a day or two later.

So what’s the connection between physical therapy, pain and REM?  Whether you’re struggling with acute pain from a recent injury or chronic pain from something that happened a while ago, I would encourage you to make an appointment with your local physical therapist. Physical therapists are trained to evaluate and diagnose mechanical pain and the chemical pain that comes as a result. We will develop a treatment plan that includes not only long-term benefits but the management of your current pain. In the dark cloud that is physical pain lies a hope-filled silver lining. As Bill Berry, the drummer for REM, wrote, “Don’t throw your hand/If you feel like you’re alone/No, no, no, you are not alone.”

[Disclaimer: Pain is a very complicated subject and today I attempted to simplify it according to the majority of patients I treat. This post is in no way all inclusive in its description, nor is it meant to replace a visit with an MD, DO, or PT.]