01 Jun Know Thy Pain: A Lesson in Broadcast Management
BY: DR. JEFFREY SCOTT, DC
What is Pain?
Webster’s dictionary defines pain as: a localized or generalized unpleasant bodily sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress and typically results from bodily disorder (such as injury or disease). The key phrase of this definition is “physical discomfort”.
Let’s all be honest, pain is not pleasant, so click on this link on pain to read what Dr. Chris has to say on pain and fibromyalgia.
Ideally if we were given a magic wand and we could erase all of our pain forever, most of us probably would.
However, at its root purpose pain is a signal. It is a signal that lets you know that something is not working the way that it should. And just as all signals have a source from which they are broadcasted, so too does pain.
In fact, when we begin to unpack the pain signal we can actually derive valuable information that can help lead us to the source.
Below is a chart illustrating a few common types of pain and the structures they are often associated with.
| Symptoms | Structure |
| Sharp Pain on Motion | Joint |
| Burning and/or hot feeling | Nerve |
| Tingling and/or numbness | Nerve |
| Cramping/knot/spasm | Muscle |
| Dull ache | Muscle |
| Throbbing pain | Vascular |
As one can see when we look more closely at exactly what type of pain we are feeling we can begin to identify the area of the body where dysfunction is occurring.
The Four Fundamentals of Musculoskeletal Pain
Now that we understand that pain is a signal, it is important for us to know what factors influence the strength of that signal. (<– blog from Dr. Crhis on understanding your pain signal!)
In all musculoskeletal problems there are four variables that are always present. These variables are load, capacity, symptoms, and dysfunction. If you want to KNOW THY PAIN you’ll need to understand how these variables work. And for that lets take a deeper look at each of these individually.
- Load
Load simply boils down to how much work you ask your body to do.
For example if you go out and ride your bike for 10 miles you’ve placed 10 miles of load on your body.
Similarly if you held your 20lb newborn niece for 30 minutes, you’ve placed 20lbs of load on your body over a 30 minute time period. However, like all things in life, if we follow this concept a bit further we can get even more specific. Let’s say when you were holding your niece that you held her in your right arm for 20 minutes and your left arm for 10 minutes.
While you loaded your body for a total of 30 minutes, your right side handled double the load that your left side did. As we get more specific with loading we can begin to see how imbalances can arise.
- Capacity
Capacity is defined as how much load your body is capable of handling without being damaged. For instance does my body have the capacity to ride my bike for 10 miles? Am I capable of holding my newborn niece without getting soreness, aches, or fatigue in my shoulder? These are the types of questions the capacity variable forces us to ask.
- Symptoms
Symptoms are the signals we receive from our nervous system. They tell us that we have exceeded our bodies capacity. When we push our tissues beyond what they can safely handle symptoms are the only defensive mechanism our body has to minimize the amount of damage we are causing.
- Dysfunction
Dysfunction is the opposite of health. It exists in any part of the body that is not working properly or is deficient in some way. It’s presence is inherently connected to the degrees of the other three variables.
Relationships Among the Four Fundamentals
- Relationship 1: Load vs Capacity
If the four variables are the building blocks, the relationship between load and capacity is the foundation.
When load is less than capacity all is well with the world. In this instance the body has enough capacity to buffer the load being placed on it, meaning no damage is occurring.
This is the ideal scenario. On the other hand when load is greater than capacity, this is where problems begin to arise and damage begins to develop. When load exceeds capacity in healthy tissue there are two common ways this typically occurs:
| Healthy Tissue Scenario 1 | Healthy Tissue Scenario 2 |
| Load type: High Excessive | Load type: Small Excessive |
| Time Period: Short | Time Period: Long |
| Results: Tear or crush injuries | Results: Overuse type of damage |
| Examples: Car accidents, fall, contact injuries | Examples: Tendinosis, Adhesion, Disc degeneration, arthritis |
As stated, the above scenarios imply that the tissue in question is healthy and is being subjected to an unhealthy amount of load.
When we have unhealthy tissue the capacity of that tissue is also being exceeded.
However, in this case, the load being applied might actually be “healthy”.
Because the tissue is already unhealthy (damaged or dysfunctional) its capacity is diminished, therefore when it is subjected to load that might be considered “normal” an injury can occur. An example of this is a muscle strain.
Let’s say you’re out for an easy 3 mile run, something you’ve done numerous times without any issues. Then all of a sudden “BAM”, your hamstring starts to spasm, you start gimping off to the side of the road, you can’t straighten it, and then the pain sets in.
“Why did this happen? It was just a 3 mile run?”- you start to ask yourself. The majority of musculoskeletal injuries, such as the one depicted above, are the result of small load to capacity imbalances that eventually get pushed over the threshold without any substantial trauma.
In our runners case, there was already something wrong with their hamstring (say a significant amount of adhesion) and what appeared to be a “routine” run was simply enough load to cause damage to a tissue that was already unhealthy.
- Relationship 2: Symptoms and Dysfunction
Typically the severity of one’s symptoms is correlated with the amount of dysfunction taking place.
While this is not always the case, for the sake of simplicity let’s use this presumption. For example there is a clear difference between someone who reports having a low back ache of 1 out of 10 after squatting, compared to someone who has 8 out of 10 shooting low back pain and can’t sit for more than 5 minutes before the pain increases.
In this example you would presume that the patient reporting the higher severity of symptoms is also experiencing a greater level of dysfunction as indicated by their inability to sit for any real length of time.
The key to understanding the relationship between symptoms and dysfunction, as well as, how they relate to load and capacity, is to understand the terms buffer capacity and symptom threshold.
Buffer Capacity: is the quantity of dysfunction the body can handle before symptoms begin to appear. In essence it is how much loading a system can manage without harm or damage resulting
Symptom Threshold: is the ceiling of the buffer capacity. It is the metaphorical line in the sand, that once crossed the onset of symptoms begin
- Piecing it together
The relationship between these four variables is always shifting depending on what we are asking of our bodies.
Generally speaking the more load you are placing on yourself, the more dysfunction you are building up. As the loading continues and the dysfunction builds, it decreases the capacity the body has to handle them.
Eventually, the body becomes saturated and can no longer buffer the dysfunction at which point the symptom threshold is crossed and the onset of pain begins.
This is true for both acute traumatic injuries, as well, as chronic overuse injuries.
The only big difference is the amount of time under which the load is being applied.
What’s In Your Bucket
Applying it to The Body
The Golden Nugget Takeaway
When pain is present, it is a signal that you are subjecting the body to loads that it is no longer capable of handling.
In order to prevent further damage, the body introduces the pain signal so that it can continue to function, while ensuring the tissue in question is being protected. Like all good broadcasters we need to understand how the signal functions.
When we understand the fundamentals of load, capacity, symptoms, and dysfunction we can begin to address our pain properly and piece together what actions might either increase the signal or reduce it.
In following these guidelines, we can work to manipulate those variables to get out of pain, or manage them properly so pain isn’t produced in the first place.
For additional information on this topic I encourage you to read the blog post entitled:
YOU’RE IN PAIN: YOU’D BETTER UNDERSTAND LOAD AND CAPACITY
If you think you might be a candidate for the PERMANENT pain relief we offer at Barefoot Rehab, give us a call at 862-205-4847 to speak with one of our patient advocates and take the next steps and see if you qualify!
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