Posts Tagged ‘pain threshold’

Today I wanted to take the time to share my favorite way I have ever heard pain explained. Like most good things in life, the genius is in its simplicity. It comes from a brilliant chiropractor and soft tissue specialist Dr. William Brady.

I think one of the most challenging aspects of transitioning from a student to a practicing clinician is explaining to the patient what you are treating and what their problem is. Students go through school and have to learn a different language (medical-ese) but once in practice have to take that language and translate it so that the patient understands. Because really, telling a patient they have an “acute tendonopathy of the gastroc-soleus complex with concomitant flexor hallicus longus fibrosis” sounds really smart but explains nothing to a patient.

Ok, enough with the jokes (maybe, no guarantee) and let’s get to the explanation.

The following is the chart Dr. Brady uses to show a patient why they are in pain in the absence of traumatic injury (i.e. getting hit by a MAC truck). These are classically referred to a cumulative trauma injuries. Really, it’s just a fancy way of saying your body is a mess and now you are paying for it.

ps: it took me 45 min to figure out how to get this from my phone, cropped, edited, and finally on to the page  so I hope everyone really, really enjoys it.

Now for the explanation:

Let’s say one day you wake up and the bottom of your foot hurts. You have been training for a marathon for a few months, doing fine and then slowly you start to feel “something on the bottom of your foot.” Most importantly, you can’t remember falling, tripping, or doing anything that you think would cause the pain. You may be a classic example of the graph on your viewing left.

On the top of the graph you see “pain threshold.” This means, you woke up saying “ouch” and now you are in the office for treatment. Your body has finally reached a point where it is bad enough for the brain’s alarm to go off.

On the ‘x’ axis, the label is dysfunction. In previous posts I have spoken about dysfunction. This graph does a great job of illustrating the ” building blocks of dysfunction leading to pain.”

Let me quickly explain the numbered blocks:

“1” might be a core instability issue that has been lingering for years. With only this issue, you have been able to compensate yet still function at a high level

“2” may be a weak Glut Medius muscle. This helps to stabilize the hip as well as many other functions. Still, no pain.

“3” could be a lack of hip extension due to tight hip flexors. Again, you are building dysfunction, but in your case those three dysfunctions on top of one another still have not caused pain.

“4” is a tight Achilles tendon leading to decreased dorsiflexion of the ankle.

“5” is a plantar muscle overworking. Finally, the alarm goes off in the body, and you have pain.

If you look at these 5 dysfunctions, something becomes evident. 4 out of 5 problems are not on the bottom of the foot. Only after building dysfunction in 4 other sites, did you actually reach threshold. Yes, it hurts in your foot, but there are many other issues that need to be addressed.

Another point that needs to be discussed piggy-backs on my last article on Functional Screens found here. I think this graph does a great job of showing the need for functional screens. In a case like we showed above, treatment may be applied to the bottom of the foot and the pain may go away. We have simply addressed dysfunction number ‘5’ and this got you below the pain threshold. However, we have done nothing to fix dysfunctions 1-4, so we are still very close to pain. One more small problem could cause the same pain.

As Dr. Brady says, his job is to “chip away” at each dysfunction, slowly unbuilding (My word, not his. In fact, not a real word at all.) those blocks that have led to pain. This will give a person more wiggle room, or room for error so they can go about their daily activity or training schedule without the inconvenience of pain.

Thank you for reading. Have a wonderful day!