This is a summary of section 6 of “Explain Pain” by David Butler and Lorimer Moseley.

Management 101

The most important thing you can understand is that no one has the answer for all pains. Pain is entirely individualistic, hence requiring different answers. There are several strategies which one can undertake to triumph over pain.

Tool 1: Education

Knowing how pain works is one of the most important components to overcoming pain. Instead of no pain, no gain, the authors like to use “know pain, or no gain.” Understanding pain is essential for squashing fear of pain, which leads best toward the road to recovery.

Here are some important concepts to be known about explaining pain.

• Anyone can understand pain physiology.
• Learning about pain physiology reduces pain’s threat value.
• Combining pain education with movement approaches will increase physical capacity, reduce pain, and improve quality of life.

Tool 2: Hurt ≠ Harm

It is important to understand that when someone feels pain it does not equate with damage. The same can be said with recurring pains. These pain types are often ways to prevent you from making the same mistake twice. If your brain sees similar cues that were present with a previous injury, the brain may make you experience pain as a way to check on you and make sure you are okay.

Just because hurt does not mean harm does not mean you can get crazy though. Because the nervous system is trying to protect you, it will take drastic measure to prevent re-injury. Therefore, the best option is to gradually increase activity levels without pressing past the nervous system’s threshold.

Tool 3: Pacing & Graded Exposure

All the body tissues are designed for movement, therefore this is how we will increase activity. Here are the steps to pacing and graded exposure.

1. Select an activity you want to do more of.
2. Find your baseline – The amount of activity you can do that you know will not cause a flare-up. A flare-up is an increase in pain that leaves you debilitated for hours to days.
3. Plan your progressions.
4. Don’t flare up, but don’t freak out if you do.
5. It is a lifestyle change, requiring a little bit more planning.

Take walking for example. Suppose you know you could walk for 5 minutes, but if you did 7 you would pay for it over the next couple days. You might walk for 5 the first day, then 5:15. Eventually, you would work up to past 7 minutes, then so on and so forth.

Access the Virtual Body

Just like the body, the virtual body can be exercised as well. Ways to work on the virtual body are as follows:

1. Imagine movements – a la graded motor imagery.
2. Alter gravitational influences or surfaces.
3. Add varying balance challenges.
4. Vary visual inputs – Eyes closed challenges the virtual body even more. Use a mirror to give the brain visual input and further decrease threat.
5. Alter the activity environment.
6. Move-in different emotional states.
7. Add distractions.
8. Perform the desired movements in functional activities.
9. Break down functional movements.
10. Perform sliders.
11. Perform movements with the surrounding tissues in relaxed positions that do not hurt.
12. Work out of your glitches – If you walk with a limp from an ankle you sprained in 1962, try changing how you walk.
13. Let your mind go.