Pain, Motor Control, and Presence
Over the past few years, I have read a lot about neuroplasticity (the ability of the nervous system to change), and last year, I took a continuing education course on pain science, and an advanced course on motor control (how the brain controls the muscles and joints to produce movement). A few of the important concepts that have really stuck with me are:
1. When the body is injured, the nerves send
nociceptive input to the brain. (Nociceptive input indicates harm or potential harm to the tissues. Nociceptive input is one factor that contributes to the experience of pain. Pain is an output of the brain.)
2. The brain wants to minimize the nociceptive input, so it
shuts itself off from feeling the full amount of the nociceptive input coming in. This is a
3. However, when the brain shuts itself off from incoming nociception from an injured region, it also
shuts off incoming messages from the joints and muscles about their position in space (called proprioception) from that area.
4. When the brain shuts off incoming messages, it can
no longer send effective outgoing messages to the muscles and other structures either. This causes a lack of precise motor control.
5. Without precise motor control in the injured region,
further injury is very likely. (This is the reason when you sprain your ankle once, without proper rehab to reestablish normal motor control, you are more likely to sprain the same ankle again.)
6. In addition to controlling muscle movement in an injured area, the
brain also controls inflammation and circulation. Nerve endings are wrapped with immune cells and the nervous and immune systems are intricately linked. If you shut off brain-to-body regulatory control, the localized immune response to an injury can get out of hand.
I had a personal experience with all of these concepts last year, while cross-country skiing for the first time ever, in Voss, Norway. I have had two severe left ankle sprains (5 and 2 years prior, both due to falls), and despite being a PT, did not do all the ankle rehab that I should have done. Well, after about two hours up on the mountain, and about an hour away from the ski lift, I fell with my skis twisted under me and severely sprained (you guessed it) my left ankle. The sprain was so bad, and my ankle was so unstable, that I could barely stand. My choices were a) wait for two hours in the freezing cold while my husband got the ski patrol to rescue me, or b) see if I could make it out on my own. I chose option b. My ankle felt awful, but I remembered that if my brain blocked the sensations coming in, it would also block the motor control going out, and I needed motor control. So with every single step, I consciously directed my attention to my ankle, and kept my brain and ankle fully connected.
I stayed present in my ankle.
I paid attention to my hip/knee alignment, my core and leg muscle contractions, and how I was transferring weight. I actively controlled my movements and didn't let my brain shut off or wander. It took a huge mental effort to do this, but I didn't have another option. Long story short: I made it off the mountain, and compared to my two other severe ankle sprains, was very surprised to see how little swelling and bruising I had. This may have been because I kept moving after the injury, but I also think that deliberately keeping my brain connected to my ankle nerves allowed it to stay connected to my immune (and circulatory) systems as well. Staying connected also decreased the pain output of my brain.
A big part of what we do as PTs is teach patients how to reconnect injured and/or painful areas of their bodies with their brains. We help patients reestablish incoming sensations as well as outgoing control. This process changes the size of the "body map" in the brain that is dedicated to that particular area. It helps patients re-learn
how to be present in the area of their body that was injured. This process works whether injuries are recent, or occurred many, many years ago. Our brains and nervous systems can adapt and change to experience less pain and more motor control, at any age. Ask your PT at CTS for more information!