Injuries are an unfortunate part of sport. No matter how hard we try to prepare athletes prior to competition, sometimes injuries happen.
It is commonly thought that pain and injury have a one-to-one relationship – IE, I twist my ankle and I get pain. While this may be so in some situations (especially acute situations like an ankle sprain), it is important to remember that pain is a lot more complex than that. Pain doesn’t exist in your muscles, joints, or ligaments. Rather, pain exists in your brain (and like Arnold says, “it’s not a tumor”….well, sometimes it might be a tumor!).
Pain is an important aspect for our survival. It tells us something is wrong. In fact, if you did have a brain tumor, those intense headaches that are the source of your pain would force you to go to the doctor, get a thorough evaluation, and then get appropriately treated. However, sometimes the signals of pain can get crossed.
What about those people that for whatever reason aren’t having pain when faced with a life threatening condition? For example, the people who have cancer eating away their stomach, yet experience no pain at all, until it is to late, only to find out about the problem a week or two before they pass away. Where was their pain? Where was their warning sign?
What about the people that are always in pain yet there doesn’t appear to be anything medically wrong? What gives?! Why are they so prone to feeling pain?
Pain is a multi-factorial process and takes into account several of the bodies systems collectively feeding information, in the form of signals, to the brain. These signals are bombarding the brain with information and the brain is basically filtering things out and deciding what to react too based on everything else going on – which signals present a potential threat? (Think about the soldier who gets shot but doesn’t realize it because there is the chaos of war going on aruond him.) I liken this to those in charge of investigating every single terrorist threat that the USA receives daily. They have to filter out all those threats and decide what is not worth reacting upon and what is really important. They can’t react to everything, right?
This collection of inputs and outputs from various systems has been termed the neuromatrix by pain researcher Ronald Melzack. This information can be better understood by spending sometime studying the below diagram.
As you can see, many factors/systems affect pain – visual, sensory, endocrine, vestibular, past experience, anxiety, depression, etc.
Based on what we know of the neuromatrix model it is important that we appreciate and respect the fact that the body consists of many systems that are all dependant on each other and work together to support healthy function. Whenever we try and distill things down to one single system as the “problem” we end up missing a lot of other stuff going on.
Unfortunately, this is how anatomy and physiology is taught. You go through chapters devoted to one single system – circulatory, lymphatic, nervous, integumentary, musculoskeletal, etc – but no one seems to teach you how to put it all together and how to address or manage these systems collectively, especially when there is something wrong.
Because pain is created by the brain as a result of information received from these systems, when dealing with athletes in pain, it would be appropriate to keep all of this in mind and not just focus on one element in the equation, but rather try and see the big picture (the full human).
Just some things to ponder.
References
Melzack R. From the Gate to the Neuromatrix. Pain 1999; Supplment 6: S121-S126.
Melzack R. Pain and the Neuromatrix in the Brain. J Dental Education 2001; 65(12): 1378-1382.