A Practical Exploration of Pain and Healing

A Practical Exploration of Pain and Healing

Jenn Pilotti

 

I was doing Russian dancers recently, a move I have always struggled with (for those of you who have no idea what I’m talking about, a Russian dancer is a one armed backbend that dynamically switches to the other arm by shifting your weight forward to your feet). I learned that if you don’t shift your weight forward to your feet, you land hard on the other hand. I also learned that if you do this repeatedly because you have somehow forgotten that the weight needs to shift into the feet, you run the risk of your shoulder getting a little bit angry. This anger is displayed through loud sensation.

It is extremely unusual for me to injure myself through movement. I prefer grander gestures of injury, like getting hit by a car or misjudging the placement of the couch as I’m cartwheeling out of a handstand. Because I am slightly accident prone, I am accustomed to the healing process; I also love pain science and proprioception and a lot of my clients see me specifically to help improve load tolerance so they can feel more stable and/or to help them reduce the sensation of pain. This means I am confident in the body’s ability to heal with the right input.

This doesn’t mean I love being injured. Like most people, I would happily avoid uncomfortable sensations for the rest of my life if that were an option.

Within 24 hours, the shoulder was a nagging, diffuse sensation with a heavy, electric quality. There was no question my right arm felt different than my left arm, and certain movements caused what could only be described as less than pleasant sensations. (I have always had a hard time with the word pain. What does pain mean? It’s more obvious when it’s a bone or joint injury, a deep cut, or bruise but when it’s simply an irritated skeletal muscle, the sensations are uncomfortable, but not necessarily painful. Or maybe I just have a skewed way of looking at things.)

Anyway, by the time I finished my seven mile run the next morning, not only did my arm feel heavy and slightly alien, my left ankle was irritated. I knew they were connected, and I felt, for lack of a better word, off, but I wasn’t quite sure how.

I tried some things, but they only made the electric feelings worse. I decided to let it rest (novel idea, I know), and work on some admin work.

While I was waiting for video to load, I found myself scrolling through instagram. Someone had posted an exercise in quadruped with one arm elevated on an ottoman while performing cat/cows. “That looks interesting,” I thought, as I set myself up in front of the coffee table to try it.

The first attempt at cat/cow with my right arm elevated was completely uncoordinated. “Hmmm… I can’t move my spine around my arm while it’s fixed in shoulder flexion. That’s interesting. And my left arm feels light and my spine organizes just fine when it’s in shoulder flexion. It’s a little better the second time. And look! All of the sensation is gone, both in my ankle and my shoulder!”

The benefits of neuromuscular techniques

Did I “fix” my injury? No. I clearly had done something to the tissue that needed time to heal. I also noticed on subsequent attempts of the same movement there was discomfort when I moved my spine into flexion with the arm overhead, which was likely the actual injury. Everything else was simply a nervous system response.

What I did do was shift the loading pattern through the glenohumeral joint and remind my brain that my right arm was an actual part of me that could provide stability, not something to be avoided at all costs.

I did this movement a few more times during the course of the day. Each time, it provided instant relief that lasted for longer and longer periods. The lack of coordination in the spine eventually evaporated, and I began to more my spine more easily around the shoulder.

What about the ankle? What was that about?

While running two days later, my arm felt heavy and on guard. I noticed that part of my strategy was to subtly lean away from the right arm. “Aha! This is why I am overloading the left ankle. What happens if I lean into the right arm and allow my breast bone to rotate to the right?” Within three minutes, the sensation in the arm dissipated, my gait felt fluid, and my arms felt equally light. My run was uneventful, my ankle felt fine, and my cat balance and cat hangs at the park afterwards felt balanced.

What happened?

The nervous system controls how we move based on the input it receives from the mechanoreceptors in the joints, our physiological state, and our emotional state. When something feels “off,” the nervous system shifts its strategy for movement. It’s easy to simply accept our movement output as our destiny, to forget the fact that we can, via voluntary control, interrupt the automaticity of our movements through observing and trying the same movement in a different way. The ability to do this requires trust, not just in the physical structure to make the shift, but in our selves and our ability to choose something that isn’t going to make the situation worse.

The nervous system, breathing, and pain:

I woke up four nights after the initial injury with a start, my heart racing, my shoulder achy (I never felt my shoulder while sleeping. Only during movement). I quickly realized my panic was associated with the inability to breathe.

I tape my mouth at night, which allows me to breathe through my nose. I realized that my sleeping self felt like I was suffocating, not getting enough oxygen, due to my sinus congestion.

I gave myself a moment, reminded myself I was breathing adequately enough that I didn’t need to remove the tape, and started doing multiplication tables, my trick for falling back asleep.

After an indeterminate amount of time (because middle of the night time is so much harder to determine than day time) I felt myself calm down and the shoulder ache disappeared.

When the sympathetic nervous system is unregulated and/or a situation has been deemed threatening, there is a shift in muscular tension, proprioception, and sensation. It’s not unusual for people to attend a restorative yoga class or to take a mellow Feldenkrais ATM and feel their entire sense of self shift, their chronic pain suddenly gone. The autonomic nervous system craves balance; when that balance is restored, the perception of threat dissipates and the muscular system has an opportunity to relax.*

*This is a simplistic explanation for the sake of keeping this post under 2500 words

Creating space:

I found myself thinking repeatedly, “if only I could get some soft tissue work.” I don’t often use soft tissue modalities, but the novel input from having the arm passively moved while the tissue is being actively pressed on can be enough to alter tissue perception and further down regulate the nervous system.

Since we were in the middle of shelter in place, active release therapy, a soft tissue modality I used years ago after I ran into a moving car while bike riding, wasn’t an option. I would have to figure out how to create the sense of space in the joint myself.

Hanging, which I was already doing, was an obvious solution. So was passive stretching, something that has become completely vilified over the past several years. I played around with some passive stretches, found the ones that offered immediate relief, and interjected those before my movement practice the next morning. It was obvious I organized differently when the sensation was imperceptible, and I wanted to continue loading the shoulder as tolerated.

After doing a bit of ground work and locomotion, I continued exploring the idea of traction. I did two sets of Jefferson curls and an old school physical therapy exercise that involves allowing the arm to hang down while holding a light weight and making small circles with the weight. I performed this in different orientations, using the weight to pull the arm down and keeping the circles small.

By now, my shoulder was feeling pretty darn good, so I finished up with club bell swings and L-sits, because L-sits can be a magical exercise for shoulder things.

Later that day, I noticed my shoulders felt almost the same. The nervous energy running through my arm was gone, I could move normally without any discomfort at all, and the thought of bearing load on my arm didn’t give me pause. I could put the dishes away on the second shelf without wincing, something which the day before wasn’t a possibility.

I continued to passively stretch it during the day, and the only movement which continued to be uncomfortable was internal rotation with the arm horizontally abducted. I added in side lying internal and external rotation to load the movement in a pain free way, which brings me to today.

Conclusion:

  • Injuries associated with bodyweight movements generally occur because of an inefficiency receiving the ground or an inefficiency leaving the ground. I injured my shoulder not because the movement I was performing was bad, but because I wasn’t dealing with the load from the floor in an efficient way.

  • If I felt fear around the sensation I was experiencing, it would have been really easy to stop using my shoulder all together. Tissues heal when blood is feeding the areas surrounding the injury. Blood is shunted to an area when the limb moves, so continuing to move the area is critical for healing. Additionally, adhesive capsulitis, aka frozen shoulder, becomes a potential risk when you stop moving the arm.

  • Though my right shoulder has seemingly nothing to do with my left ankle, the nervous system avoids discomfort at all costs and will cause subtle shifts in normal daily movement when it perceives a potentially threatening sensation. This shift alters loading in other areas and can lead to issues of discomfort, or worse, if it isn’t addressed.

  • It is possible to interrupt unconscious movement by paying attention. The sensation of feeling “off” can be altered with the right input and with the right curiosity. There is often fear around moving “wrong” or making the injury worse; as a result, people don’t realize how they move is a choice, not a foregone conclusion. Empowering people to realize they have a choice can make a huge difference in the experience of discomfort.

  • Since the nervous system reigns supreme in all things related to sensation, altering joint position alters sensation. This is why it’s possible to experience immediate relief with specific movements and why calming down can cause a shift in sensation.

  • It’s also why small, subtle movements are often be more potent for pain relief than big, grand movements. Subtlety is like the body’s version of turmeric—a little bit sprinkled in can have profound health benefits.

  • When people are given permission to use whatever language they choose to describe what they are experiencing, it can offer clues about what will make things feel better. My shoulder felt like it was jammed in the joint and like I needed to create more space. Passive stretching created a sense of lengthening around the area; I followed that up with tools that made my arm feel long, like I was creating space in the joint.

    Are these anatomically/biomechanically/physiologically correct descriptions? No. Did they allow me to explore what would ultimately completely dissolve my comfort? Yes. Language is a form of expression, a way to put words to sensation. When people are allowed to use their words to describe their experience, often what the person needs can be found, embedded in the words they use.

  • Using tools like soft tissue work and passive stretching are entry points to more movement. The temporary resolution of discomfort enables pain free movement, which provides nutrition to the joints in the form of blood flow.

    I share my story and these bullet points because there is a disconnect between the experience of sensation and the inherent power of the individual to change the sensation. There are, of course, exceptions. Injury to the joint itself, cysts around a nerve, and arthrokinematic changes can all cause sensations that are unresolvable. But, in my experience, these are exceptions, not the rule, and when you experience a sense of embodiment you “know” when something is seriously wrong, just like you know when your experience is temporary and can be altered. My discomfort lasted six days, probably three days longer than it should have. I watched it curiously, taking a mindful approach to the way it unfolded and trusting, both in my body’s ability to heal and my own ability to make myself feel better.

    Are there other ways my shoulder sensation could have been addressed? Yes. Would those ways have been as effective? Probably, with the right practitioner. There are always many ways to arrive at the same conclusion. One way isn’t better than another; what matters is that it works for the person.

    Move often. Pay attention. Explore connections. Don’t fear sensation, but don’t ignore it, either. It’s there for a reason. Take the time to listen.

 

*Editor’s note: A month later, skill was acquired and move was completed.

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