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When my pain started, I had already planned a backpacking trip, to Patagonia of all places. It was a dream trip, and I remember asking my doctor, “will I be out of this boot before my trip?”. He said yes, with some trepidation, and I held onto that as my lifeline. Thus began, however, the string of disappointing news about my pain situation; I went to Patagonia, but still in a boot, and backpacked for two weeks, but the pain was ever present. Each night, changing out of my hiking clothes, I remember catching by breath as my pants passed over my foot. I was in so much pain. The experience was so completely disheartening that I sold all of my backpacking gear when I got home, utterly convinced I would never ever do it again.
Flash forward 2 years…
I was probably a year into working on my pain in a new way and was convinced of the mind body connection. I’d already had my miraculous 5 days pain free after a yoga nidra class (if you haven’t heard about that, feel free to check out my interview with Dr. Stracks here), and my pain was improving. But, I hadn’t yet gotten back to most activity I really loved. I still wasn’t running or hiking and definitely still felt certain that my doctors were right about those activities; they would be the “hardest ones for you” and would “only get worse.”
Around that time, I met a man in Colorado, so, despite the pain, I started going to Colorado (from Chicago) every other month, to play in the mountains with a man I knew I was falling for. We skied and biked and hiked. Pain was a companion, but I wasn’t as scared, and that felt clear. And then something totally unexpected happened. Sitting in his car, moments after setting my backpack down after an overnight trip in the backcountry, I realized, for the first time, that I had just done the one thing I thought I would never do again. I had strapped on a backpack, walked into the wilderness carrying all I needed on my back, and hadn’t even batted a lash. So much so that I didn’t even realize what an accomplishment that was until after it was over! Maybe even more astoundingly, I did it without any pain. When I look back on that experience, I often identify it as one of my biggest triumphs in moving away from a pain story and toward a life that felt vibrant and free. It propelled me even more confidently into my continued work. Movement is powerful like that; the direct experience that movement offers really can’t be beat, and is so incredibly impactful. But, how did it actually happen?
Getting back to movement as part of a healing journey with persistent pain can be a bit tricky, especially considering the primarily biomedical messages we get from most providers. But, it’s totally doable, using what you know about pain, healing, and yourself. Here are some pointers to set you off on a good path.
1. Build connection, in any way you can, to a new way of thinking about pain. Pain is a story your brain is telling you. You can change that story. Pain being changeable was most definitely not a message I got from any of my medical providers. As far as they were concerned, my pain would likely just continue to get worse, and would follow an expected trigger and response pattern. Walking too much meant pain; running, hiking and backpacking, activities that involved more force, equals more pain. But, then I learned about the neuroscience of pain. And, with that knowledge, I started to find holes in the story I had been telling myself about pain and movement. Sometimes I could walk for hours without pain, while other times, I hobbled just in getting to the bathroom. Sometimes I put no extra force through my foot, and it hurt more, seemingly without any physical trigger. There were definitely inconsistencies between my pain experience and the biomedical messages I had received, and noticing those inconsistencies also let me walk away from the limitations the biomedical model put on healing pain. Learning about pain helped me build confidence that I could change my story.
Below are a couple ideas for getting started with this first step:
2. Build confidence in other areas first. Movement, for me, was the most scary thing to return to. That might not be the case for everyone, but, if it is for you, be gentle with yourself and consider simply starting somewhere else first. Use tools you’ve learned from Curable for returning to safety on a daily basis, including calming your body, creating boundaries, or giving yourself permission to let go of perfectionism. Once you start to see how these approaches can change pain, you might be more confident that you can do the same in regards to movement. Or, you might totally forget movement could be a trigger (that’s how I ended up with a backpack on my back without even thinking twice - wow!)
3. Start with joy, awe, and play. Move your body just for the love of it, so pain (or no pain) is no longer how you measure success. When I look back, it’s easy to see that I was incredibly scared of doing the activities my providers had outlined as “most likely to cause pain”. So, I didn’t start there. I started to build joy in my connection to nature, leaning into the sights and sounds as I explored my favorite parks, lakes, and mountains. Instead of running, I started swimming and cycling. And, before I knew it, I had agreed to riding over 400 miles in the mountains of Oregon with my sister for Cycle Oregon. It was one of the most special times I’ve ever spent with her. Ever.
Leaning into joy, awe, and play harnesses your own internal medicine cabinet, flooding your body with all the yummy chemicals that decrease pain (and make you happier!). Joy also promotes outcome independence, because we get to celebrate the joy, regardless of whether or not pain is present. So, make joy something you move towards, daily. And, experiment with outcome independence. For more on outcome independence, I love this short (and somehow always funny!) article from Alan Gordon.
4. Practice Movement-Based Somatic Tracking This is one of my favorite approaches to returning to movement, but don’t discount the steps preceding this one! A solid foundation makes this type of work more possible. Take your time in getting here.
The great pain educator, Lorimer Moseley, points out that there are two strategies we know do not work with returning to movement; one is to avoid painful movement, and the other is the “no pain, no gain” approach, pushing way beyond pain. I’ve definitely done both of these and can easily tell you that my experience confirms his claim. These approaches did not work for me.
As an alternative, here’s what we know does work: start getting exposure to the painful movement, at the edge of pain, with powerful messages of safety on board. This might look like moving your foot while also actively working to relax your body, imagining the joints moving smoothly and effortless over one another, and breathing gently (that’s what I did). Or maybe it’s taking just two lunges, to a depth where pain just starts, while also relaxing the body and breath, reminding yourself of what you know about pain neuroscience, and leaning into your felt sense of confidence and strength.
No matter what you choose to start with, lean into creating safety. As you do the movement, consider, “what might I shift to move closer to safety in this moment?”. You might bring in a mantra, an image, shift your breath, relax your body, or change your position. Rather than making the first “go to" response to stop the movement to make the pain go away, or fight the fear by pushing through the pain, how might you stay at the edge of pain, allow the sensation to be there, and also relate to it with more safety or create more safety in your body?
Remember, movement is a powerful way to retrain the brain towards safety. But, it needs to be done with the brain in mind, sneaking up on the “danger meter” that determines when pain happens, and coaxing it back to safety while you are moving. If you feel like you need more help with this approach to movement, check out Pain Care Collective, a yoga therapy studio specifically for those experiencing pain. The studio is inspired by the practices of yoga and also rooted in pain neuroscience, making it a powerful companion to any healing movement plan.
Movement is medicine, and will, at some point, become a part of everyone’s journey to healing pain. After all, we live life in a body and our bodies are meant to move. However you start, remember two important points: your body is healthy, and, pain comes from the brain. No matter what specific form your return to movement takes, keep those two main points as your foundation, and remember to stay close to them as you progress. Then, build your access to safety, and bring that safety into your movement. You CAN do this.
About the Author
Michelle Grim is a Physician Assistant and Yoga Therapist, in addition to Somatic Experiencing Practitioner in training. She believes in the power of the body as a potent avenue through which healing can happen. Her work is founded in the idea that threat physiology is the root of most chronic symptoms, including pain, and that working to decrease threat and increase safety, especially through embodiment, can be a powerful means to healing. She is highly involved in the mind body community, seeing patients at Cormendi Health with Dr. Stracks, in addition to working one-on-one with patients in her private practice, Embodied Health. In January of 2021, she co-founded Pain Care Collective, an online yoga therapy studio specifically for those experiencing persistent pain, that is dedicated to harnessing the many practices of yoga, including movement, to change pain.
Please note: This article is made available for educational purposes only, not to provide medical advice. The views expressed in this article are those of the author, which do not necessarily represent those of Curable or other contributors to the Curable site.
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