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I had one of those moments last week…a moment when the old light bulb went off and I realized what some of my patients were really asking me. It started when a patient who was clearly in a lot of pain said with disbelief, "My doctor says everything looks good, but I still feel awful." Ah ha! I realized that her statement was actually a question, and I finally heard what she was really asking. Her real question to me can be translated like this: "The doctor says everything looks good, but I hurt as much as I did before surgery. How is it possible that everything looks good when I feel so bad?" Fortunately, there is a very easy answer: healing is not the same thing as getting better all the time.
Before this gets too confusing, let me expand on what I am talking about. Healing is NOT always associated with pain, and healing does NOT always mean your pain will decrease.
Certainly there are times when one or the other is exactly what happens, but healing and pain are not the same thing. We can have pain without healing and we can have pain with healing. Equally, we can have healing with and without pain. They are not always connected.
Let me give you two examples. I fractured my wrist when I was 12. It hurt for a couple of weeks and then I didn’t have much pain. However, my bone was not "healed" for 6-8 weeks. So in my case, the pain stopped before the healing stopped. When I was in my early 20’s, I tore ligaments in my ankle. This really hurt. In fact, this hurt for months after the original injury. I couldn’t walk without limping for at least two months and it was hard to run and play basketball for over a year. Despite the lingering pain, the healing was complete 6-8 weeks after my injury.
I use the 6-8 week maker because when scientists study our bodies' healing, they find that most conditions are healed in that amount of time. Some conditions take longer, but for argument's sake, let's just say that most heal in 6-8 weeks. This is important to remember. When I sprained my ankle, I hurt for close to a year, but I was healed. So had I gone to a doctor, I would probably have heard, "Things look good." Meaning, "Your healing looks good."
The fact that I still hurt even after the healing was complete seems to contradict that I actually was healed. But in reality, healing means that the tissues are repaired. Pain, remember, is the emotional response to a noxious stimulus. So if my tissues healed but there was still inflammation at the site, I would feel pain. If my tissues healed but my joints were not moving fully, I would hurt. If my tissues healed but they healed in a shortened position, I would hurt when I stretched them.
There are a lot of reasons for still having pain, and these reasons have nothing to do with healing. This is absolutely critical for people to understand, because this is why rehabilitation is so important. If you avoid activities because they hurt and you think it will delay the healing, then you may be actually perpetuating the pain. It is not that you are intentionally contributing to why you hurt, it is that you are trying to protect something that does not need protecting.
Follow me on my thought process. When something is healed, it requires another injury for you to damage yourself. Remember that pain is NOT always a sign of injury. If I pull my finger back it hurts, I have pain, but when I stop pulling it back my finger stops hurting. Pain does not equal injury.
My patient with back pain is months out from surgery but still has pain. Most, if not all, the healing that is going to take place has taken place. Consider healing as repair. The area that was injured is now repaired. It is ready to handle stress and remodel itself back to healthy strong tissue. This does not mean it won’t hurt. Remember, my ankle was better, it was healed, but it still hurt.
From this day forward, consider healing and pain to be different. Pain is a great warning sign for us and it clues us into whether or not healing is going as planned and if there are complications. But most often, pain is only one of many clues that let us know healing is happening. Pain alerts us that the body wants us to pay attention to something. Pain is an alarm system.
So in the early phases of healing, pain is a great guide to tell how we are progressing. Pain should progressively get better as we heal. But once the healing phases are complete, pain becomes a less reliable source of information. After healing is complete, pain becomes more and more emotionally related. As I have said before, pain is the emotional response to a noxious stimulus, so when the healing is complete, most often the noxious stimulus has nothing to do with whether the tissue is repaired and more with to how our stress levels are. When we still feel pain, it starts to affect our emotional/mental outlook. This is what I have been writing about for the last several years. This type of pain is something that can be resolved with a Wellness Approach.
For my patients with healed injuries, I provide reassurance them and teach them safety rules like "Go to the pain, not through the pain" so they can reduce their pain levels and get back into life. For my patients with injuries that are still healing, I pay more attention to their pain and encourage them to listen to it and to trust it. "Don’t push through pain" is especially important when you are still in healing phases.
As a general rule, most of the healing from an injury takes place in 6-8 weeks. However, if you suffered a major injury, it can take longer. If you are ill, it can take longer. If you have other medical conditions like diabetes, for example, it can take longer. But the bottom line is there is a point where things are healed, but you may or may not still have pain.
Chronic pain is often associated with an old injury, but from a physiological perspective the old injury is no longer relevant, because it is healed. If the tissue healed in a way that causes pain, it is necessary to remodel the tissue into a way that doesn’t hurt and the best way to do this is with exercise.
There are some simple things we can all do to be well, and one of the most important is to understand the difference between pain and injury. And based on my light bulb experience, it is also important to understand and keep in mind the difference between healing and pain.
Matthew Goodemote is the founder and owner of Community Physical Therapy & Wellness in Gloversville, NY. He has degrees in Exercise Science, Health Science, Physical Therapy, and he is one of just over 250 in the world with a Diploma from the McKenzie International Spine Institute. Matthew is recognized as an expert in the fields of Physical Therapy, orthopedics, spinal disorders, sports medicine, and wellness. He is routinely called upon to offer tips and suggestions relating to health and wellness. His unique approach makes him a highly sought after expert at different ends of the media spectrum. He has received requests to participate in studies for scientific journals, and to write articles for trade magazines and popular press magazines such as Fitness to offer proven recommendations that stand the test of time. More of Matt’s blogs can be found at http://www.matthewgoodemote.com/blog/.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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