Why am I in chronic pain? The perspective that helped me heal - Upright Health

Why am I in chronic pain? The perspective that helped me heal

When you’re suffering with chronic pain, you search for meaning in it. Why am I in chronic pain? Why do I keep hurting every day? What's wrong with me?

But the meanings we ascribe to our chronic pain do not always helps us get out of pain. Oftentimes, the theories we attach to chronic pain can actually make our pain worse. 

In this article, we’re going to look at how your understanding of your pain influences your ability to move and live your life again without pain. 

The meaning of my chronic pain

When I pulled my groin as a roller hockey goalie in high school, I was in a lot of pain. And I knew why. I pulled a muscle in my groin! It was hurt and injured. Doctors and physical therapists told me to rest. Because I was young, it would heal on its own. 

The pain meant I had damaged a muscle. That was the meaning. I needed to rest the muscle. That was the strategy to fix it. 

When my back wouldn’t stop hurting for months and months and months, my doctor X-rayed me. He said it would get better with rest. That was the strategy to fix my pain. 

When my feet and knees started hurting, doctors told me I was just getting older…I just needed to rest more so that I didn’t wear down my joints. Rest was the fix for my pain. 

When I started suffering with severe pain, numbness, and tingling in my hands and wrists, doctors told me that I didn’t have carpal tunnel syndrome. They said I had just overused my hands and wrists. That was the meaning. 

The fix for my wrist pain? Just rest my hands and wrists (i.e. no more using the computer). 

In all these examples, you can see how the meaning - the interpretation of the pain - leads to specific strategies to fix the persistent pain. 

And that’s where chronic pain sufferers like you and I can get trapped. 

Just because a meaning for your pain makes logical sense, doesn’t mean the strategy works 

In all the cases above, rest wasn’t a terrible suggestion for my aches and pains - at least not at the beginning. 

After all, rest can give you time to step back and assess what’s going on. 

Whenever I work with a client with chronic pain who does Crossfit or similar high intensity exercise classes, I often suggest backing off so we can see how their body works more clearly. Is it something about the classes that are making that shoulder hurt or that hip ache? You can’t tell unless you have at least a week away from the class...

But my team and I - and our clients - have found that resting for chronic pain is a terrible option in the long run.  In fact, it can be a terrible option in the short run too. 

Doctors have found that as well. That’s why doctors have changed their tune drastically over the last few decades on back pain. They used to say, “rest until the pain goes away. If it keeps hurting, get an X-ray or MRI so we can see what’s damaged. If your back hurts chronically, something is damaged that we need to fix surgically."

Now they say, “keep moving, and don’t get an X-ray or MRI unless there are signs of something serious like cancer or severe nerve impingement.” 

The meaning of back pain fundamentally changed. Where doctors used to say, “chronic back pain means you’re severely damaged,” they now say, “don’t worry, it’s probably just a muscle thing. It’ll get better with time if you keep moving.” 

The meaning changed - and the strategy changed (as long as you see a doctor who's up-to-date on the science). 

If you keep moving, will your back pain really go away?

Doctors like to say that if you keep moving, things will just resolve on their own. This may be true for some lucky people, but don’t get overly frustrated when it doesn’t work for you. 


If you keep using the same movement patterns and habits that got you into back pain in the first place (or you are constantly compensating in specific ways), your back pain may never fully resolve.


I discovered this in high school after a stubborn case of back pain that took over a year to resolve. 


This applies to hip, shoulder, ankle, knee, etc. pain as well. 

The meaning you ascribe to your chronic pain can make your pain worse

What most people don’t realize is that the meaning you decide on influences more than just your strategy to fix your chronic pain. It influences how severe your experience of pain is. 

Put another way, if you think your pain is because of something severely damaged, you’ll feel the pain more severely. You’ll guard more. You’ll be more on edge and anxious because you’re afraid of doing further damage. 

There’s some interesting brain wiring that makes this happen, and it’s been demonstrated in experiments with real-live humans like you and me. 

Check out this video for science experiments demonstrating the role expectations play in the intensity of pain. 


You think you’re about to be hurt badly? It’s likely to hurt a whole lot worse. 

You think your knee hurts because it’s degenerating and grinding away due to advanced osteoarthritis? That knee pain is likely to feel a whole lot worse. 

You think your back pain is due to arthritis that you saw in an X-ray? Whenever your back feels even a twinge, you’ll think you're doing even more damage, so you tense up, lock everything down, and stop moving your spine. And every little jolt feels like you’re being electrocuted.

You think your hip pain is because you’ve got torn up labral bits and bone shapes that are causing premature rubbing? You interpret every twinge as a sign of your hip breaking…and the pain gets louder and louder (even as the muscles around the hip get weaker and weaker).

And then you’re trapped in a cycle of feeling MORE pain…which you attribute to being even more badly damaged…which makes you feel the pain more…which makes you guard that "badly damaged" body part more…which makes you feel even MORE pain...

With chronic pain, don’t get tricked into a bad meaning with a bad strategy 

When you’re suffering with chronic pain, there are plenty of meanings to choose from to explain your chronic pain. 

Maybe you have arthritis. Maybe you have a torn labrum. Or a torn meniscus. Or tendinitis. Or bursitis. Or some kind of chrondral lesion. Or a torn rotator cuff...

You might have the X-rays, MRIs, or CT scans to "prove" it.  

Or maybe you have fibromyalgia. Or one of the other diagnoses on the growing list of muscle and limb “disorders.” 

The question to ask yourself is this: what's the strategy that comes with the meaning I’m choosing? 

Almost without exception, the strategy that comes with these medical explanations for chronic pain is REST. And eventually something invasive (like arthroscopic surgery or jabbing needles in for anesthetic injections or some fancy new kind of injection with little evidence to back it). 

Are those productive strategies? 

No.

Those strategies and their meanings suggest that you are so broken that you no longer have any power to help yourself. They suggest that you have such severe damage that nothing short of the miracle of modern medical technology can end your pain. 

You are out of the driver's seat. You can do nothing. You have no more responsibility. You have no say in the way this goes anymore. 

And that’s disempowering, makes you fear movement, and makes you believe that any bit of pain is a sign of further damage. 

That traps you in a cycle of pain that makes your pain worse and worse and worse. 

It's also an incredibly big gamble. If a surgery doesn't work, does it mean the surgeon wasn't good? Does it mean you are even more damaged than you previously thought? That's a common story for those who have undergone unsuccessful back surgeries - over and over and over again. 

What if you choose something less invasive? What you do some massage, acupuncture, electrical stimulation, or some other modality that doesn't work? Does that mean you need a STRONGER intervention? Or maybe your practitioner doesn't know how to massage you or needle you the right way?

Those are certainly possibilities, but they also make you blind to the role YOU need to play in getting your body moving again.

BUT I DEFINITELY HAVE ARTHRITIS!

Many people with back pain, knee pain, and hip pain have been told that their pain is from arthritis. The evidence of arthritis can be easily and plainly seen in X-rays, after all. I have been told I have hip arthritis (and a spondylolisthesis, if you really must know). 

There’s the damaged bone! No cartilage! It's plain to see on the X-ray! That’s your explanation. Full stop. 

What you might not hear is that research consistently shows that the severity of arthritis in an X-ray has NO LINK AT ALL to the experience of pain.

Put another way, you can show “bone on bone” arthritis in an X-ray and have absolutely zero symptoms.

This is a consistent phenomenon with all kinds of allegedly iron-clad orthopedic theories. 

The takeaway here is simple: these explanations for chronic pain are based on fantasy and not scientific fact. And they infect you with counter-productive fears. 

To beat chronic pain, you must choose a meaning with a productive strategy 

The medical meanings don’t give you a productive strategy. And if surgery or an injection or whatever high-tech solution doesn’t work (which is unfortunately common), you’re left with an increasingly expensive and invasive set of options (all of which suggest that you are EVEN MORE damaged than previously believed…).

So we encourage anyone battling chronic pain to take this first brave step: choose a better meaning for your pain. 

The one we believe is most helpful and productive is this: 

My pain is telling me I’m not training my body properly.  

It’s a simple meaning that encompasses many scenarios and gives you the power to make great change. 

  • Hip pain? You sit on your butt for 17 out of your 18 waking hours? You’re under-training numerous muscles around your hip joint (and neglecting so many different motions your hips should be able to achieve). Time to make a change.
  • Knee pain? You run 300 miles a week and never stretch, massage, or otherwise relax your leg muscles? You’re over-training your foot, ankle, calf, thigh, and hip muscles in an extremely repetitive pattern. Time to make a change.
  • Shoulder pain? You curl your body over your laptop and mobile phone for ten hours a day? You’re under-training muscles that allow for proper spine, shoulder blade, and arm positioning. Time to make a change. 
  • Foot pain? You wear stiff, thick shoes all day long and haven't let your foot, ankle, or calf muscles do any real work in decades. Would you expect your arm to feel good if you encased it in a cast for the rest of your life? Time to make a change.

In this perspective, pain is not a sign of damage. It’s not a sign of a malfunctioning body. It’s a sign that you need to make a change to the way you move and use your body

This is not a short-term, quick fix strategy. You can’t pay someone to fix it for you. The process can take months, even years to retrain your body. 

But it’s the least invasive, cheapest, and most rewarding, productive, and empowering strategy we’ve found.

Movement can't fix my pain problems!

Whenever we work with someone who has had pain for a long time and/or a severe amount of pain somewhere in their body, one of the biggest challenges is mental. When you've been hurting for a while, you start to think that this means your pain cannot be solved without drastic intervention. 

This belief gets reinforced when your aches and pains don't go away in the time frame that you want.

For example, you're training your body for three months, and your hip still doesn't feel perfect. Or you're stretching and strengthening your shoulders for a year, and they still don't feel as good as you want. 

It's easy to think, "that must mean this [body part] is really messed up."

That puts you right back in the mindset that can increase your pain and make you feel helpless and hopeless.

The reality is simple. If you want to be able to move more without pain, you need to practice moving more. You may need to learn some new things and move in new ways, but staying still will never improve your ability to function in daily life. Lying in bed only makes you better at lying in bed. Sitting on your butt only makes you better at sitting on your butt. 

To get better, you must train your body to move more and in a variety of new ways. This makes you resilient. 

If the history of back pain is any indication, this is the direction of the future of medicine. 

Closing thoughts on my chronic pain journey

"My body needs to be retrained." This is the meaning I ascribed to my chronic pain over the years.

I went from feeling constantly fatigued, lethargic, achy, limited, victimized, and frustrated to feeling confident, powerful, and hopeful. I went from being unable to walk down stairs without pain in my twenties to working on complex movement tricks in my late thirties. I went from constant pain and tingling in my hands to writing articles like this. 

These days, I get frustrated trying to learn physically challenging movements and positions, but I no longer feel frustrated that my body is breaking down before its time. I get annoyed that my growing son has more energy reserves than I do, but I rest with a smile knowing that I can show him how to move right and feel right for the long term. 

My chronic pain is not destroying my life. And it's not destroying my family's. 

This is only possible because I chose a meaning that gave me a productive strategy. I saw that every other meaning led to the same conclusion ("you’re broken and done for"). I chose to believe that there was something I could do to help myself. And over time, I did. 

This same perspective has helped thousands help themselves. 

I hope this perspective helps you, wherever you are on your journey out of chronic pain. 

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About the Author

Matt Hsu is a trainer and orthopedic massage therapist. He fought a long battle with chronic pain all over his body and won. He blends the principles he learned in his journey, empirical observations with clients, and relevant research to help others get their lives back.