The Final Stage

It’s been weeks— maybe months—since the pain was really bad. And you’re finally starting to feel better. 

You started out by becoming aware of the things that were making the pain worse and the things that helped. Using that information, you did less of what made it worse and more of what made it better.

Then you slowly started building back up your movements and activities, doing slightly more over time without making the pain significantly worse.

You’ve been working judiciously.

At this point, you’re just happy to be able to do your daily tasks without pain. You’ve reached a stage where things are pretty good. Sure, there are still some things that you don’t feel fully comfortable doing. And no, you’re not back to all of your desired activities, but at least you can live your day-to-day life without major issues.

You take a deep breath, feeling the relief of your realization. 

Maybe I’m through the worst of it, you think. 

Maybe life will get back to normal now. 

But there is a shadow of a thought in the back of your mind: 

What if it gets bad again? It’s happened before—several times, actually. It could happen again.

So what do you do? You stop.

You call it good enough. 

Do I really need to get back to that? 

Do I really need to get back to where I was before this episode of pain? 

85% is good enough. After all, I’m feeling pretty darn good, I don’t want to push it and make it get bad again.

And so life goes on for a while. The pain fades like a distant memory as the weeks and months pass and you live your life without pushing it.

That is, until one day, there it is again. 

Maybe it’s not as bad as before, or maybe it’s worse.

But it’s back.

This is a very common cycle. 

Perhaps one that is familiar to you. And while pain can be complex and be influenced by a variety of factors—some in our control, some not so much—there is something very important missing from this story.

Something’s missing

When we are recovering from any injury or pain episode, the recovery process is one of rebuilding our mind-body’s stress tolerance to be such that it allows us to perform our desired activities without the alarm bell of pain going off.

When things are bad enough that we can’t do much, we have no choice but to figure out this rebuilding process. But once things begin to feel better, it’s very common that we stop pushing it for fear of making things worse and going backward. 

But when things begin to feel better is the exact time to keep pushing things further.

What’s missing from this story is the final stage of recovery: Hunt & Confront.

Hunt & Confront

The stages of simple pain management are as follows:

1. Awareness: Identify the factors that make it worse and better

2. Relative Rest: Do less of what makes it worse and more of what makes it better

3. Rebuild: Slowly build up your movements & activities to their previous levels

Hunt & Confront lies within the 3rd stage of Rebuilding. But the rebuilding stage is often cut short when we stop pushing for fear of making things worse or going backward.

What does Hunt & Confront look like?

Hunt & Confront looks like it sounds. Whereas in the earlier stages, you were avoiding things that bring on the pain, in this stage, you are specifically looking for things that bring on the pain (or feelings of stiffness, weakness, limitation).

What do you do when you find them? You do them in a sustained or repetitive manner.

Hunt for the movements, activities, or situations in which the pain arises.

Confront the movement, activities, or situations by repeating or sustaining them.

For example,

• Maybe you’re recovering from an episode of knee pain. It’s mostly gone but still comes on when you go down stairs slowly. Instead of going down stairs quickly to avoid it, confront it by doing the exact thing that hurts in a slow and controlled manner.

• Maybe you’re recovering from an episode of low back pain. It’s mostly gone but still comes on when you bend forward and turn to the left. Instead of avoiding that movement, confront it by repeating it a few times.

• Maybe you’re recovering from an episode of hip pain. It’s mostly gone but still comes on when you walk more than 20 minutes. Instead of stopping your walks at the 20-minute mark, confront it by walking a few more minutes.

Each time you hunt & confront, your mind-body will adapt to be better able to tolerate the stressors (activities, movements, contexts) that you would like to place upon it.

A caveat

Of course, there is one caveat. One two-part caveat.

Remember when you were judiciously paying attention to your symptoms in the earlier stages to make sure that what you were doing wasn’t making things significantly worse? You should keep doing that. You can use the Activity-Safety Meter for guidance.

Second, always keep in mind the principle of relativity. What is your body used to now? If you have been avoiding a particular movement for some time, don’t scream BANZAI and confront it 20, 40, 50 times or hold a painful stretch for 5 minutes.

The element of surprise isn’t useful here. Start with a gentle confrontation—a nudge—a few times and see how it goes. You can always do more or push harder next time.

This is a two-part caveat because the call in both instances is to:

• Keep in mind where you are now and progress in a graded fashion

• Continue to pay attention to how you respond to what you’re doing

What comes up

The hunt & confront stage can be, well… confronting. 

What often comes up in this process is fear. Fear of injury, fear of damage, fear of regression, fear of pain.

But with fear also comes the opportunity to deepen our trust in the resiliency of our bodies.

And there is something deeply therapeutic about identifying things that we’re afraid of and doing them in a manner in which we feel safe and in control. It expands beyond just movement and the body. It includes our entire being because these complex experiences (pain, fear) include our entire being. 

Keep going

So if you can see yourself in the narrative at the beginning of this article, keep going. Don’t stop at good enough. 

That doesn’t mean that there won’t be setbacks along the way. The path often isn’t linear. 

There’ve probably been some setbacks up to this point, why should it be any different now? 

But by continuing the rebuilding stage by hunting and confronting, you are building resiliency, stress tolerance, and—perhaps most importantly—you are working toward doing more things that you love to do. 

And living your life in the way that you want to live it is worth a little confrontation, isn’t it?

Good luck out there,

Andrew

P.S. Does the rebuilding stage ever really end? Do we ever reach a point where we’ve arrived at some state or place in which we are truly operating at 100%? Perhaps. But until then, I’ll be hunting & confronting.