If it hurts, do it again

Recently I have been experiencing some shoulder pain. There was no trauma or identifiable mechanism of injury. It just showed up one day as I was reaching my arm overhead.

When I first began to notice the shoulder pain with certain movements, I began to do what I always do when I experience a new ache or pain: I immediately repeated the provoking movement. 

I did the thing that made it hurt and then began to explore other variations of that movement.

Why would I do such a thing?

I do this for several reasons.

First, repeating the provoking movement allows me to become aware of the pattern of the pain — what makes it hurt, what doesn’t, and what makes it feel better. This extends beyond movement and can include any other non-movement-related factors as well. Stress, for example, is a non-movement-related factor that I have found to be related to my low back pain. 

Second, it allows me to experiment with the pain to see if it stays consistent or changes, if it gets better or worse, or if it moves, changes, or fluctuates. This process of experimentation inevitably involves refinement of my sensation in the area, as well as my further awareness of the pain pattern.

Third, it allows me to break the common habit of pain → avoidance from forming or running rampant. This is the common pattern of experiencing an ache or pain followed by the (often subconscious) avoidance of the provoking movement.

The Avoidance Habit

Intertwined in this pain → avoidance habit is a lot of prediction. In an ongoing effort to protect itself, the body-mind is constantly making predictions. When something hurts, the body immediately starts making predictions about when it will hurt, where it will hurt, and how much it will hurt.

These predictions can be helpful at certain times (e.g. if we sustain a serious injury, it’s nice to be able to predict what may cause further harm so that it can be avoided). But at other times (e.g. shoulder pain that began following no identifiable injury), avoiding movement might not be necessary or the most helpful thing to do. 

In fact, barring an obvious and serious injury (and even then following the very initial stages of healing), it may be such that the way to improve painful movements is through the wise application of stress through movement.

Breaking The Habit

As I repeat the painful shoulder movement, experiment with variations of movements, and notice how the pain changes over time, I am recalibrating my body-mind’s predictions and breaking the habit of avoidance at the same time.

After repeating the movement a few times, one of two things typically happens:

1. It gets better with repetition, and I proceed with hunting and confronting until it’s totally gone.

2. It stays the same or gets worse with repetition, and I continue the process of awareness, relative rest, and experimentation until it begins to improve with movement.

This simple formula can save a lot of time, energy, and suffering, especially when applied with a few subtle nuances.

Nuances

There are a few nuances that can make all the difference when applying this simple procedure.

1. Be curious

Recall that the reasons that this approach is beneficial center around information. When I repeat my painful shoulder movement, I am looking to gather accurate information about what is happening with my shoulder and recalibrate the predictions that occur (often subconsciously). This requires truly feeling what I am feeling and noticing the subtleties and changes that occur with repetition and over time. Having an attitude of curiosity is essential in this process. 

2. Stay relaxed

Pain goes hand in hand with many other protective mechanisms that all have the goal of keeping us safe. One such mechanism is our autonomic nervous system, which includes the sympathetic nervous system (fight, flight) and the parasympathetic system (rest, digest, heal). When we stay relaxed, we activate our healing parasympathetic system, expediting the recovery process.

Some simple ways of staying relaxed while repeating and experimenting include:

• Breathing slowly and continuously through your nose

• Keeping your face relaxed

• Being curious about what you are feeling, moment by moment

3. Find the balance 

As with anything, this process of repeating and experimenting with a painful movement can be overdone. 

In the initial stages of my shoulder movement experiments, I noticed that repeating movements in certain directions made the pain worse, while the pain with other movements improved with repetition. I gravitated toward those that improved and eased off the ones that didn’t. I also noticed that my shoulder needed a break between bouts of testing and experimenting. 

So there is a balance between testing and resting that you can discover as you experiment. And that balance will change as the pain changes. So stay curious.

The Next Time

So the next time a movement hurts, you might do it again. 

Experiment with variations of that movement. Notice the pattern. See what happens with repetition and variation. 

You can do this knowing that you are recalibrating your body-mind’s predictions and breaking the habit of avoidance.

Based on what you find, you can take the most appropriate next step toward healing and wellness. 

Good luck out there,

Andrew