Lego houses and the journey of overcoming pain
Using a simple analogy to help you understand what you need to do
This is my current favourite analogy for helping my clients to understand what they must do when working to overcome their symptoms.
By keeping this analogy in the back of your mind, you can always return to a helpful perspective no matter what level of symptoms you are experiencing.
Scenario: you have fairly persistent back and hip pain and a neck that gets really tight too. You feel symptoms every day or every other day. You've had treatments of many different types and you've had scans that show you don't have any clear structural problem that's contributing to the symptoms. Previously in your more athletic days, you've pulled a hamstring or two, rolled a few ankles and hurt your back lifting something heavy.
I'd like you to view pain and the regular pain experiences you've had like this:
Each time you have a pain experience, you add a Lego block or a couple of blocks to a Lego house that has been built up over time, block by block. This house represents THREAT. This house is already built and is something that your nervous system factors in when deciding how much pain, protective muscle tone or behaviour change is needed in any given moment.
On the other hand there is another house. Or maybe more accurately, there are the foundations for a house. These foundations represent where you will build the house of SAFETY. It is currently more of a building site, with half finished walls here and there and in some places the foundations are still exposed.
Your goal is simple:
Stop adding blocks to the house that represents THREAT. Start building blocks on the foundations that will become the house of SAFETY.
That's the journey in a nutshell. So lets help you understand it a little better.
Threat.
Pain experiences, injuries, learned beliefs about the body & what is safe for you to do or unsafe. Poor sleep. High levels of stress. Low energy. Negative emotions like fear or anger or worry. Overloaded tissues. Asking under-loaded tissues to work really hard when they don't have capacity to.
All of these things make it more likely that you add blocks to the house that represents threat.
For people with ongoing symptoms, this house is already established and often is well built. It is a body of evidence that the brain will reference when deciding how to respond in any given moment. This will carry a lot of weight that lends itself towards producing protective responses such as pain, altered range of motion or muscle tone, stress responses and thoughts that change behaviour.
As I will write about more in depth in another blog, negative experiences transfer across to long term memory more readily than positive ones.
There is an inbuilt bias towards survival that leads us to “log and store” evidence of anything that might cause a problem for us in the future more quickly than a positive experience.
Which means it's likely easier to build the house that represents threat. That's hard, because in a way, it might be easy to think that the cards are stacked against you. (Let's not think that though, it will discourage you and that's not the intention at all!).
What it does mean is that we will have to work hard at consistently providing evidence of safety. Anyone who finds themselves with persistent or chronic symptoms will be all to familiar with the short term responses that treatments bring. They help, and they also lull you into a false sense of security where you think that you can “get fixed” if you do more treatments.
I'm here to tell you that they help and they are one hour in your week. What you do in your own time is more important for long term progress!
So lets have a look at how we can build some safety ⤵️
Safety.
On social media and in conversations with the people in your life, you will get recommendations for this approach, that approach, people swearing by this type of treatment or this therapist, that spiky massage ball, yoga, acupuncture, pilates, etc etc.
Always remember, principles are few, methods are many.
I was guilty of being one of those people for a long time. What I recognise now is that even though I have a preferred way to explain things, preferred methods to use and preferred frameworks to use during clinical reasoning, what really matters is that we find how to create safety during movement for you.
Without that, you aren't going to be able to demonstrate any evidence that will lessen the need for protection.
Without that, the foundations for the house that represent safety become an overgrown hole in the ground and the house never gets built.
So what could safety making look like?
My preferred methods are to help you to get a more accurate and realistic understanding of your body. This one always comes first!
This involves diving into previous treatment experiences, understandings and beliefs about your body and your symptoms, cultural and personal narratives about your pain and offering you a chance to explore this in a collaborative way.
We do this so that you are given the best chance to have a neutral or positive interpretation of any exercise, movement or treatment provided.
After this my next favourite thing to do is to give you a safe movement experience. I think this is so useful because it provides a powerful contrast to what you regularly experience in your body.
Then you learn how to do this to help yourself create evidence of safety during movement on a daily basis.
I'm not the builder here. I'm more like an engineer or architect who is guiding and designing in collaboration with you. You have the opportunity and responsibility to do the work to build and then inhabit your own house of safety.
Other ways that you can create and lay down blocks for the house that represents safety:
Having fun
Social interaction
Strength training
Stretching
Walking
Getting more and better quality sleep
Practicing self care strategies
Hands on treatments
Yoga
Pilates
Minimising stressors
As I wrote earlier, principles are few, methods are many. Understanding what you are up against is half the battle. This analogy usually lands nicely with my clients and I hope it's been useful for you too.
Once you know what has to be done, your next step is to pick your methods and be as consistent as you can.
There is no escaping that this takes work.
Forget about the claims that this treatment or that therapist is all you need. Short term gains might add a few “safety blocks” but they won't build a house. Learn how to build that house and get after it!
If you don't know where to start, I have built this entire process out for clients that cannot make it to the clinics for in-person work. If you'd like to use this, it is available for a reasonable monthly membership of €29.
It contains modules to help you transform your understanding, movement plans to build evidence of safety and practical strategies to help with stress management, improving sleep and lots more.
Right now (Nov 2022) it is focused on people who have lower back pain, hip pain and knee pain. By early 2023 it will contain everything needed for neck & spine pain, shoulder pain and elbow wrist and hand pain).
You can check it out here.
Stay well. Move well.
David