In this article in a series devoted to the mind and body’s battle against daily stress, Lillie talks about the sources of chronic pain and how to get out of it.
This week, I have to ride around 500 km in 3 days to complete a race called Dead Ends & Cake. As it takes place in Switzerland, it’s a total of about 8000 meters of D+. Oh, and I should mention that I only started riding my “unassisted” road bike again in April since my illness in August 2019 (see articles 1 and 2).
So, starting from a baseline fitness of ZERO, how am I actually going to accomplish this? And without hurting myself, of course. It’s actually quite simple. I’ve taken to heart the immortal words of the 40s and 50s campionissimo Fausto Coppi, who was asked the secret of his training: “ride a bike, ride a bike, ride a bike!”
So, to improve, I simply ride my bike. In fact, I cycle a lot. As part of my training, of course, I had to test my ability to cover around 150 km in a day. Inspired by an article on cycliste.ch about the unknown paths around Le Mollendruz, last month, I decided to test what I could physically achieve in a day.
The 148 km, 2700 m ride took me 10 hours. And something quite ordinary happened during the ride, something I hadn’t felt in a long time… I developed aches and pains.
My cycling friends, you all know these pains:
- Sitting on this tiny saddle made of who knows what becomes miserable, and I start moving around, getting up, doing anything to find a pain-free place to sit.
- I could barely turn my head to make turns and signal changes of direction in Morges traffic, so stiff were my shoulders and neck from holding my head up all day.
- And my hands, oh, that was the worst… they tingled with occasional nervous twinges that I tried to avoid like COVID. Opening my little bag of sweets was almost torture, but it was essential to feed this hungry beast.
But this “ordinary” pain was one of the happiest experiences I’ve had during my healing process, which has now lasted almost two years. I was literally in tears of joy. Why? I’d just spent 10 hours of hell on a bike. All this pain was completely normal… it was to be expected as it had been years since I’d ridden for so long. Woohoo, I’m f*ing normal !!!!
And like a normal human being, my body healed. After a good meal, a beer and a good night’s rest, I felt great the next day, ready to ride another day.
Happy cyclist enjoying a “real” coffee on the Grand St. Bernard pass
Living in chronic pain
Almost every day since August 2019, I’ve started my day in pain. On good days, it’s mild burning in my muscles. On bad days, the stabs are so intense that I have to hold onto the walls and resist fainting and vomiting. Fortunately, over the past few months, my pain has been reduced to a mere inconvenience, and even on bad days, I know it’s only temporary.
Every day I have this pain, I have to remind myself that there’s nothing physical about it. Yes, my muscles are tight, my joints ache, my nerves are pinched and throbbing, and I feel the resulting pain. But there’s nothing physically wrong with me. There’s no injury! Since August 2019, I’ve actually been struggling with restricted movement due to fascia adhesions that can nonetheless leave me in disabling pain.
A short video on fascia. ARTE has also produced an excellent program (1 hour) on fascia here: https://www.youtube.com/watch?v=2lKDcNvQ9FQ. These videos were sent to me by Tim following my first articles on the site. Thanks to the cycliste.ch community!
But how can muscle fascia be damaged if not by injury? It’s simple: our muscles also contract under stress – it’s an autoimmune response. The more the body is stressed, the tighter and more oxygen-deprived the muscles become. This leads to muscle deterioration and increased pain. For example, think of the knots in your neck and shoulders that accumulate after a long day in front of the computer. Imagine these spots lasting days, weeks, months, even years?
In October 2019, 2 months into my illness, I had so many adhesions all over my body that my physiotherapists didn’t even know where to start. Most of the time, I was curled and twisted up as if I were living in a body of a 100 year old. I had to take powerful painkillers to accomplish basic tasks, to get out of bed most of the time. There was so much damage and pain everywhere that it was hard to find the source. It took months of intense massage to release and smooth out most of the fascia. But even after eliminating most of the knots, they just kept coming back. Why were my muscles constantly tense, even after therapy?
The electric bike was my saviour. Chronic pain specialists told me that movement was what I needed to escape the eternal cycle of pain (see diagram below). And they were right. Every day I cycled, no matter how bad I felt at first, the pain almost always disappeared within an hour. But the pain always returned after exercise. The same knots came back in the same places, no matter how much exercise or physical therapy I did. But why?
To understand why, you first have to understand where the pain comes from.
So, what exactly is pain?
We all know it. We all feel it. But where does it come from? Why do some people seem to have infinite tolerance to pain, while others don’t? Some people are able to completely ignore pain to achieve a goal. Others give up at the first tingle of discomfort.
Traditionally, the sources of pain are classified into three categories:
- Pain due to some kind of physical injury (e.g. a broken limb, a bee sting).
- Pain due to the inflammatory reaction to the injury
- Pain resulting from damage to the nervous system caused by the injury (e.g. a pinched nerve).
Pain should disappear over time, as the body heals, especially for the first two types. The third type is more complicated, as nerves don’t heal as well as other parts of the body, so damage to the nervous system can certainly lead to chronic pain that lasts a lifetime. Things like paralysis and phantom limb fall into this category.
However, the source of chronic pain can sometimes be extremely obscure. Millions of people worldwide suffer from chronic pain with no recognizable physical origin. It’s a problem of epidemic proportions.
Stress hormones and the autoimmune response
Fortunately, much research is now focusing on how the endocrine (hormonal) and immune systems play a key role in the individual’s perception of pain. Pain is an autoimmune response that tells us something is wrong. This “pain perception mechanism” develops from the earliest experiences of life and determines how our body will deal with pain for the rest of our lives.
But our body’s perception of pain can also be altered by trauma, both physical and emotional. My perception of pain was altered by emotional trauma, which may be the case for millions of people suffering from chronic pain. Many researchers theorize that the source of pain lies deep in the unconscious. And unfortunately, the endocrine and immune response affects the mind and body in such a way that chronic pain sufferers are literally trapped in an eternal cycle of pain.
Our bodies are amazing at doing whatever it takes to keep us alive. One key mechanism is the endocrine system. If you’ve ever overcome a truly dangerous situation, you understand exactly how this system works. Your heart rate races. Hormones like adrenalin and cortisol kick in. You feel a surge of energy throughout your body. Your mind is clear and time suddenly seems to slow down. You can take action to do exactly what you need to do to survive. This is an automatic response to external danger. It can be triggered in an instant and give you superpowers to overcome enormous pain or physical obstacles. It’s an incredible part of our autoimmune system that has allowed us to survive as a species to this day. This system is probably responsible for helping you survive some of those “type 3 fun” errors in judgment.
In the past, I’ve followed the HTFU mantra: grit your teeth, ignore the pain and move on. I have an iron will… I never give up! As I described in article 2, I’m not afraid of suffering. Maybe I even embrace it. My pain tolerance threshold was very high.
This attitude has made me very successful in life. But it was also at the root of my illness – because I no longer listened to the pain signals my body was sending out.
My burn-out was an auto-immune response to external stress. I had buried in my unconscious years of emotional manipulation and abuse in the workplace. And one day, my consciousness woke up and saw it, and I had an overwhelming endocrine response. Like I was about to be attacked by a bear. As a result, my body’s alert system associated my work with a place of danger. Because I continued to go to work after the shock, my unconscious made the nervous system generate pain to divert attention from the real emotional burden I was experiencing. It was only when I was able to confront the emotional source of the trauma, through various forms of rehabilitation and psychological therapy, in combination with physical therapy (chiropractic, osteopathy, massage, acupuncture and specific exercises for muscle re-education), that the physical pain finally began to subside.
For a better understanding of how the autoimmune system works to induce pain, I highly recommend reading Dr John Sarno’s The Mindbody Prescription.
Video: an excellent summary of Dr Sarno’s book
So this is my journey… overcoming the trauma that caused my pain perception system to treat stress as pain. A big part of my journey has been learning to manage stress through mental exercises and mindfulness, and slowly uncovering the multiple sources of trauma that continue to trigger my pain.
But the key to my recovery has been exercise and physical stress – I need to reteach my body and mind what is “normal” pain and what is pain that can be ignored. Saddle sores cause physical pain. Repressed shame, regret and anger shouldn’t. In fact, I need to rebuild my pain tolerance threshold. This is indeed a long journey with many ups and downs, but it’s the adventure of a lifetime that, in the end, will only make me stronger. It really is as simple as Fausto Coppi said: to get better, “ride your bike, ride your bike, ride your bike”.
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