Spending time in the West Country you cannot help but be drawn into the culture of surfing. Whether it be watching the action from the beach, taking a lesson, going shopping in one of the vast array of surf outlets or sitting in a cafe watching footage of surf champs (the most intriguing are those that illustrate the 60s and 70s surfers in sepia without the modern day equipment). So, taking in a healthy infusion of the lifestyle so removed from the metropolis, I asked a local instructor Pete from @KingsurfNewquay (King Surf, Mawgan Porth) about the types of pain and injuries that surfers suffer.
Like most outdoor adventurers, these guys and girls are robust. They don’t moan but rather get on with their pursuit and deal with aches and pains at the end of the season. Of course this may not be the best course of action, however there is a way or perhaps a code that is unwritten but known and communicated with expressions and colloquialisms such as the ‘sea ulcer’. This is not something you find on a rock but rather a breakdown of flesh that struggles to heal despite the fitness of the surfer. Simply due to the repeated friction with certain parts of the board and the hours spent in the sea water, the healing process struggles to keep up with the repeated damage.
Pete tells me that the commonest pains are in the back and knees. Another instructor Nick, adds in shoulders. Both agree that in fact you can experiences aches and pains in different places across the body that seemingly pop up randomly. Of course the reality is that these aches and pains are not random at all, but part of the body’s incredible protective device in action, responding to perceived threats.
Briefly, why would these areas predominate? The paddling action requires a great deal of shoulder use, the back is often held in extension and there is a fair amount of twisting force about the knees. That could be an explanation that would make sense to most people however, we have to ask about those who make the same actions yet feel no pain. We must also consider the fact that any sports or physical activity is accompanied by the pain of exertion that is entirely normal. Most people are familiar with the pain that follows a new exercise regime or an unaccustomed activity that lasts for a few days. This type of pain usually settles, however if you do not allow the body to adapt to the demand, you could further wind-up the sensitivity and see a more persisting pain develop.
Pain is a response to a perceived threat. Who does the perceiving? Actually it is the brain that works out the threat value of what is going on, even if we know the activity is not really dangerous. The problem is that the ‘output’ from the brain when it perceives threat to the body is pain in most cases, and this really feels like you have injured something, even if you haven’t. This is often the situation when we have a persisting problem. In an acute injury, the pain is a vital attention grabber so that we take a course of action to promote survival and healing. It hurts when we move or touch the area which is very useful and adaptive in the first days as the inflammation takes hold and kick starts the process of repair. Other responses include changes in motor control, blood flow and sometimes we are aware the we feel and think differently, more protectively. We guard and make decisions based on how the body feels. This is all entirely normal. As the healing process rolls on, the sensitivity often reduces and movement becomes easier, and we resume activities as before. Often to encourage the right conditions and to ensure that we restore normal control of movement and sense of the body, we follow a rehabilitation programme that may be accompanied by treatment. This is typically effective when we fully understand the injury, the mechanisms and our role in proactively rehabilitating the problem both physically and mentally.
In some cases, and these are the cases that I specifically see, the pain and sensitivity persist or recur. Why is this?
Scientists continue to research why people continue to suffer pain. Approximately 1:5 people have an on-going pain and although many are able to continue with their normal lives, there are those who are unable to work or play. Clearly there is a spectrum and between these ends are individuals who suffer but persevere with their activities. This often includes sportsmen and women who ‘patch’ themselves up and keep going. Admirable though this is, it may not be doing them any favours in the longer term. One major issue is that often it is these individuals who rely upon their body and an ability to be active for their income. This will clearly change the context and as regular readers will know, context in pain is a key factor for the meaning of the pain and consequently the on-going response.
What we do know is that in the early stages of an injury, if the sensitivity builds and causes changes in the central nervous system (central sensitisation) this mechanism will underpin persisting pain. This will typically occur when a nerve is injured. Nerve tissue in the periphery (body) can be damaged like any other soft tissue except that the injury causes changes in the spinal cord and higher centres manifesting as a widened area of pain, changing locations and a reduced ability of the nervous system to inhibit the sensitivity. Altered function of specific cells in the brain stem also affect both the facilitation and inhibition of the flow of danger signals thereby amplifying the sensitivity under certain circumstances. Inflammation can also cause persisting sensitivity from the periphery as the molecules bathe the nerve endings, ramping up their excitability.
The key point to remember is that pain is not an accurate indicator of tissue damage. Phantom limb pain is the classic example with their being no tissue (limb) yet the sensation of pain exists. This is because the brain perceives a threat in a limb that despite not being present, still has a representation in the brain. The body is mapped out in the brain, allowing the brain to know where sensory information is coming from with accuracy and to control precise movement. Motor and sensory function is integrated to create the ‘concrete’ sense of self that we experience. The feeling of our body is constructed by the brain as is the visual field we experience. Both vision and pain share common features in that the brain receives information and creates a reality that we feel and sense to be true. As we know from the great illusionists and many other life situations, our experience of ‘reality’ is hugely variable and often suggestible—how scary is a dark corridor after watching a horror movie? How quickly do we move after repeating a train of words pertaining to youth?
Knowing pain helps us to rationalise fears that we may have and thereby create the right conditions to move forward. To change a state of persisting pain we must be proactive but this requires the understanding of pain, the development of confidence in using the body self-sustaining tissue nourishing techniques and strategies that re-train the way in which the brain is protecting the body on the basis that the real threat is diminishing.
For the surfer who has to keep going for competition or livelihood, gathering knowledge as described above, and integrating a range of strategies into the day will be important in re-learning normal movement patterns rather than guarded postures. Pain has physical, cognitive (what we think) and emotional (how we feel) dimensions, and all must be addressed in an on-going pain state as they are entirely interdependent. For example, regular simple movements of the affected body areas that are tolerable and develop confidence as well as nourish tissues that have often become tense with a consequential poorer oxygen supply, neurodynamic movements to mobilise the nervous system and the interfacing tissues, pacing activities and mindfulness practice. With any exercise routine, it is not enough just to consider the movement itself but also the mindset, any known factors that could prime the neuroimmune system (eg/ fear of movement, stress, fatigue, previous activities) and the timing. I consider a good analogy to be taking a prescribed drug that seeks to alter physiology in the body as does exercise. Except exercise and movement when performed with confidence has a wider positive effect physically and mentally. It is the best drug we know!
Suffering persisting pain is more common than most people realise. With perhaps 20% of the population experiencing on-going pain, we need a wider shift in understanding and knowing our own pain so that we can create the right conditions for change. We are fundamentally designed to change, learn and grow with the neuroplastic characteristics of the neuroimmune system, it is just knowing how to access these mechanisms proactively and in a self-sustaining manner in order to attain the freedom we desire.
If you suffer persisting pain or injury, contact us to learn how you can creat the conditions to move forward: 07932 689081