The description of pain is one of those impossible, meta-terms that is comparable to trying to verbalize how fear or sorrow or happiness feels “inside your being.” We know that animals will also exhibit a behavioral response to injury. Even a microscopic paramecium with a single celled brain can avoid noxious stimuli, so there is obviously a strong, biologic basis of pain that is independent of higher level intelligence and a well defined system of feelings. But the brain is a strange and mysterious thing. What can start as pain outside of our heads, can sometimes wind up dwelling in there long after our bodies have healed.
Traditional Chinese Medicine classifies illnesses and pain according to various patterns that are observable in nature and intuitive to understand. They use terms like “fire rising,” or “dampness clouding,” or “coldness stagnating.” Someone with the same Western diagnosis of rotator cuff tendinitis could have multiple different causes for his or her problem, requiring different treatment strategies. Remember, it’s easier to understand the general nature of these injury-type, musculoskeletal pains as behaviors of people — or better yet as some sort of collection of villains — instead of the inflammation of biological cells and tissue.
I’m going to try and synthesize both Eastern and Western concepts of various types of pains so that they are easier to understand, without coming across as sounding too abstract or bizarre. Don't worry, we're not going to dive into strange, atypical pains like you might find in organ diseases, such as with a heart attack or bowel obstruction, or neurogenic type pains that you might witness in severe mental illness.
Let's begin with the most basic pain first...
Muscle Pain
Think of muscles as big, hulking bruisers that just lift things up and puts things down. They look big and menacing, but there’s no real intelligent activity. Muscles are very basic and simply follow orders from a higher power, known as your brain. They are not complex or crafty. They don’t get inside your emotions. They don’t hurt on damp days like an arthritic knee, or cause tight gripping pain down the back of your leg like sciatica. If a muscle is injured then it will hurt when you use it, and won’t hurt when you rest it.
Muscles heal fast — very fast — compared to other areas like ligaments or tendons or bones. That is because muscles are filled with an over abundance of blood and have amazing circulation. Think of when your muscles are swollen after an intense workout. They are essentially blood pumps. A pure muscle pain that lasts for months and months is very rare, and highly unlikely, unless it is permanently torn and stressed beyond it’s limit. That tight, rope-like muscle spasming often found with chronic pain is not due to the muscles themselves, but actually the nerves controlling the muscles. The muscle aches only because it is exhausted and constantly tense from the painful nerve activity.
As the weeks went by, she quickly regained normal function, however even after 6 months she could not lift the same heavy weight in the gym without some minor buttock pain. As long as she didn’t do that high level stress activity, she was fine. Whenever she attempted it again, it hurt. That muscle tear from the MRI could not reattach because it was too far torn away. Therefore, the power of the muscle could never be equal to the uninjured side. There are simply not enough “horses pulling the carriage” as there once were.
That is a true muscle pain. “I pick things up and put things down.” It is not very common in chronic pain conditions, unless there’s a permanent tear, severe weakness, or actual disease process present like fibromyalgia or muscular dystrophy.
Tendon, Ligament, and Sinew Pain
Sinews are basically the connective tissue that holds and interconnects the muscles, bones, nerves and organs within your body. This broad category includes tendons, ligaments, fasciae, bursae, and joint capsules. Sinew pain is very annoying and can be quite debilitating if severe. Imagine these pains as if they were a sneaky henchman who’s got you in a vice. With a twist and a little pressure, he can make you feel unpleasant and achy. But if you try to move around and do too much activity, the vice will tighten hard and cause very intense pain. This is sinew pain; it’s a creeping, building, intensifying pain — but it’s dependent upon your activity. And, if you leave it alone, and don’t try to pull your hand from the vice, it’s not going to hurt you.
Sinew pain is frustrating because it can last a long time and really impact your fun and active lifestyle. The blood supply to these structures is typically not great, and a normal timeframe for healing here is about 6 to 8 weeks, on the conservative estimates. I’m sure many an orthopedic doctor has told you to wait the infamous “6 to 8” after an injury or surgery. That’s because it takes soft tissue about two months to heal, as long as there is no obvious complication — such you continuing to perform the same activity that provokes the problem. However, it is not uncommon that certain tendons with poorer blood supply, such as the Achilles in your ankle, can take 2 to 3 months to heal.
Sinew pain is one of the most common types of musculoskeletal pains. Think of that henchman with a vice. It’s very frustrating!
Derangement Pain
A derangement sounds screwy and acts just as screwy as well. It’s a broad category of pain, which essentially refers to any structure of your body that is out of place, or “deranged.” A typical derangement that you might have heard of is the torn meniscus in your knee, or the damaged labrum in your shoulder. You actually have a lot of meniscus-type structures in many of the large joints of your body, like your jaw, your wrist, and your hip. But, the absolute most common derangement of all would have to involve the intervertebral discs of your neck and back.
Try to think of a derangement as a wild animal that got out of its cage. These types of pains typically do not go away, unless you put them back where they came from — back in their cage. You can feel perfectly fine and then all of a sudden the derangement can “attack” you, and then go away again. Sometimes it may even be hard for you to provoke the pain. However, there is a general insecurity or fear that it can come back again at any random moment and without warning. As a result, people tend to contort or twist their bodies into abnormal positions to avoid it happening again. This is a derangement pain, and it can be quite unsettling because you don’t trust your body anymore and you can even look crooked.
The blood supply to these meniscal and disc structures is not very good, so just waiting around for spontaneous healing is typically not going to work. Aside from surgery, there’s usually two options here for conservative treatment. The first would be to put the derangement back in its proper place; the second is to temporarily compromise some of your normal movement or function in the hope that it may someday go away — which is not the best option.
Sometimes derangements can’t be put back into place no matter how hard you try, and a surgeon is required to remove the problem completely.
Nerve Pain
Any time you feel sudden numbness, weakness, tingling, buzzing or electricity, burning —sometimes even coldness — in an arm or leg, it may very well be because of nerve pain. In my experience, I’ve found that most other types of pains usually occur at the same time with some form of nerve pain. This is because nerves innervate or connect to so many different structures. They are essentially the electrical wiring of the living machine that is your body.
Nerve pain is the worst type of pain because it exists within your nervous system, which is also where your brain and your emotions and mood reside. Trauma to your nerves, whether suddenly or over time, can be overbearing and oppressive to your sympathetic nervous system. This is the “programing” of your body that deals with “fight or flight,” and can therefore create a sense of anxiety, depression, or even nausea along with the localized pain response.
Nerves are smart — they live within your nervous system. Nerves are even smarter than you!
It is very difficult to predict and visualize a clear pattern to the healing process of nerves, which is usually a very long time. They take no less than six months to recover from injury, and sometimes take even years to fully heal… or never even heal at all. It is really best not to look at your overall progress from a day to day or week to week basis, but instead to look back at yourself a month ago and compare it to the pain you’re feeling today. This is how therapists approach patients with debilitating chronic pain conditions, where the brain has now “learned” to perpetuate the sensation of pain even after injury has resolved. In the worst case scenarios, nerve damage can change circulation to the area, waste away the muscle, and cause excruciating pain to even the lightest touch of a feather.
It is because of this “wicked, unpredictable intelligence” that I tend to think of nerve pain as some sinister, mastermind super-villain — the kind you see cackling wildly in those old James Bond movies with his big, brainy head and spindly, long fingers. You really can’t push through nerve pain, because it is too debilitating and often worsens very quickly. You have to focus on relaxing, using your breathing and mediation, and staying in control for the long haul.
There are many types of nerve pains, just as there are many different sensations and functions that a nerve can control.
Bone Pain
Outside of various disease processes like cancer and sudden fractures from trauma, bones usually don’t cause too much pain in and of themselves. They’re very tough… thankfully, since they do support your entire body. However, bones actually have a skin, called a periosteum, covering them. This can really hurt if some connective tissue pulls on it or if something hard presses against it. In fact, our discussion earlier about tendon pain from tennis elbow can also overlap with a similar aching pain from the “bone skin.” If the periosteum begins to become inflamed in the area where the tendon attaches to the bone, it is going to feel like a very stubborn tendinitis that can actually last long after the 6 to 12 weeks of tendon healing.
Imagine bones as tall but delicate body guards covered in thick armor. They can take quite a beating, but once you break through their protective exterior, it is game over. Bone pain will shut you down and totally arrest your normal function, and it usually occurs the day after the provoking injury. That is because bones are filled with blood, and the slow leakage delays the onset of swelling until later.
At the deepest level of your body, bones provide the framework for every other soft tissue and muscle to anchor off of. In other words, bone healing takes priority — even if everything else suffers just so that it can slowly recover. That’s why doctors are okay with muscle wasting while you’re in a cast or splint. Because, if the bone doesn’t heal properly, then the whole biomechanics of your body’s function will be off.
The problem with bone healing is that it takes quite a long time to heal — usually around 3 to six months under normal conditions — and yet you can still feel soreness in that injured spot on damp days years later. Bones are very sensitive to atmospheric pressure changes. Strong, but delicate, and very slow to heal — that is bone pain.
The “Gang” Combination
So we’ve discussed many different types of pains, thus far, and personified many different “villains” here, but the honest truth is that in reality it is usually never just as simple as one isolated type of problem. Compounding the problem even further is the inevitable tightening and knotting up of the subcutaneous fascia, or connective tissue webbing, that envelops every one of these body parts and basically “holds” the body into a painful alignment for prolonged periods of time.
Most of the time these pains will overlap with each other in more or less of a gang-type mentality, like a bunch of deviant characters from some sort of twisted cartoon show.
I know that’s a bit of a stretch on the imagination here, but it really does make actual medical diagnoses much easier to understand if you visualize them in a simplified, stylized way.
For example, let’s say you have an arthritic knee and are dealing with a host of all different types of symptoms. You have the deep bone pain from loss of cartilage. Then you have the sinew pain from joint capsule inflammation, and possibly even a deranged and damaged meniscus. Because the nerves are constantly feeling pain, the muscles in your thighs and calves will become tense and begin to ache. This will be sensed by your peripheral nerves and transmit tension and soreness into your low back, where the lumbar nerve plexus resides. It’s a whole cast of villains cloaked in the “smog” of inflammation, where everything seems to blend into everything else.
You see how a vicious cycle can develop here? Knee pain can cause back pain, which can worsen your leg pain even more… and on… and on…
Witnessing this troubling, never-ending-cycle of pain being reborn over and over reminds me of a pathogen in the world of Chinese Medicine, called “Phlegm.” This is not exactly the same mucus-like goop that you cough up into a tissue after getting over a head cold. Phlegm, according to the ancient doctors, was an ominous pathogen known as the “father of 100 illnesses.” It was also said that even the mildest of conditions — if left untreated and given enough time — would begin to behave in strange and unpredictable ways, making traditional cures impossible to provide.
Phlegm sounds a lot like what we think of today, in terms of modern medical terminology, as “chronic pain.” It is very difficult to treat, and very easy to self-perpetuate. This is when Lifestyle Modifications, reviewed in Pillar 3, really proves to be of utmost critical importance in the overall treatment strategy.
When you are finished reading through this essay, click here to return to Pillar 1, where we will conclude our preparation for your first session.
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