Why do I still hurt? Part 2

Last time we talked about the changes that happen in our joints and nervous system when we have chronic pain, get injured or have surgery. We spoke about how when our joints stop moving then our brain loses out on the information coming from them and doesn't know what's going on in those joints. It doesn't get complete information. There are no updates on the situation so to speak. We talked about how the lack of movement is actually protective at first and that if the injury or surgery has healed but the joint still isn't moving then the brain is not getting the updates from the joint(s) in question so it still doesn't have the full picture. This can show up as a lack of movement and/or the presence of compensations like limping even though their is no pain. Part of this can be emotional protection especially if there was significant trauma when the injury happened. That pretty well sums up the effects from a nervous system perspective. What we'll look at today are the physical changes that happen both immediately after and long term. The changes that happen immediately are not necessarily the same changes that occur with chronic pain.

Immediately after an injury or surgery our bodies respond to protect us from further injury. It can deactivate muscles to limit range of movement and prevent further damage. With damage to muscles, tendons and bones there can be bleeding. Our body's respond by starting to clot the blood to stop the bleeding. More white blood cells are moved to the area to prevent infections. Fluid starts to build up and swelling occurs, which can also limit movement in the area. All of these things are natural responses to our body's being injured including when the injury is due to surgical cutting. They are all beneficial in the beginning. Some of them if left unchecked or unaltered can limit healing as well. Like swelling for example. If it continues and starts restricting blood flow to the injuries then healing is slowed. The blood is what carries the nutrients needed for repairs like proteins and other compounds. It also carries away the waste products from the initial injury and what is produced by the healing processes.

Within a few hours other changes occur. Scar tissue begins to form to stabilize the area and limit movement while replacing some of the tissue; muscle, ligaments and tendons, to provide more stability to the area. More blood is directed toward the area to provide the nutrients needed to create the scar tissue. Tissue repairs begin with new cells being formed and multiplying. If bone is involved bone cells are created repairing breaks and cracks. Swelling may start to subside once the area is more stable. Pain may be reduced as well. The area may be tender to the touch or when trying to move. Pain usually doesn't subside completely until the area is almost fully healed.

As time goes by, which can range from days to weeks to months depending on the severity of the injury or surgery, The scarring can increase to a certain level, tissue repair continues until all of the tissues that can be repaired are repaired. In the case of muscle, tendon and ligament injuries if the damage is severe enough scar tissue can become a permanent replacement for those tissues. Swelling has gone down; blood flow reduces as less is required and pain lessens. The ability to move improves with limitations and adaptations. We move differently because of the injury itself and to prevent more injury. These changes in movement create increased stress on other parts of our body's. They are necessary in the beginning for our survival. If primitive man didn't adapt when they got hurt they would die. They had to get moving again as quickly as possible for food, shelter and protection. Although we are sometimes hurt in a life-threatening manner more often than not the injuries we have don't threaten our survival and we have many more resources and time to heal. It may cause significant inconvenience to our everyday life for a while our survival isn't at risk.

Over time if the adaptations to our moving aren't changed back these movements and the increased strain they put on other parts of our body's start creating injuries in other parts of our body's and even the same area as the initial area. These appear as over-use injuries that can become chronic and produce continuous pain. They happen because the tissues in the areas affected are doing things either they weren't designed to do or in ways they weren't supposed to be doing them. The spaces within joints can become smaller and parts of us that weren't designed to rub up against each other start doing so. This causes a wearing a way of those tissues and continual swelling which limits repair and healing. You may be familiar with someone saying that their knees are bone on bone or that part of their spine has fused. This happens because of this wearing process. The cartilage separating the knee bones and the discs between the vertebrae of the spine aren't there to prevent the bones from making contact. In the knee the bones begin to wear away and bone spurs develop causing arthritis. When the discs go away in the spine the vertebrae start to fuse together to prevent further movement and wearing away of the vertebrae. This is very important since our spinal cords run through them and if they are injured we can lose the ability to move our limbs or even die. This process may have happened in the area injured so over time it starts hurting again.

Pain is present in all of it as are the other mechanism to help the area heal like limiting muscle function, swelling, scar tissue formation and increased blood flow. There are also new adaptations to movement to try and prevent further damage to the new areas. Thus, starting the whole process over again. It can become a vicious cycle that over times gradually limits our ability to move and our whole lives. The good news is that our bodies are also great healers. Sometimes they just need a little help. We'll get into that more next time. Until then please post any questions or comments you have down below. I'll do my best to respond as quickly as possible.

In the mean-time I wish you all health and happiness.