Is My Pain Damage?

Written By Drew Coverdale

A Common Question


Many people ask me if their pain is a sign of damage, and I've included one such question as the subject of this post. See if the threads within this question relate to you or your pain and explore whether you can consider aspects of the answer to your situation.

Hello Drew and everyone! I'm having trouble reconciling (a) the idea that chronic pain is the brain overreacting with (b) the presence of what appear to be physical manifestations - such as muscle tightness and knots/trigger points. A (very amateur) triathlete, I've had glute/lower back muscular pain for well over two years.

Ten months ago, whenever I tried getting back to running, I would be suddenly struck by a sharp, tight pain in my left calf and had to limp home in agony. It would subside in a couple of days but came back whenever I tried to run,  and each time took longer to subside.

Then it started in my right calf too (October 2021), leaving me unable to walk for 1-2 months. I haven't had sharp pains for a couple of months and have been gradually getting back to hiking, cycling and running. Today, I had to abort a run again (this last happened in October) with the same tight, sharp calf pain, and still unable to put weight on it.

So whenever I go for a sports massage, I'm told my calves etc., are tight and pressing on trigger points is painful. So I'm confused whether this means there is something physical there. I'm thinking fear/anxiety/trauma is causing muscle tightness, which is experienced as low-level pain day to day, which results in actual damage/tear when running?

So perhaps not suited to the methods described here? Or have I misunderstood the principle, and is there another explanation? Thank you!

Hi, Thank you for such a great question. I've broken down my answer to help you follow my thinking for the different aspects of what you are asking.


I'm having trouble reconciling (a) the idea that chronic pain is the brain overreacting with (b) the presence of what appear to be physical manifestations - such as muscle tightness and knots/trigger points.


Physical manifestations such as muscle tightness, knots and trigger points are the trickiest encounters for someone in persistent pain to overcome. The physical presence of something that you can touch, feel, and sense as responding to a physical stimulus from you or someone else makes it hard to believe that this is something manifested by your brain.
The thing is that all pain manifests in that way for every person.


There is a belief that pain always represents damage. Although it can come with injury, anyone who has felt a painful emotion will know that no physical damage is needed for that to feel physically painful.


So when you follow the logic of the belief that the persistent pain you're experiencing is damage based, it usually doesn't hold up to scrutiny. So if you look at the pattern of your pain and the circumstances where it appears, it doesn't fit pain linked to acute damage. 


According to what you are presenting below, let's look at its history.


A (very amateur) triathlete, I've had glute/lower back muscular pain for over two years. Ten months ago, whenever I tried getting back to running, I would be suddenly struck by a sharp, tight pain in my left calf and had to limp home in agony. It would subside in a couple of days but returned whenever I tried to run, taking longer to subside.


Here you are describing what you think is pain from an injury.


You may believe that your calf is vulnerable, fragile, weak or about to go with running overload. For example, when you said you would be ‘suddenly struck by a sharp, tight pain in my left calf’, you may think you’ve torn or pulled the calf again when you haven't. If you tore the calf at that moment, it would take six weeks for the tissue healing to occur and then around six weeks of further rehabilitation to get that muscle tissue back to its pre-injury capabilities.
You're also describing it as a situation that resolves over a few days.


The load at the point of perceived injury is relatively not that great. You would usually be ok at that distance for a while. So I picked up from another moment when we had a short Facebook conversation about this, and you said it would come on when you got towards the end of the run and thought, OMG, I’m going to make it!


Rather than this pain occurring as damage with load or tissue breakdown, it looks more likely that it is the load, your thoughts and your feelings in a particular context. Your body and brain recognise a threshold of cumulative stress sufficient to trigger your unconscious brain's neural protective pathway of choice.


The difficulty you have is that it is during an activity that you most likely see as one of your favourite activities for reducing stress, and now it becomes one that stresses you.


The pain makes the whole idea of running so frustrating and fearful. The paradox is that those emotions prime the context of running and getting calf pain so that neither a large amount of running nor a large amount of emotion are needed to re-trigger that pain that annoys you so much.


Like any repeated pathway with emotion, it becomes easy to fire and much more wired unconsciously in our brains and bodies.


It eventually takes no conscious thought but appears with such a shock and confusion that the conscious thoughts we do hold about it inadvertently sensitise that pathway even more. 


So we pour fire on the flames whilst thinking we’re doing all the right things to put it out. That’s not your fault because when you look at all the driven traits that have brought that person much success, achievement and a sense of validation or worthiness in their life.


It makes no sense to see this pain as different from other forms of resistance you have pushed through to succeed, yet it is the opposite of what you should be doing. That instinctual behaviour drives the pain that you are desperate to overcome.
So the pain from each episode starts to take a little longer to settle, and eventually, running seems no longer worthwhile even to start. 


Then it started in my right calf too (October 2021), leaving me unable to walk for 1-2 months. I haven't had sharp pains for a couple of months and have been gradually getting back to hiking, cycling and running. Today, I had to abort a run again (this last happened in October) with the same tight, sharp calf pain, and still unable to put weight on it.


The new pain is where the system gets clever. It is very frustrating to the individual, but when you understand that it is using pain as a protective mechanism and not a punishing one, it should become more apparent to you.
When a pain, designed by the unconscious aspect of an organism to protect it from the conscious intent to use a particular behaviour, is ignored or overridden, another strategy initiates.


Remember, there is regulatory feedback of all the past, current and anticipated behaviours the person consciously chooses to undertake. For example, suppose they continue to push past pain or repeat the behaviour when overload, physical injury or threat appears. In that case, the organism uses another pain and the one ignored.


When similar symptoms appear on the other leg, it confuses the patient. They don't have the original pain, but they have a similar one on the other side of the body. The phenomenon known as mirroring is the physiological mechanism that explains this.


This extra pain usually also represents another warning that finally stops the actual behaviour that the first pain didn't manage. The person takes a break from the activity that their unconscious system is now practically demanding.
It creates enough conscious caution that the person gradually returns to gentler activities before considering a total return to the original fear causing running.


To the person's despair, when they finally muster up the strength to attempt running again, they approach it with the same or even increased fear that was present before, and failure awaits. When that pain fires at the threshold of no injury, but the person believes it’s another injury, the cycle of boom and bust continues, and so does the pain.
More fear and frustration swish through the system, and the pathways are heightened for the next failed attempt whenever the person tries again.


If you take these calf pains and trace the earlier pains present in you, this sentence highlights what pain you hadn’t resolved before you attempted to start running.


‘I've had glute/lower back muscular pain for over two years’.


It is inevitable that trying to push past a pre-existing unresolved and persistent pain does not fade. Instead, it stays or increases and is often superseded by another pain. The organism unconsciously attempts to regulate the conscious behaviour that it struggles to accommodate due to its overload.


We don’t have a history to clarify whether the onset of the low back pain was traumatic, but if it was, then sufficient time has passed for that trauma to heal. If there was no trauma, then the circumstance of the person’s life at the time, how stressful it was and how they chose to deal with that are always worth exploring.


But if the pain has become persistent and an additional load is placed on the system, then another alarm in that person's body will appear. Another pain in a different body is the classic stop sign often ignored again.


The organism uses a sequential and contextual alarm system with additional pain following each ignored warning level. As a result, the conscious awareness of that experience becomes more fearful and more frustrating.


The next phase of the question comes to the issue of showing this clinical presentation to a therapist.  
Whenever I go for a sports massage, I'm told my calves etc., are tight and pressing on trigger points is painful.
Everyone who attempts to help you with your situation does it from their perspective, training, and truth. The person is not telling you lies, but in my opinion, you are not given the facts as I see them. Again this is only my perspective, and you can accept or reject it at your leisure.


Your pain represents persistent pain or a persistent pattern of pain. It doesn't follow the way of an acute muscle tear, although there are similarities. These include the location of the pain, type of pain, and activity that brings it on. Unfortunately, these are only physical cues present in the situation, and there hasn't been adequate consideration given to the other components that we know can influence pain.


What else was going on in your life two years ago?


Why were you running so hard?


Why did you push past pain?


Do you have some personality traits that predispose you to this happening at some point?


What approach have you been using to address the pain you've experienced?


Did you use these traits to try and overcome that pain?


What do you believe to be the cause of your injury?


This final question is very telling as it appears that you believe that you have suffered repeated calf strains from the physical attempt to run at a certain distance and pace. This is how you present to this therapist, and their opinion is that your pain is due to physical injuries and the circumstances you have described to them.


I doubt whether you or they have explored this superficial perspective in the last ten months, but the reason for not doing that is likely to be the reason you remain with this pattern of pain. From the therapist's perspective, they’re looking for signs that support the hypothesis that you have a physical injury, and it's their job to help you find out why.

Unfortunately, finding tightness and knots is simply part of their clinical language used with you and many other people who attend their practice. I’m not saying that you don't have tightness or knots. But I am saying they are not coming from an acute injury. They represent the physical manifestation of your brain and body being in a protective state for that stimulus level.


What do images of knots and tightness create for someone already scared of what is happening to them?
Does it increase the reactivity of their stress apparatus or reduce it?


This approach with persistent pain almost equates to the blind leading the blind.


I am sorry to be so blunt, but it is misguided to describe signs of physical change witnessed in the clinic and feed them back to a patient in persistent pain in a scary way.
I understand it is from someone who may know no better, and I admit I have been that soldier many times in over 25 years of clinical practice.


I know now that it is not the correct approach for persistent pain.


Anything that is presented with persistent pain or with a pattern of it must incorporate a stimulus that makes the nervous system of that individual feel safe. The explanation must be thoughtful, and the touch or treatment must be respectful of the person's response. Therefore, the emotional intent of therapy has to be based on a scientific awareness of neurophysiological mechanisms and allied to the natural compassionate approach inherent in any authentic clinician or therapist.


So as we come to the next question of your enquiry, we can explore how to help you understand your situation.


I'm confused whether this means there is something physical there or not. 


You do have a physical component to your pain.


You have a context where it plays out, and you can practically predict it. You know where you will feel the pain and which leg it will appear in more often. Sometimes it will surprise you, and sometimes not. You know the words you say to yourself when it happens, and interestingly you also are starting to notice what words you said to yourself before the pain appeared. That may help you see some of the emotions just before the pain.

These emotions might reflect feelings about other things that may have been apparent in your life around the time your pain started, especially around two years ago.


Depending on whether you could control this situation or not may be relevant, but if you couldn’t and went to bed or woke up with that unresolved sense of fear, frustration or any other negative emotion, it can be a challenging situation to bear.
That's where our quickest stress-reducing activity always has its appeal.


If running is your thing, then to run harder, faster and for longer in those moments or to just run with the tension of life’s stresses at such a high point in your life means that your body has rejected the proposal that you had for using the adrenalin and cortisol system to help you get over how you felt back then.


You may not have had trauma with a capital T, and you may have just lost access to your favourite down buttons for a while. However, you may not see anything stressful to have led you down this path. Either way, something has created this protective and oversensitive nervous system response that is now your responsibility to reverse but only with the right approach and the correct tools.


Often hitting our favourite and quickest mechanisms to feel better is understandable, but sometimes these are misplaced attempts to place effort when overcoming stressful times in life. Hitting them harder, as many have done after lockdown, can be the load that has triggered the pattern in you and many others.


So although the physical element is relevant and so important to address contextually for you to return to running, there has to be consideration given to you as a whole person. Understanding that and understanding you means a much better potential for you to return to running and returning pain-free.


Your following statement shows how you are at this tipping point of recognising the other factors influencing your pain, and from this point, you can make real progress.


I'm thinking fear/anxiety/trauma is causing muscle tightness, which is experienced as low-level pain day to day, which results in actual damage/tear when running?


Yes, the fear and anxiety are causing the muscle tightness, but there is no new trauma with this pain. 
You are experiencing re-traumatisation as you experience some but not all the circumstances of trauma. 
That residual fear and frustration, which stays day by day, is the driver for the pain which is there day by day. The loads through the legs are nothing special at all, and all of us are walking around with the same weight every day on our legs with no pain.


Your system is so primed that as soon as you put any weight on your legs, and possibly even from being awake without weight, they are ready for any sense of overload that comes from getting up on your pins.
It's the last chance your unconscious mind has or warning you to get up and go, and if you do, it's the last chance it has to say to you to go carefully.


It is not saying there is still damage.


That pathway had become so intertwined with the prediction of overload that it's saying quietly in the background, ‘Lads and lasses, as soon as Helen opens her eyes, based on what she did before and how hard she pushed herself, we had better warn her not to do the same again. We won’t have long because she usually just gets up and carries on regardless of our signals.’


This mechanism is trying to protect you from yourself.


Probably not from running, as that is such a healthy way to reduce stress, get fresh air and feel liberated from some of the stressful things. It is part of a wide range of stress-reducing activities that we must use with balance.
Your pain is probably wired to the feeling of overload from the stressful circumstances, which may or may not be apparent to you from when the low back pain started. It now stops you from doing anything that could be considered overloading.
You may recognise that you have some of the traits of pushing through, and although these have helped you achieve lots in life, that approach now is not what you should be doing.


Using a gentler and more balanced way to change how you feel and how you run is the way to reverse what is currently happening.


You can use physical methods to do this but not biological processes alone. For example, looking at how you feel before the run, during the run, and after a run must all be at a level where no fear or frustration appears, and if they do, you must feel rational enough to know that you are safe. For some, they have to walk the route. Others have to start to imagine running or running at intervals to control the urge to run too fast or lose themselves in the activity.


You have to exercise consciously.


Sometimes the breathing exercise before, during, or afterwards brings a sense of control that is counterintuitive but necessary.


Noticing the circumstances around your life and the traits you used to deal with them at the onset of your pain is of interest, but you do not need to explore this deeply to recover. You just have to recognise that something went wrong in the normal recovery process, and although you are responsible for that, you are not to blame.

However, you can now consider a much more balanced approach to returning to running, possibly with a slower and more phased return to the pace and distance when your pain previously appeared. 


Incorporating this more balanced understanding of how you deal with stressful situations may be one of the best learning experiences. I know it was for me and many others who have gone through similar events, and I wish you all the success in your steps to recovery.


So here’s a long journey to the final sentence of your question.


So perhaps not suited to the methods described here? Or have I misunderstood the principle, and is there another explanation? Thank you!


You are suited to the methods described in this group.

https://www.facebook.com/groups/1025115861234206

Yes, you have misunderstood the meaning of part of your pain, but it is an easy and common mistake to make. Patients and clinicians make the same mistake every day of the week. Some go a lifetime without ever making the corrections, and some never recover from pain.


The explanation I've provided is the best I can give without ever meeting you or looking at your calf or your back. It is a perspective based on theory and shouldn't be considered clinical advice.
If and how you choose to return to running is entirely up to you, and although you could get someone to assess you and your progress, you may not need it physically.


You can be your coach, but if you decide you want someone to check you physically as you rehabilitate, make sure it is someone who understands the whole situation and not just part of it.
It is not their fault either if they don’t, as they do what they think is best for your pain, how you present it and what they currently know.


What you know now should be more helpful to start to consider a programme of recovery that takes in all aspects of who you are and looks after all of that as you gradually put on your running shoes, smile and take those first slow steps to feel amazing again.


Kind regards Drew

What’s next?
Take Your First Step to Recovery.

Drew Coverdale
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