Post Exertion Pain and Symptoms - Breaking The Cycle

The pain flare that comes after physical exertion but not during is a response to the stress chemicals during the exertion and not the physical exertion.

It's a very subtle but important difference to understand.

There is no pain during the fight or during the chase from the lion.

As you place your conscious focus on that thing involving the exertion, it triggers norepinephrine which is a neurotransmitter that helps you maintain your focus, so that you can complete whatever task you have chosen to focus on. You may know this as tunnel vision.

This goes for things you do or don’t enjoy. Whether you enjoy or dislike the thing you are involved in focusing on, the stress chemicals of cortisol and adrenal are circulating at levels relative to the intensity of the exertion you are undertaking.

If the physical exertion is not creating any physical trauma, then the pain following it is not down to any new damage. If the exertion is not physically overloading, then the pain following is not down to being physically overloaded.

However, if the person experiences pain following what they consider to be minor, or normal physical exertion, then it makes no sense if there has been no physical trauma or overload.

It only makes no sense though, if we’re only looking to the physical aspect as a cause of that pain.

The brain uses pain as protection in 4 ways:

1) Regulation of the physical tissues of the body through thermoreceptors, pressure receptors or chemoreceptors.

2) Regulation of the amount of water in the body.

3) Regulation of the amount of food in the body.

4) Regulation of the amounts of stress chemicals in the body.

There are early warning systems that provide gentle nudges that become a conscious awareness to act. These need to be understood correctly and any early warning can be considered, acted upon, ignored or overridden.

If the threat to a particular system remains despite that first warning, then a stronger sensation is triggered and pain is at the end of that continuum before any actual damage occurs.

The hand is withdrawn from the radiator before the burn happens. There is no damage to the hand.

The headache at the end of the day prompts the realisation that the person hasn't drunk enough water throughout the day. There Is no damage to the head.

The stomach ache from not eating reminds the person to take nourishment. There is no damage to the stomach.

Each ‘pain’ is contextually correct to help the person consciously interpret its meaning.

The survival of the organism cannot allow any further conscious overriding of the earlier warnings as there may be none left and pain is the last chance saloon.

Beyond that, it is tissue damage, injury, organ failure and death.

Pain is the cavalry to take control when the individual had not acted upon or misinterpreted the earlier warning signals that came before pain and maybe continued for a while despite the pain.

The physical pain relating to an excess of stress chemicals is just another example of how the brain uses its final opportunity to warn the individual that the behaviour they are focusing on, is bringing their system towards a place or overload or failure.

Those stress chemicals will cause damage over the long term if that level of stress is maintained beyond the physiological capabilities of that organism. Other systems cannot function in that state.

Pain is triggered when the perceived threat to the organism reaches a threshold. This threshold is based on past experience, beliefs, and protective neural networks that are already in place.

Any previous experience where the brain or body recognises that level of intensity as a predictive indicator of danger can mean a short circuit to quickly prevent that from happening.

The previous laying down of those neural pathways, and their myelination (insulation so it's faster) through repetition with high emotion, makes then a really quick unconscious survival mechanism.

So in someone with habitual traits of ignoring how they feel, pushing past what their body is telling them, suppressing emotions, and putting others first, their brain and body have a perfect warning system to protect that person from themselves, when they start to misinterpret, ignore or override danger signals.

The past experience highlights a lack of self-regulation, which is not the fault of the individual, so the unconscious system uses what it knows best, for that context, to bring the behaviour to a painful sudden frightening halt.

So this pain after the exercises come because there is no physical threat at that moment and whilst undertaking that activity, the person is flushed with adrenaline and cortisol, to not feel much in that moment anyway.

It is the focus and intent behind the exertion and the presence of the stress chemicals with that intent, which present the threat to the organism. It is very likely that an extremely high level of stress has led to danger in that organism previously.

That is the cue, for the cascade of physiological reactions which result in the short circuit firing of pain before any actual damage occurs. The stress system is already in a hypervigilant state so now only needs an occasional top-up to trigger the alarm of pain. That intent during the exertions is the top up and the trigger, but one so small that the person does not even see it.

That pain from that trigger is only experienced once the stress chemicals have been naturally metabolised, in the time that takes, and the person then becomes aware of that pain.

That's the pain after exercise, or the one that wakes someone in the middle of the night, or the one that is present as they wake.

And what needs to happen at that moment? That pain must be interpreted to give it meaning. As you place your focus on that ‘pain’, the same norepinephrine helps you work out its meaning. And how is that pain interpreted? Calmly or through a dangerous filter?

‘I do not understand this!’

‘Why am I getting this pain?

‘It’s back with a vengeance!’

‘It’s frustrating me!’

Because you can’t associate it with any recent trauma, or overload, and it makes no sense then that continued focus brings uncertainty, a lack of information on how to deal with that pain and a sense of loss of control. People with trauma have a nervous system that defaults to a sense of threat. The reactions are based on processing sensory information that sparks a contextual memory of being unsafe. So, at the most basic level, if you were living in prehistoric times with a small clan of humans in a cave and you were out on a hunt, you might see or hear a small rustling in the grass nearby. Your sensory processes will respond long before your cognitive brain has a chance to think, "There might be a tiger there," and your nervous system will shift into an activated state to help you run or fight to stay alive. Our sensory systems are picking up on tons of info that slips right beneath our conscious awareness all the time. When there is trauma, the tendency is for your nervous system to hyper focus on sensory stimulus that feels dangerous or threatening (grass rustling) to the exclusion of all else. If your nervous system is in an activated state for a long time, ALL sensory stimulus starts to appear dangerous to it (this is a big aspect of what happens in cases of non-specific pain conditions, too).

These are the three elements that define the stress response in all humans.

And this stress around that pain, the adrenaline and cortisol that follow that perception, continue to be the fuel for its transmission.

That individual may not interpret the exertion as stressful because they consider it something normal. They don't see the activity as consciously stressful, they don't recognise how close they are to the stress threshold to trigger pain, or may deny that connection even exists.

Even when they understand that connection, between stress levels and pain, often there is an unconscious addiction in the brain for those stress chemicals. So whenever there is a void of them, they feel compelled to act out a stressful behaviour, whenever a particular cue appears in their life.

When you realise it's not the physical exertion, but the ‘good’ or ‘bad’ stressful intent behind it and your interpretation of the effect of that, which triggers and completes the cycle, then you can start to understand how to unwire and rewire that mechanism towards becoming pain-free.

For those with trauma, this also entails gaining capacity to tolerate sensation in the body without it triggering a threat response, finding a felt sense of safety bit by bit over time (felt safety not spoken/verbal), and not overriding the bodily signals to settle/rest after a little activation. Becoming aware of our natural and innate activation and settling cycles in order not to bust through our nervous system threshold is a practice for many people, especially in a society that encourages us to live in our heads and ignore the bodies. As we come to do this very gently in many cases, the nervous system can ‘uncouple’ the threat response from movement/exercise/activity and we can begin to grow back our capacity to move our bodies and be out in the world. So an antidote is also to increase your physical awareness of non-threatening sensory stimulus too. As long as we are continuing to learn to live in our bodies and respect our cycles of activation and rest, instead of habitually pushing through these innate rhythms, we will absolutely regain our capacity to move and be out in the world.