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Soulful Sundays: Katastrophizing Pain (by Kat Hamblin)

"The most terrible and beautiful and interesting things happen in a life. Whatever happens to you belongs to you. Make it yours. Feed it to yourself even if it feels impossible to swallow. Let it nurture you, because it will.” -Cheryl Strayed

The other day, a coworker suggested I spend some time in a deep squat position. I immediately felt resistance and my mind came up with dozens of reasons I should NOT deep squat. As we talked about anatomy and mechanics, my thoughts began racing, “This not comfortable for me, is something wrong with me? What if I re-injure myself? Am I potentially further damaging myself? Why would I even need to do this? Deep squatting is stupid.” It was all I could do not to roll my eyes and go take a sip of water.


Later, reflecting on this moment, I was shocked that I was so threatened by just the suggestion I should deep squat. Why had my reaction to something simple felt so stressful inside my body?


We often think of our bodies as the muscles, bones, joints, and fascia. However, another huge player is our nervous system. To sum it up very briefly, our nervous system includes our brain, spinal cord, and peripheral nerves that act as a highway of information from our body parts to our brains and other command centers in our bodies. What we call the autonomic branch of the nervous system controls involuntary body functions like our blood pressure, breathing, etc. As you may know, there are two states to this branch — sympathetic and parasympathetic.


These autonomic states were meant to help us survive threats by triggering our “fight or flight” response so we could run away from prey or defend ourselves from some attack AND to help us recover from this stress once it had passed. These states were meant to be triggered without our conscious mind having to think and make decisions. Specifically, the sympathetic nervous system (when activated) becomes fight or flight and the parasympathetic system is designed to help us calm down.


In our modern lives, we may not often have to face the life-threatening aggression of a bear or a lion, but we still have the sympathetic nervous system that was designed to respond to stress. Oftentimes, when we perceive something as threatening, we go into fight or flight mode, even though it may not be an appropriate response to the situation. There is a complex cascade of stress hormones that are released during a threatening event that affect changes like increasing breathing rate, increasing blood pressure, the release of glucose into the bloodstream, and sustained muscle activity or tension. The context for this response isn’t always negative though and you will experience this during certain, ahem, pleasurable experiences.


Interestingly, the sympathetic nervous system actually inhibits pain signals, so you can still run away or fight while having pain or an injury. That makes sense when you hear stories about soldiers continuing to fight or save someone’s life on the battlefield all while suffering a huge injury. Most of the time they report not even being aware of or feeling the injury until afterwards. However, when the body stays in a chronic stress state, we see maladaptive changes in both our stress response and our pain response. In a nutshell, after prolonged time spent in these states that are meant to be temporary, our nervous system becomes dysregulated. They can either over perform making us hyper-vigilant, increasing our sensitivity to pain and threat; or, they underperform and make our body’s natural pain killers difficult for us to access. And sometimes, both!


One component of pain or injury we don’t often talk about is how psychologically stressful it can be. Not only do we experience physical symptoms, but we start creating worry and anxiety in our mind. A few years ago, I was working at my dream job as a physical therapist in a children’s hospital when I injured myself running. My job often had me lifting kids from the floor every day and I became increasingly worried that my stabbing pain would happen and I would drop or injure one of them. I tried to hide my limp at work and started avoiding certain movements and positions. Running and weightlifting were the only ways I knew how to relieve stress and I worried I would never be able to do them again. I was told I would need a massive surgery that would require me to take weeks off work, as I wouldn’t be able to drive or put weight on my leg. The outcomes for the surgery were not consistent and people often needed revisions. In short, the vibrant and active life I had imagined for myself, began to fade into a bleak future. The term for this kind of thinking is called “pain catastrophizing” and the more someone believes these thoughts, the harder it is to decrease their pain. Our thoughts have enormous power over our perception of healing.


So, it doesn’t surprise me then, when my coworker asked me if I could do a deep squat, my body perceived this as a threat. No deep squatting for me sir, I’m just fine standing up! Even though I’ve healed (mostly), the fear of my injury has stayed in my nervous system. When our bodies perceive something as a threat or unsafe, we can misfire our flight or fight response and increase our pain. The key then to dealing with chronic pain then, is to find a way to regulate our nervous system and luckily, we have many tools to do that.


First, you must become aware of how your body feels. You have to be able to notice when you feel stressed or threatened. So many of us are disconnected from our bodies, especially when we are in pain. We just want to turn it off. I encourage you to challenge this, and take note of how your body feels. Do you feel a tightness in your chest? Do you sweat? Do you feel like kicking down a door or walking out of the room? Or are you tired? Do you want to reach for things to help numb you out? It’s important to be able to recognize the feeling of stress so you can begin to notice patterns and how this relates to your pain.


Next, we learn how to decrease stress in the moment, or activate the parasympathetic nervous system. The easiest way to do this is through breathing, but there are many tools. Remind yourself that whatever situation you are in, it is not a threat to you. You are safe. Trust yourself to make safe decisions for your body. As you gain trust, play with the line of what is pushing your boundary of safety. Is my life really being threatened if I lift this weight? Will my world fall apart if I twist my spine? That’s not to say that those thoughts are silly, they aren’t. They are trying to protect you. However, we don’t need them after our tissues have healed. Becoming aware of the thoughts, thanking them, and gently replacing them with better thoughts will help you ease your body back into movement and decrease your pain.


If you find you need or want help with this, there are many practitioners that can help guide you. As a physical therapist, I would love to help you start to feel safe moving in your body. I like to teach people how to connect with their bodies through cultivating safety and awareness and learning new tools so they can start building the life they want, with or without pain.


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