PT on the Net Research

Developing a Pain-Free Mindset


Most people engage in corrective exercise programs with the goal of decreasing aches and pains. The application of exercises and/or manipulation of environmental factors to improve body mechanics and enhance function are very successful ways to help achieve these objectives. However, one central element vital to the effective working of the human body must also be considered in corrective exercise programming. It is the brain; more specifically, its ability to interpret and learn from past/current (and shape future) experiences of pain (Levine, 2010). This article will discuss features of the brain’s role in experiences of physical discomfort. It will also highlight what you can do as a personal trainer to help clients develop a better mindset when it comes to overcoming chronic pain.

Learning Objectives:

  1. The reader will learn how people develop mental responses to pain by mirroring and mimicking others
  2. The reader will learn how this mindset affects a person’s ability to recover from experiences of pain
  3. The reader will learn strategies they can incorporate into personal training programs to help clients develop a pain-free mindset

Like Father Like Son. Like Mother Like Daughter.

From the moment we are born, parts of our brain work tirelessly to learn how to communicate effectively, interact with others and the environment, and interpret the world around us. The brain picks up these skills quickly by mirroring and mimicking people of significance in our lives. Portions of our brain activate by observing our parents’ (or caregivers’) facial expressions, voice, speech patterns, dialogue content, gesture, movements, etc. (Van der Kolk, 2014). This ability to copy behaviors assists us in learning various skills necessary for safety and survival. However, it can also be devastating from a mental standpoint if your role models do not possess practical and positive strategies for dealing with experiences of pain and discomfort.

father and son sitting outside

Parents or caregivers that experience recurring aches and pains and/or who dwell on experiences of pain as being negative and personal (perhaps something they learned from their parents or caregivers), can predispose their children (i.e., your clients) to developing a dysfunctional mindset when it comes to pain. A typical statement from clients who fall into this category might sound something like this: “My mother had painful bunions. That is why I have them too.” or “My father always complained about his bad back. It runs in my family.”

Playing Broken Records

A person’s current beliefs are, in large part, a result of the little voice inside their head that interprets their experience of what is happening to them (Bandura, 1986). Clients bought up with parents/caregivers in chronic pain (especially those who escalated or catastrophized experiences of pain with negative thought patterns) learned that such reactions were an appropriate way to respond to pain and discomfort. They subsequently now apply those same overly-intensified approaches to their own experiences of pain. For example, someone with dysfunctional thinking patterns might jump to the conclusion that musculoskeletal pain felt the day following a long day of gardening must be the result of an injury or problem (like a herniated disk or sprain) rather than the fact that they have simply overexerted themselves. Such mental overreactions to physical sensations of pain affect one’s ability to relax, rest, recover and heal from overexertion (Berdik, 2012).

So how do you help retrain your client’s brain so that their mind defaults to a more positive and practical approach to resolving their ongoing experiences of pain? The short answer is to promote the development of a pain-free mindset through the use of simple breathing and visualization techniques. These strategies together can stimulate relaxation while overwriting the negative internal dialogue that accompanies sensations of pain.

Using Your Brain to Your Advantage

Breathing is one of the only involuntary processes in the body that you can control voluntarily. Breathing patterns influence the nervous system and the brain’s control over bodily operations. Drawing breath in activates the sympathetic nervous system (i.e., our “flight and flight” responses) which causes the heart rate to rise, blood pressure to increase and the nervous system to excite. Breathing out activates the parasympathetic nervous system which slows the heart rate and allows the sphincter to relax (i.e., our “rest and recover” responses). The small pause between inhaling and exhaling helps us regulate these changes both physically and mentally (Van der Kolk, 2014). People who are hyper-aroused from sensations of pain (or who have anxiety issues surrounding their experiences of pain) are typically shallow breathers. They never fully take a deep breath in or exhale completely. This is in part because of their ongoing pain, but also because their amplified reactions to it have left them feeling nervous and agitated. This constant state of “flight or fight” leaves the person wearied and prevents physical and mental rest and recovery. This fatigue leads to more thoughts of dread and desperation, which further alters breathing patterns and continued experiences of pain (Van der Kolk, 2014). Retraining breathing patterns from shallow breathing to deep breathing can help change the brain’s (and body’s) involuntary (i.e., automatic) responses. Coaching clients to control their breathing (by taking long, slow, deep breaths in and out) when they experience physical sensations of pain can help them trigger a change in their nervous system and allow their system to “reset” (Sherrington, 2010).

The addition of positive affirmations and/or visualizations in combination with breathing awareness and control can also help clients change the way they experience pain. If physical sensations of pain produce thoughts that typically catastrophize the situation (e.g., thinking that they are never going to get better, believe the cause of their pain is not curable, etc.) teach them to strengthen their mindset using affirmations like, “This pain/condition is temporary. I am doing all the right exercises to strengthen my body and it will eventually get better”. Work with clients to develop their own affirmations using their own vocabulary. This will empower them to visualize an alternative way of thinking and help cement these new thoughts and emotions by putting them into words (Kushner, 2009).

woman taking deep breath

Imagine, for example, that you are working with a client with ongoing back pain and they suddenly feel a sharp pain in their back and begin to get anxious or panic. Instruct them to stop talking and take five long, slow deep breaths in and out. Once they have cleared their mind (and body) of stress and alarming thoughts, coach them to use positive affirmations and/or visualize an alternative present (and different future) that does not include recurring sensations of pain. Encourage them to use this strategy every time they experience pain (in their back or anywhere else) to change their initial reactions and redirect focus toward solutions to their problem (i.e., their current corrective exercise program).

New habits, especially developing a new mindset takes time. Urge clients to practice these new techniques faithfully until their new way of thinking becomes habitual (Price & Bratcher, 2010). Although future sensations of pain will naturally cause a state of heightened arousal initially, the breathing techniques and positive self-talk will enable them to stabilize their mental reaction and allow these temporary sensations to pass. Circumventing overreactions of the mind and body in the face of pain will facilitate a quicker and easier recovery from pain and/or injury.

Conclusion

Ongoing experiences of pain (and any associated negative reactions to these feelings) can disrupt the natural healing properties of the body. Teaching clients to retrain their brain to develop better responses to sensations of pain can help decrease mental stress and allow their body to rest, recover and renew.

References

Bandura, A. (1986).  Social Foundations of Thought and Action: A Social Cognitive Theory.  Englewood Cliffs, NJ: Prentice Hall.

Berdik, C. (2012). Mind Over Mind: the Surprising Power of Expectations. New York: Penguin.

Kushner, H. (2009). Conquering Fear. New York: Anchor Books.

Levine, P. (2010). In an Unspoken Voice. How The Body Releases Trauma and Restores Goodness. Berkeley, CA: North Atlantic Books.

Price, J. & Bratcher, M.  (2010). The BioMechanics Method Corrective Exercise Educational Program. San Diego, CA: The BioMechanics Press.

Sherington, C. (2010). The Integrative Action of the Nervous System. New York, NY: Ayer Company.

Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Brain in the Healing of Trauma. New York: Penguin.