Injury, Re-injury & the Brain


Many of us have experienced recurring injuries.  From Achilles tendon pain, low-back pain and whatever else-type of pain, we often feel great only to have the maddening issue return–often for no clear reason.  Anyone who’s experienced this pattern knows how crushingly disheartening it can be when after a layoff,  you feel good and with great joy you’re able to return to your chosen activity… only to fall back into the same injury pattern as before.  It’s more than just physical pain.  It’s a highly emotional and psychologically challenging obstacle to overcome.

To this point, the Peak Performance newsletter features an excellent article called Once Injured, Twice Fearful.  (Peak Performance is an great resource.  You can register for free and access many well-researched and well-written fitness and performance-related articles.  For a fee you can access more of Peak Performance.)  The main issue is how our brain is affected by an injury.  We may reach a point where our tissues are healed yet mentally we aren’t yet prepared to return to our sport.

Most interesting to me is the discussion on the pain neuromatrix.  What is the pain neuromatrix?  Well, there is no easy answer.  This is a theoretical construct that sort of consists of our perception of a threat and whether or not the brain decides that the threat is sufficient to create pain.  For instance, we sprain an ankle.  The damaged ankle is literally a potential threat to our survival (Not so much in 2010 but for most of human existence a sprained ankle may indeed have led to our starvation or death from the elements or predators.)  The nerves in the ankle send a status update to the brain, the brain then interprets this information as damage and thus gives us pain.  Why?  Pain gets our attention.  Pain will cause us to alter our activity so that we don’t further damage that ankle, thus we should survive longer.  (In contrast, if we sprain an ankle while we’re running away from an erupting volcano, the brain may say “That volcano is a far bigger threat, so no pain for you–KEEP RUNNING!!!“)  This is a fairly complex thing.  Here’s a brief explanation.  For further information, read Ronald Melzak’s paper on the topic.

Once injured, our brain pays particularly close attention to the damaged area.  The neuromatrix keeps close watch so that we don’t re-injure ourselves.  If all goes well, the tissue heals, we start moving normally and pain free, the neuromatrix senses no threat and the pain is gone.  However, this close scrutiny by the neuromatrix may sort of get stuck in the “on” position.  The tissue may heal but the athlete may still feel pain and anxiety at the prospect of re-injury.  This often results in poor performance because the brain is focused on monitoring the area of injury and thus can’t devote full attention to sport skills.

So what’s the solution?  First, simply explaining this psychological model to the athlete can be quite helpful in calming anxiety.  His or her knowing that pain doesn’t necessarily equal injury can be very reassuring.

Next, we must modulate the threat as it’s perceived by the neuromatrix.  If for instance a soccer player sustained a major injury on the field, simply returning to the field in soccer cleats may be perceived as a threat and pain and/or anxiety may be the result.  Certainly then running, cutting, dribbling, etc.–playing soccer in other words–may be a huge threat.

(A more overt example of this type of situation can be seen in war vets suffering from post-traumatic stress disorder.  Though the person may be safe and the actual threat long gone, any number of minor events may trigger extreme reactions such as panic attacks or violent behavior.  The sound of a book dropped on the floor or trash bag in a yard may cause the sufferer to react in a way that’s vastly inappropriate relative to the actual threat posed by the event or object.)

The player must be gradually re-introduced to the movements and environment of soccer.  Brief, easy jogging on the field; simple ball handling drills, and slow- to moderate-speed agility drills may be introduced as a way to ease the player back into the sport.  Variables may be added as the player feels more confident.  Speed, duration and predictability of drills may be adjusted.  Opponents may be introduced.  Playing surfaces may be changed.

A key part of this process is movement reeducation.  An injury doesn’t only include tissue damage.  The connection between the brain and the injured region (let’s say it’s the ankle) is also disrupted.  Such a disruption means the ankle tissue may heal but control of the ankle may remain deficient.  This sort of thing may cause pain–but it may not be ankle pain!  A poorly moving ankle may cause pain at the knee, hip, back, anywhere along the spine, shoulder, even the jaw.  Such is the nature of this highly interconnected system we live in called the body.

The Z-Health system has by far helped me more than anything in addressing my own pain as well as my clients’ pain.  R-Phase is the introduction to Z-Health.  With R-Phase we start to relearn the ABCs of movement.  We reestablish control over every joint in the body: feet, ankles, knees, hips, spine, shoulders, elbows, wrists, hands, fingers, jaws and even the eyes.    Through methodical, mindful movements we can very effectively reduce pain and increase performance very quickly.  Here we recreate and reinforce the foundation for all our more complex movements such as running, stair climbing, shooting baskets, swinging a golf club, etc.  We can then safely reintroduce our favorite sporting movements and activities.  It’s a very powerful and exciting system.

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