3 Reasons why your pain keeps flaring up

Recurring pain is a source of much distress which only gets amplified when your best efforts do not seems to work permanently. The answer may lie deeper than you think.

As a follow on from the recent article on this topic, we know that despite getting the correct diagnosis, addressing the underlying cause(s) and seeing the treatment process through, we still have instances where people suffer from recurrent bouts.

This may be for several reasons and if the condition is highly recurrent (more than what you care to manage) or more easily triggered over time, the deeper background to the cause of the problem needs attention.

I will explain this through a few examples but please know that this doesn’t cover everything.

Addressing any emotional strain

Firstly, we can’t eliminate stress and strain from our lives completely, so when the nervous system has learnt to cope in a certain way (by causing back pain when you have a deadline or headaches when you fight with your spouse), we can down-regulate this physical reaction from a physiotherapy perspective but this doesn’t eliminate the stress.

Should the strain be unrelenting, it may be time to brave the internal (unjustified) embarrassment and opt to see someone who can assist directly with the emotional or psychological strain you find yourself in. This may involve some hard choices and changes or acceptance, but your nervous system should be able to breathe a sigh of relief as a result, if this was the reason for your recurrences.

Strengthening the area around a pinched nerve

Looking from a different angle, it feels a bit like the chicken and the egg.  A nerve can be in an uncomfortable environment (think pinched) because your movement patterns lack sufficient directional variety.

Many of you would have seen how months or years of pain melt away in response to a single movement done repetitively. This finally addressed the pinch itself and not merely the muscles which tried to cope in the situation (as soft tissue work may have done here). So, it feels like we solved the puzzle!

You may then find that three or months down the line the symptoms return, and while you’re now equipped to deal with it, should you have to? And repeatedly so?

You may be a candidate for local and general strengthening of the area where the pinch occurred – not where you felt the symptoms. We want those surrounding structures to not allow the nerve to be pinched again. This strengthening process is something that both your physio and your bio can help with, providing that the pinch itself has been resolved, which you may know by now, is most of what we do here.

Dealing with a distracted nerve

Conversely, if you have a history of e.g., recurrent hamstring tears which respond as expected to relative rest and a complete rehabilitation program, we think we’re past the problem and a few months down…..? Torn again!

If you’ve completed your rehab, this should not be a sign that you didn’t do enough. It is more likely that the nerve responsible to care for the affected area, is distracted and doing a poor job at managing the situation because the nerve is under pressure elsewhere.

So the (eg sciatic) nerve can be left vulnerable because the (back and abdominal) muscles are inefficient and allowing the nerve to become pinched OR the muscle (hamstring) can be vulnerable because the nerve used to be pinched and left the hamstring under developed and ill-equipped – or BOTH can be impacting you at the same time.

Addressing these will start from the largest driver of your current situation and may then be expanded upon to include additional needs based on your presentation.

Your action plan

It is therefore advisable that if you have a return of the same symptoms after having cleared them completely for a few weeks or months, you may not want to accept receiving the exact same treatment as before. Rather ask, How can we make this time be even more effective to reduce the recurrences even further?

Your health and physical wellbeing should be a priority deserving of quality care. Make sure to discuss any concerns you may have directly with your preferred physiotherapist, so that you can receive the appropriate guidance for your unique situation.