Why does my foot… (insert your pain here)…. still hurt?

Pain is a funny old thing. My brain has a particular relationship with my right ankle.

A while back I injured my ankle; it healed fine over the following few weeks, BUT, subsequently, I kept re-injuring the same ankle. So now my nervous system is super sensitive about that bit of me.

Our nervous systems are a repository of layer upon layer of interconnected neural maps – kind of memories that act as references for behaviour, so that we can act appropriately within whatever context we find ourselves. These maps are constantly being updated and changed as we move through our experiences.

Sometimes, (like with me and my ankle) because I had repeatedly injured it, the neural maps associated with my ankle become very sensitive to what my nervous system deems to be excessive movement, it has become over protective. So I only have to very slightly over stretch the tissues for the pain to be really severe and quite out of proportion to the injurious action (I did actually cry once). My nervous system has made a map about my ankle that strongly associates excessive movement with pain – so when I move it too much it hurts! So although the actual tissues of my ankle have long ago healed, it still feels a bit like something is still damaged.

This is such a common situation, especially when an injury happens in a stressful context – the injury, the pain and the threat associated with the stress response all get hooked up together in a map. And occasionally this can develop into a negative spiral whereby any kind of stress can link into the map and instigate a pain response, even in contexts far removed from the original injury. In fact chronic stress always lowers the pain threshold because threat and pain are like twins.

To help this kind of pain we need to (I need to) rewire the neural maps associated with it. We can do this by a program of gentle, mindful, exploratory movement. So for me and my ankle I need to gradually teach my brain that it’s ok for me to jump on it again or to run on it or put it through a full range of movement without it hurting. I can do this by exploring movement and sensation mindfully and at the soft edges of pain and range of motion. The key ingredient is mindful attention – there is something about the energy of focused attention that fosters changes in those neural maps much more readily.

So most tissue injuries should heal within 6 weeks, if you still have excessive pain after this period, it’s worth considering that it’s the nervous system not the tissues themselves that need a bit of rehab.