explain
pain
section
6
page
118
Pacing and graded exposure
(continued)
Stay patient
I
n the 10 years since Explain Painwas first published,
many people have found thesemountain figures are a
useful way of understanding the relationship between your
pain, the nervous system changes that occur with persistent
pain, and the brain retraining activities of graded exposure
and gradedmotor imagery.
103,168
The images are often
affectionately called ‘Twin Peaks’. Let’s walk through the
left side of the top figure.
TT
(initial) The old tissue tolerance line
Before your pain started, your tissues were fit and healthy.
There was a certain amount of activity or specificmovement
that you could do before your tissues would react in some
way. Most tissues are damaged by reaching the tissue
tolerance line too quickly (eg. falling, lifting a heavy weight,
a car accident). Sometimes, this line is reached slowly while
you are distracted (eg. working or training).
PBP
(initial) Protect by pain line
Danger sensors are activated before damage occurs and
your brain is alerted. Usually, the pain ignition nodes are
activated, the neurotag for pain is produced and it hurts.
Painmotivates you to stop or change the activity to get
your tissues out of danger. A great system. You could go
further or climb higher, but it becomesmore dangerous.
NTT
The new tissue tolerance line
Look at themountain on the top right. If youhave had pain
for some time, the tissue tolerance line shifts. Your tissues
are not like theywere – especially if they have sustained an
injury. Although the tissuesmight have healed, theymay not
perform in quite the sameway. More importantly, youhave
not used the tissues asmuch or in the sameway since your
pain started. They are unfit, weaker, more easily fatigued.
This is one reason you shouldn’t just push through pain, try
to beat pain, dose up on analgesics or climb a steepmountain
for example.
NPBP
New protect by pain line
Look at the position of this line. Your alarm system and
pain ignition nodes are sensitised. You have pain at very
low levels of activity, ormaybe even imagining or thinking
of movement. Your brain is really looking out for you. Now
the protective buffer between the onset of pain and the new
tissue tolerance line is huge. If you progress slowly, it will
be impossible to re-injure the tissues because it will hurt
toomuch to even get close to this line.
FUL
The flare-up line
BL
The baseline fromwhich to begin training
