To get rid of pain, you need to involve your brain. Running Injury & Performance Specialist Matt Phillips reveals why…

As runners, most of us have enjoyed the pain relief brought about by passive treatments such as massage, manipulation, stretching, acupuncture, kinesiology tape, etc. Occasionally the pain stays away, which is fantastic, but in many cases it returns after a day or two, so we go back for more, and more. Before we know it, we’ve had a month of treatment and are no closer to pain free running. So, what’s the deal? Why aren’t these sessions fixing our issue? Let’s investigate…

It was once thought that passive therapy like deep tissue massage, myofascial work, mobilisations, stretching etc. directly affected the structure of tissues. Modern research however suggests that the changes in tension, mobility and pain seen after these passive treatments are more likely to be the product of temporary changes to the nervous system. To promote long term changes, we need to involve our nervous system, i.e. we need to be the ones doing the moving. Only we can fix the more important of our two bodies.

Two bodies?

Yes, you read that right. The brain contains a ‘virtual’ representation of every part of the body, a ‘body map’ if you like, made up of a network of neurons (nerve cells) formed by sensory information received from the body. You may be familiar with the image of a man with huge lips and hands called ‘Homunculus’, created by Canadian neurosurgeon Wilder Penfield in the 1930’s to illustrate the body parts that send the most information to the brain.

When it comes to recovering from injury, this ‘virtual body’ within the brain plays a huge part. As far as pain goes, the brain’s body map is reality. If your body map says your foot is on fire, you will feel like your foot is on fire, even if you don’t even have a foot! This explains phenomenon like not feeling pain until you see the blood, pain being worse if you are stressed and symptoms manifesting themselves after you read about them on the internet.

Change your brain

The exciting thing about body maps is that they are always changing size, shape and organisation. This is a process called neuroplasticity. The better the size and quality of a body map, the better the perception and movement of the physical body part it represents. When you practice a movement, the body map representing the physical body part involved grows in size. However, if you stop using a particular body part, for example when you are injured and/or in pain, the body map for that particular body part becomes ‘blurred’ (also referred to as ‘smudged’.) In other words, if you don’t use it you lose it.

When a body map becomes blurred, the brain’s perception of the body’s movement becomes distorted. Its powers of assessing a particular situation become hindered and it becomes threatened unnecessarily. If the brain feels threatened it outputs pain. In order to restore the brain to a less threatened state, we need to restore the integrity of the blurred body maps.

What is mindful movement?

Blurred body maps are cleaned up by us performing goal orientated, concentrated movements, in other words mindful movement. The simple act of slowly and carefully drawing the alphabet with your toes can often result in a sprained ankle hurting less when you try and walk on it again. You have not affected the physical structures of the foot; you have filled in some of the gaps on the body map in your brain. If moving in a certain way is regarded as threatening by the brain, changing the movement slightly so that you can perform it with less pain and more coordination will encourage reintegration of body maps, a less threatened brain and nervous system, and therefore less pain.

How can we use mindful movement for rehab?

The existence of body maps and neuroplasticity has huge implications when it comes to performing rehab. First of all, it reinforces the fact that if you want to move better and be in less pain, you have to do your exercises! The second is how you perform the exercises. Rushing through the exercises without thinking or just going through the motions will stimulate very little if any neural change.Modern therapists can continue to provide you with the benefits of passive therapy, but they will also be able to guide you through how to perform rehabilitation exercises.

Matt Phillips is a Running Injury & Performance Specialist and host of the podcast