When movement is limited by pain for too long, could the pain become a conditioned response to the movement? Rather than an accurate indication of the tissue state? Like Pavlov’s dogs salivating in response to a bell instead of food.
This article by Ben Cormack of Cor-Kinetic explores the potential to “recalibrate” painful movement by gradually breaking the association between the movement and pain with the “5 R’s of Rehab”:
- Red flags — Rule them out.
- Reassure — Probably nothing serious.
- Reconceptualize — Pain as an alarm. Oversensitive.
- Recalibrate — Graded exposure to varied movement.
- Robust — Increase movement demand & build buffer.
I’m fascinated by this idea and think it has a lot of value, but I also wonder if the case for a primarily conditioned painful response is a bit overstated. Is that really a thing? I don’t doubt that it is possible, but is it common? I have clinically witnessed (and personally experienced) many chronically painful movements that really did not seem like a conditioned response persisting long after the resolution of any problem in the tissue. I think a stubborn source of tissue-driven pain (nociceptive pain) is highly plausible in many cases.
Just thinking out loud here.