tl;dr how can I tell whether a) I’m hocusing myself into pain and incapacity and I’m actually just fine or b) running is bad for me?
You guys have some mighty interesting ideas about pain, and it all rings pretty true to me in the context of lifting weights. I’ve had a fair number of lifting injuries, some quite scary at the time, but did my best not to panic, kept moving at a tolerable level, and pretty much always got back to where I was pre-injury within six to eight weeks. (Not that I was ever terribly strong, mind.). Meanwhile, low-grade chronic pains came and went without obvious causes but also without hindering progress or daily life, and all was well.
But I’ve recently started to run again and hike with weight for work-related reasons, and things keep hurting. Started slow, still not running very fast or very far, a little heavy for serious endurance work at 6’ 190lb but not grossly so, but I keep getting mystery low-grade pains that respond to things like acupunture or hydrolyzed collagen but don’t go away entirely, little or no agreement between podiatrists on diagnosis and solutions (from “have you tried swimming?” to “well, it’s a minor problem, whatever it is, I’d just keep running”), imaging inconclusive. And this isn’t the first time this has happened–I had about a year of plantar fasciitis and another year or so of tibial stress fractures, both quite a while ago and with several years in between, both associated with running and skipping rope, and both refusing to go away until I essentially stopped moving. Actual pain was and is minor to negligible as long as I wasn’t running, but the psychological distress from not doing anything on my feet and risking setbacks from returning to activity too soon was substantial. (Or, now, distress from potentially having to quit a job I enjoy.).
So, on the one hand, lots of room for non-structural explanations here, and with a history like that it’s not impossible that I’ve conditioned myself to hurt when I run, per neuroinflammatory/psychosocial models. On the other hand, running is different than lifting [citation needed?] and it sure feels like real pain, and presumably it is in fact possible to have a chronic structural injury, Sarno et al notwithstanding. The running world does not seem to have a whole lot of useful insight here. Per the tl;dr up top, thoughts?
Sorry to hear about your frustrations, psmith.
So one thing that we always have to make clear is that we aren’t dividing between “structural” and “non-structural” models of pain, suggesting that anyone’s pain isn’t “real”, or that it’s all in their head.
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All pain is real.
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All pain is produced by the brain. Always.
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The biopsychosocial model holds that the experience of pain is always influenced by a combination of biological factors (including structural issues in certain situations), psychological factors (like fear-avoidance, catastrophizing, or the psychological distress that you specifically mention experiencing in your own history), and social factors (what you’ve heard / learned about pain in general, or a particular condition from observing / interacting with others throughout your life). There is no such thing as pain solely related to a structural issue - for example, even if you acutely fracture a femur, that fracture occurred in a particular psychosocial context (like, say, a major highway car crash with family in the car versus a fall alone at home) that will also influence the severity of pain you experience - this is why you hear stories about horrific injuries that the victim doesn’t even feel until much later, and people say it was “because they were in shock”. Which just means that their brain had other things to prioritize (like, say, survival) over the importance of protecting a specific body part (which is the primary purpose of pain). So we see Sarno’s ideas, while certainly on the right track, may not encompass the full story.
I hope this clarification makes sense. I say all this to clarify that no one is doubting that what you’re feeling is real or that it’s possible to have a chronic injury (people who follow my lifting know I have one myself in my right elbow, for example). Similarly, pain is weird (see: Pain is Weird: A Volatile, Misleading Sensation ), and sometimes pain related to OLD injuries (like, perhaps, your old tibial stress fractures) can actually rear its head again in certain situations, and can migrate in weird ways. It demands attention and the more you focus on it, the more it tends to hurt.
If I were in your situation I might try a temporary switch to an alternative conditioning modality (perhaps lower impact, to see if that helps) to build up a bit more capacity before returning to the hiking and, ultimately, running.
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