Thankfully the action of the nerves that detect movement and pressure suppresses this pain at the spinal cord and you don't feel it. However loss of movement of an area means the suppression is reduced and pain can start to be felt. Anyone who's sat through a long film will know that. Your body is literally telling you to move so that you don't damage it. The brain itself can also suppress pain from above if it is busy doing other tasks that are deemed more important, ie running away from danger or doing something more pleasurable.
Pain is felt when the impulses from those pain fibres actually manage to reach the sensory cortex of the brain. So you register pain in the head. To achieve this you must have increased excitation of the pain nerves. This can be down to an increase in stimulus or a lower threshold to fire the nerves. The chemistry of your body and level of electrolytes can influence pain generation. If your body is lacking in nutrients that are used for the building blocks of natural anti-inflammatories then you will generally be more likely to experience pain. Or if tissue is injured, chemicals released by the damaged cells lead to easier excitation of pain nerves and you feel pain.
It is possible to have a lot of wear and tear and have no pain at all. Similarly you can be in agony when there is very little damage showing. So if you have an x-ray or scan of a recently injured joint that was previously pain free and it shows degeneration or a tear of a structure don't go straight for the surgical option. There is little correlation between tissue damage and pain. Think twice or even three times, seek an opinion of someone who isn't a surgeon. You may be in pain simply because the pain nerves are more excited and the suppressive mechanisms aren't working. If this is the case surgery won't make any difference as the torn tendon might not have been the source of the pain. It could be coming from somewhere else entirely.
Surgery should always be a last resort, once it's done it can't be reversed. There are risks of infection and risks of further pain due to the inflammation and excitation of pain nerves from the surgery itself. In some cases this can trigger a complex pain syndrome that is self fulfilling and perpetuates.
The natural approach begins by activating the neurological mechanisms that suppress pain. Stimulation of these nerves anywhere in the body can help, the strength of the effect is variable depending on what area is stimulated and is related to the representation on the brain itself. Movement, mobilisation, manipulation, taping all help reduce pain. However they have to be applied correctly to ensure the balance of neurological activity is helping rather than hindering.
If the physical therapy approach you choose isn't successful, try a practitioner in a different discipline such as Chiropractor or Osteopath, or vice versa. Or even two different practitioners within the same profession as they do work quite differently a lot of the time. After you've exhausted all options consider the surgery but remember the pain won't just disappear after surgery, you will still have a period of 6-12 weeks of recovery and rehabilitation to go through.
Also you should look closely at your diet. Lack of fresh fruit, whole foods such as nuts, seeds, dark leafy green vegetables and oily fish can mean the body does not have the raw materials to create anti-inflammatory chemicals. Furthermore smoking and alcohol can aggravate inflammation.
The use of the painkiller Gabapentin alongside manipulation and stimulation can also be helpful to suppress the nerves so that treatment can be gently started in chronic pain syndromes. We do not recommend the use of Non Steroidal anti-inflammatories or paracetomol as the former is detrimental to gut, heart, liver and kidney health and the latter has no benefit long-term and will reduce your emotional as well as your pain sensation.
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