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Why Is My Pain So Stubborn?


Pain is the most common reason someone sees a physiotherapist. How pain impacts a person’s identity, their relationships and their outlook on life, are typical factors for an individual to seek counselling support. Consequently pain is one of healthcare’s greatest challenges. We’re literally spending billions of healthcare dollars on pain management without a true solution to the problem.

Why isn’t there a solution?

This is because pain is individualized. You could have 5 people with the same injury and they will all present differently, with different amounts of pain. Their bodies will all react differently to the same approach. Conversely, their brains will react differently too. For some, pain may be seen as a challenge that needs to be tackled and overcome, for others it may be perceived as a threat that is robbing them of their personhood; both mindsets can be detrimental to recovery. Whether it be stress and frustration adhering to the slower pace an injury demands or overcoming anxiety and fear as the result of an injury, these are just two examples in a multitude of ways people comprehend pain. Interestingly, most people believe pain is experienced the same way by everyone, like we’re cars made on the same factory line. There is a belief that we all heal the same way and that the same therapeutic approach works for everyone; a one size fits all. If this were the case, North Americans wouldn’t be spending approximately $600 billion dollars per year toward the care and management of chronic pain. For practitioners and the healthcare system as a whole, this is where the challenge lies.

New research over the past 5 to 10 years has shown that pain depends on many factors. One small factor is your actual injury. Your actual injury may cause pain, but did you know that within 15 seconds of experiencing pain your brain changes the way it thinks about an injured area? So, if you hurt yourself reaching for a cup of coffee, your brain will think differently about how to reach for a cup of coffee while you’re experiencing pain. If you don’t recover from your injury, this new pathway can create adaptations in your brain that modifies your body and movement compared to how you moved before you experienced your pain.

Check out this amazing video from one of the world’s leading pain researchers:

Now, let’s take it a step further. Research also indicates that your experience of pain is greatly influenced by your current and past experiences with pain, your ability to cope and manage with emotional responses to stress, your work-life balance, your support system and much more. This is called the biopsychosocial model of pain. Considering all these factors, can we really attach all of our focus on our tissues as the main or only source of our pain? The more we learn the more we can confidently say “No.” In fact, through medical imaging, researchers have found that people can have disc bulges, meniscal tears, osteoarthritis, and many other diagnostic findings without the experience of pain. There have been multiple reports that show people without pain having the exact same MRI findings as someone with pain.

Check out the findings comparing MRIs for people with and without low back pain.

Adam Meakins Photo for Blog

Can this go both ways?

If we can be pain-free regardless of a muscular, tissue or skeletal change in our body, can we experience pain when there is no longer a tangible change in our physical structure? Totally! There are many people that experience pain for years following an injury, but their injury has been fully healed. So how do they still experience pain? Current science indicates that all the other factors discussed above may continue to influence pain for years following an injury and lead to a life with chronic pain.

You may want to ask yourself the following: Have I returned to sleeping well following my injury? Am I avoiding certain movements? Is the pain I’m experiencing hurting a relationship at work or at home? Does my pain lead to feelings of fear or anxiety in certain situations?

Check out this video about how pain can be impacted by our daily lives:

What does that mean?

It means we believe you can get better. It means that we don’t take a “one size fits all” approach to your pain but rather an integrated look at what could benefit you. It means with the right approach we can calm things down and build them back up. It means we can retrain your brain to overcome pain and return to previous levels.

Are you looking to find out more? At Bliss Counselling and Strive Physiotherapy & Performance, we’re committed to providing a multi-disciplinary and in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Check us out at www.bliss-therapy.org and  www.strivept.ca.

Have a great day,

Mike Major
Physiotherapist at Strive Physiotherapy & Performance

Melissa Reid
MSW, RSW at Bliss Counselling


About the Authors:

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Mike graduated from the University of Waterloo in 2006 with an Honours Bachelor of Science in Kinesiology. Immediately upon graduation, he was accepted into McMaster University’s Physiotherapy program where he graduated with a Masters of Science in Physiotherapy in 2008. Prior to becoming a physiotherapist, Mike served in the reserves for 9 years as a member of the Artillery in the Canadian Armed Forces. ​

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Melissa Reid is a Registered Social Worker with a Master’s degree in Social Work. Ms. Reid received her undergraduate degree from the University of Waterloo after which she pursued a certificate in child abuse studies, and finally a Master’s in Social Work from Wilfrid Laurier University, Waterloo, Ontario. Ms. Reid has also participated in numerous educational conferences on trauma, grief and bereavement.

Stress and the Pelvic Floor

Your palms begin to sweat, your stomach feels uneasy, you are tired but you cannot sleep. There is a pounding in your head, you have chest pain, your sex drive is negative. There is pain and tightness in your muscles. These are all COMMON EFFECTS OF STRESS ON THE BODY.

You cannot sit still, you are overwhelmed and irritable. You feel anxious, with a lack of motivation and focus. You feel alone even in a room full of people. You are sad, and possibly depressed. These are all COMMON EFFECTS OF STRESS ON MOOD.

You are socially withdrawn, no longer exercising, and cannot eat or are overeating. You become angry and short tempered, and may have outbursts. You rely on crutches like smoking, drinking or drugs to help you cope. These are all COMMON EFFECTS OF STRESS ON YOUR BEHAVIOR.

The human body is designed to experience stress, and to react to it. Stress can be a very important protective mechanism whereby the body becomes alert and ready to avoid danger. This positive stress is referred to as “eustress”. The opposite occurs when stress becomes negative and an individual faces continuous challenge without relief. This type of stress is called “distress”, and it is this stress that impacts the body in the ways outlined above.

So what does all of this have to do with the pelvic floor you ask? Wait…WHAT IS the pelvic floor you ask? Believe me when I say you are not the first to ask, and you will definitely not be the last. You should have a better understanding when we are through.

The pelvis is the “bony container” that surrounds the bowel, the bladder, and the reproductive organs. The pelvic floor muscles present like a hammock and span the bottom of the pelvis, holding the pelvic organs in place and playing a vital role in bowel, bladder and sexual function.

What you may not know is STRESS CAN DIRECTLY AFFECT YOUR PELVIC FLOOR!!! Remember, we talked about the body’s response to stress? When we experience stress, particularly that of a prolonged nature, we hold our muscles very tightly – all muscles, even our pelvic floor muscles. Stress plays a major role in pelvic floor disorders, and many of my clients experienced their first pelvic floor symptom during or following a particularly stressful time in their lives.

We have all encountered cyclical situations situations at some point, and a chronic state of stress is no different. Stress and the tightening of the pelvic floor muscles (consciously or subconsciously) can lead to conditions such as:

  • Urinary or fecal incontinence (leakage)
  • Urinary urgency
  • Urinary frequency
  • Sexual pain, difficulty with sexual arousal and orgasm
  • Constipation
  • Pelvic pain including vulvodynia and vaginismus
  • Bladder pain including painful bladder syndrome
  • And many others

These conditions then lead to stress and anxiety – possibly because people are afraid to discuss them – and so the cyclical pattern continues.

The only way to initiate the healing process is to break the cycle!

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The most important message I can convey is that we need to talk about pelvic pain. NO. MORE. WHISPERING. How will people ever understand the relationship between stress and pelvic pain if we do not talk about it?  Each day, I challenge every one of my clients to discuss their pelvis with one other human. This might be their partner, their best friend, or a random stranger in line at the grocery store (you may never see them again, so go for it). It might seem like unconventional advice, but people should NOT have to suffer in silence or go through life with the belief that peeing your pants when you age is normal. Or that the inability to hold a bowel movement after giving birth is normal.  Or that the stress associated with a traumatic event will forever define your ability to have pain-free intercourse. Common, yes! Normal…NO!

There is help out there, and people who want to help!  As mentioned above, sometimes it does take a village, and as a pelvic health physiotherapist I am fortunate to have established a wonderful reference team that I confidently refer to when needed. You have to start your journey somewhere – start by talking!

Screen Shot 2017-03-06 at 5.42.15 PMKeri Martin Vrbanac

Registered Physiotherapist, Pelvic Health Physiotherapist & Owner of a Body in Motion 

Keri has been a Registered Physiotherapist since 1997 when she graduated with distinction from the University of Toronto. Prior to beginning her physiotherapy studies, Keri completed a Bachelor of Physical and Health Education and a Bachelor of Arts, with distinction, from Queen’s University. Keri’s clinical expertise has included orthopedics, pediatrics, neurological specialties and sports therapy. Keri discovered her passion for Pelvic Physiotherapy in 2013 and has continued to further her education in the areas of sexual pain, incontinence, special topics in women’s health including endometriosus, infertility and post hysterectomy treatment. Keri enjoys her work with her children with pediatric incontinence, her pre-natal and post-natal clientele, as well as men and women suffering with pelvic pain as a result of bladder or bowel difficulties, interstitial cystitis and prostatitis, just to name a few.


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