Dis-inhibited

There’s a little trick we sometimes play that is quite weak. We introduce it by saying that your brain cannot possibly pay attention to all of the sensory information coming at it, and we may use the metaphor of a cocktail party. At a cocktail party there are lots of voices, but hopefully you are focused on the one voice of the person you are speaking to. You inhibit (i.e. don’t listen to) the many voices, and clearly hear the one.

The trick is getting you to become aware of an un-important body area (e.g. the sole of your foot) and realising that until you shifted focus you were almost completely unaware of it. You had been inhibiting almost all sensory information from the sole of the foot. By changing focus you dis-inhibited the area.

In normal sensation and in pain, inhibition is controlled by the contextual importance of the body area.

·       If a body part is probably safe and isn’t being used in an important task then the area melts into the background of your awareness. This is the metaphorical ‘hum’ of a busy room of voices.

·       If a body part is potentially unsafe or if we need to use it for a highly specific task then we tune in! This is the single voice of your companion that you hear clearly at the cocktail party.

We spend most of our lives inhibiting sensory information. In long-term pain the opposite can happen and the pain system stops turning things down. This happens because there is enough credible information to suggest that the area is in danger. It is an attention-shift driven by the perception of danger.

It is possible to re-train your pain system to inhibit information. Like the trick above (i.e. deliberate super-awareness of a body part), you can deliberately relax your attention to a body area and have it melt into the background or dissolve into the crowd.

Learning to relax your attention to a painful part is much easier when you are really confident that the area is safe. Understanding your pain can help you to achieve this style of confidence. Working alongside a good clinician who is skilled in diagnosis and pain is also helpful. It is best to avoid gathering information that makes you feel threatened or in-danger, especially if the information is not accurate.

So instead of fixing the painful tissues, we need to assess whether or not the tissues are damaged at all. If a good clinical assessment tells us that they are not that bad –which is surprisingly common with long-term pain- then we need to work on re-calibrating the pain system. To do this we bombard the pain system with relevant, important, functional tasks plus heaps of reassurance that you are safe. Deadlifting is an excellent way to achieve this for people with back pain.

DAVE MOEN