Not Broken…Just Changed

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The other day I was at the hostel in Winthrop, chatting about this and that with the other folks that were there.  As often happens in an active crowd the talk turned to past injuries at one point, and as often happens I heard someone express the idea, “Yeah, this one time I was doing this one crazy thing and I landed on my shoulder.  I think I screwed it up permanently.”

Have you ever heard someone say that sort of thing?  Maybe you’ve even said it yourself?

Why did the person I’m quoting say that about his shoulder?  Let’s guess.  I think he said that because he has some pain in his shoulder while doing certain activities…possibly some weakness and movement limitation too.

But why did he say he thinks he screwed it up permanently from landing on it?

I guess that he can roughly trace the onset of the pain back to the time he landed on it and not before.  He might even have a sense of familiarity from the pain.  Meaning that the pain feels like the pain he had right after the shoulder injury, so it gives a feeling that the two things are related.

I also guess that he thinks it’s permanent because it happened three years ago and the shoulder will still hurt while performing specific activities…maybe not right away, but if he does the activity for say, more than 20 minutes.

Where does this idea that we can be permanently injured come from?

Perhaps it’s from the perspective of the body as a machine.  Machines can break and have to go on the junk heap.  Or it comes from the popular, fatalistic predeterminism that finds it’s current champion in genetics…the idea that we’re programmed by our genes at conception to self destruct in unique and individual ways.   For whatever reason the idea that I am fragile and can be permanently broken is out there and it’s strong.

I would like to put forth another idea.   The idea that you can be permanently *changed*….but not that you can be permanently broken.

I once met a woman who’d had a baby.  She had this massive abdominal growth shove all of her organs into her chest cavity and pelvic cavity.  She went through this incredibly painful process of having her pelvis and associated soft tissues deformed and she had her rectus abdominus and other abdominal muscles stretched to the plastic deformation phase.  That would be considered a second degree sprain if we were talking about an ankle.

She seemed relatively normal.  I don’t think she thought she’d been permanently broken…she said it changes you though.

In comparison my friend with the shoulder thing seems to hardly have a cause for concern.   At the time of injury there may have been some torn fibers, even a chipped bone.  A fairly low level of physical trauma in comparison.

Injury is a natural process.

Someone may be thinking, “well pregnancy and parturition are natural processes that the body was designed for.”

Let’s just blow that up right now.  So is injury.  Injury is a natural process.  We were designed, or evolved, to heal.  And we do.

I don’t think women expect to carry remnants of the pain of childbirth with them for the rest of their lives.  So why do people who land on their shoulders or “tweak” their backs expect to carry that pain around with them forever?  Is it a cultural message?  (The answer is; Yes.)  But the guy who landed on his shoulder still has pain (or the person that “tweaked” or “threw out” [?!] his back) so what’s this cultural message stuff have to do with anything.

Pain is real…but it’s subjective.

Do you know the difference between subjective and objective?  Objective is something that can be seen or experienced by more than one person and can be measured in some way.  Subjective is a personal experience.  I can tell you, but there’s no way to verify it.  For example if there are three avocados on the counter we could ask any passer by to verify that there are indeed three avocados on the counter.  If I tell you I like avocados you wouldn’t be able to verify that.  If I told you I like avocados more than you like avocados we wouldn’t be able to measure my liking and your liking and compare them to each other.  You have to come up with pretty creative ways to measure something subjective and even then you don’t really know in the same solid way that you know whether or not there are three avocados on the counter.

Pain is subjective.  It can’t be measured.  There is nothing in the body that can be extracted or recorded with delicate electrical instruments that will tell someone if and how much pain is being felt.

Despite that there are various pain scales that are used all the time for studies about whether such and such worked to decrease pain.  They’re useful, but not as cut and dried as seeing that there are three avocados on the counter.

Maybe you’re thinking, “Well, when they get some more delicate instruments they’ll be able to tell how many pain signals are coming from the damaged area.  Then they’ll be able to know just how much pain I’m having.”  Nope. Sorry.  Somebody who maybe should have know better did use the expression “pain signals” once.  Which is too bad because there aren’t any pain signals.

Hopefully that’s some good food for thought.  I’ll delve a bit deeper with this in another article.

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