# Step 2 Build Shit Up ##### Untangling Pain ---  --- ## tl;dr - Building shit up means using pacing and graded exposure rather than treating every pain signal as damage. - Pain can be a protective warning before the body reaches its tissue tolerance line. - After pain or injury, inactivity and fear can lower both capacity and the point where the alarm goes off. - That can mean pain starts with less activity, even when there is no new injury. - The aim is to build capacity gradually while listening to warning signs instead of pushing through them. > [!abstract]- Transcript > > Now we're on to step two, building Shit Up, or also known as Graded exposure and pacing. But before we actually get into graded exposure and pacing fully, there are a few things that I need to go through and explain. And it's in explaining these things to many of my clients over the years that has helped them understand exactly how they can start getting back into doing the things that they love. > > So I'm gonna explain to you a little bit more about the relationship between pain and damage. And although we've covered this before in the pain science module I think explaining it this way really helps consolidate everything that we've learned. > > And hopefully this will help you see that pain does not always result because of damage, and that we can actually have a certain amount of pain even before any tissue damage occurs. Because even when we have chronic pain, there's so much fear that we are doing more damage to ourselves, and so we obviously start to fear pain. > > Now, granted in the beginning we might be pushing through pain because that's what we've been taught, but then over time we begin to fear it. So again, I'm hoping that this will help you understand and tie everything together that we've already been through. And this is one of the things that I would literally do, I don't do hands-on anymore, but this is something I would literally do with my clients. And I had a big whiteboard in my office specifically for this purpose. And these are the things that I would explain to my clients. How they can go about living their life and doing the things that they want to do despite the pain that they were experiencing and how to build those things up. > > There is a certain amount of activity that we can withstand before our body tissues actually become damaged. This is what we refer to as the tissue tolerance line. This is our capacity. It's how strong our body is, and where this line is different for everybody. And it can change on things such as fitness level, age, area of the body, and so on. > > Now, in some cases, we can reach this line really quickly. Such as if we went over on an ankle or we had a car accident. It means that we reach this line, this point, and this is where tissue damage occurs. > > It only really gets to this point when something serious is going on again, like going over on your ankle or a car accident. > > When this does happen, if this happens, so if you do go over on your ankle, if you do have a car accident, then reaching this line, there's not really that much that we can do about it. It's just one of those things. > > But the body is super smart, and if we are starting to approach this line slowly, so through training or working hard, or even sitting for long periods of time or whatever it is that you are doing. Then if you are approaching this line, a warning is produced, and this warning is produced before damage actually occurs. > > This is what we can refer to as the protect by pain line. It is when the fire alarms are being set off. > > so it is above this line that pain is actually produced when the fire alarms or the nociceptors have been set off, which alerts the brain via the spinal cord. And if the brain concludes that yes, we are in fact approaching the tissue tolerance line and the house is in fact on fire, the pain will be produced. With the intention of motivating us to stop or to change what it is that is setting off the signal in the first place. > > The whole point of this is for us to get our body tissues out of danger. Ignoring this or continuing to do what we are doing then becomes dangerous. And if we do continue, then the tissue tolerance line will be hit. And that's when it results in the body, tissues becoming damaged. > > The brain is telling us, do something or we're gonna get hurt. > > Now it's worth pointing out that we can actually reach this tissue tolerance line without a major injury occurring. So we can reach it slowly and this can happen when we become distracted. Or because we have chosen to ignore the signals, we have chosen to ignore that protect by pain line. > > And as you'll see, it's not wise to always ignore pain. After all, it is there to protect us. > > now when we do get injured, be it a sprain, a cut or a break, or wear and tear. For the record. I really hate that term, but at this moment in time, it's the best I've got and it's probably one that you understand. The healing process is still the same. > > Firstly, there is inflammation, and despite the bad press, this is a good thing. Inflammation is a good thing. Then a scar is formed, and then the tissue is remodeled to make as good a match to the original tissues as possible. > > And so when the tissues are healed, the pain should diminish. However, as we know. This is not always the case. This means that if we are still having pain after the injury is healed, then this pain is more likely associated with the nervous system than the tissues themselves, as we've discussed already. > > Now, please remember that we do not always have to have had a definitive injury for this to happen. Unfortunately, something can set things off without us realizing what we actually did. And we tend to find this in the case with chronic pain, but it's still the same. > > We had a tissue tolerance line and a protect by pain line, and now things are different as we'll see. > > So after an injury or after we have had pain for a while, the tissue tolerance line is moved to a lower level. > > This is due to the fact that we haven't been moving the way that we did before, and we may even have been avoiding movement. This means that our body or specific parts, they may not be as healthy and as strong as before the injury or before the persistent pain started. Which means that we fatigue quicker and we just feel weaker. This is why pushing through the pain or dosing up on painkillers, which obviously only mask the pain, is not such a good idea. > > With all this going on, the brain switches to overprotective mode. The body adapts with the danger alarm systems becoming super sophisticated and hypersensitive. So basically the protect by pain line is also moved to a lower level as the danger sensors become more sensitive and our body just doesn't want to go through this again, and it does everything it can to protect us further. > > This means we start to experience pain at a lower level of activity than we did previously in order to protect us from being injured again. For some people, that means feeling pain all of the time. > > Inbetween the tissue tolerance line and protect by pain line, there is a line that we refer to as the flare up line. Now this as you can probably guess, is where the problem will flare up if reached. Think inflammation or more pain or anxiety sometimes. > > So this is just another way that our body is trying to protect us. It doesn't mean that there is necessarily any damage being done. It just means that the body perceives a threat. It's a warning that we are approaching the tissue tolerance line again. Next lesson → [[Untangling Pain – Module 4 Lesson 10 – The 2 Stages of Chronic Pain|The 2 Stages of Chronic Pain]] %% ## Extra ## Version 1: Full Step Two: Building Shit Up (Graded Exposure and Pacing) Before we actually get into graded exposure and pacing fully, there are a few things that I need to go through and explain Explaining these things to many of my clients over the years has helped them understand exactly how they can start getting back into doing the things that they love Pain vs. Damage I’m gonna explain to you a little bit more about the relationship between pain and damage Although we’ve covered this before in the pain science module, I think explaining it this way really helps consolidate everything that we’ve learned Hopefully this will help you see that pain does not always result because of damage We can actually have a certain amount of pain even before any tissue damage occurs Even when we have chronic pain, there’s so much fear that we are doing more damage to ourselves So we obviously start to fear pain In the beginning we might be pushing through pain because that’s what we’ve been taught, but then over time we begin to fear it I’m hoping this will help you understand and tie everything together that we’ve already been through Client Work and Whiteboard Explanation This is one of the things that I would literally do I don’t do hands-on anymore, but this is something I would literally do with my clients I had a big whiteboard in my office specifically for this purpose These are the things that I would explain to my clients How they can go about living their life and doing the things that they want to do despite the pain that they were experiencing And how to build those things up Tissue Tolerance Line There is a certain amount of activity that we can withstand before our body tissues actually become damaged This is what we refer to as the tissue tolerance line This is our capacity It’s how strong our body is This line is different for everybody It can change on things such as fitness level, age, area of the body, and so on In some cases, we can reach this line really quickly Such as if we went over on an ankle or we had a car accident It means that we reach this line, this point, and this is where tissue damage occurs It only really gets to this point when something serious is going on → again, like going over on your ankle or a car accident If this happens, then reaching this line, there’s not really that much that we can do about it It’s just one of those things Protect by Pain Line The body is super smart If we are starting to approach this line slowly → through training, working hard, sitting for long periods of time, or whatever → we get a warning before damage actually occurs This is what we can refer to as the protect by pain line It is when the fire alarms are being set off It is above this line that pain is actually produced When the fire alarms or the nociceptors have been set off, it alerts the brain via the spinal cord If the brain concludes that yes, we are in fact approaching the tissue tolerance line and the house is in fact on fire, pain will be produced The intention is to motivate us to stop or to change what it is that is setting off the signal The whole point of this is for us to get our body tissues out of danger Ignoring this or continuing to do what we are doing then becomes dangerous If we do continue, then the tissue tolerance line will be hit That’s when it results in the body tissues becoming damaged The brain is telling us: do something or we’re gonna get hurt Reaching the Tissue Tolerance Line Slowly We can actually reach this tissue tolerance line without a major injury occurring We can reach it slowly This can happen when we become distracted Or because we have chosen to ignore the signals We have chosen to ignore that protect by pain line It’s not wise to always ignore pain After all, it is there to protect us The Healing Process When we do get injured → be it a sprain, a cut or a break, or wear and tear For the record, I really hate that term, but at this moment in time it’s the best I’ve got and it’s probably one that you understand The healing process is still the same Firstly, there is inflammation Despite the bad press, this is a good thing Inflammation is a good thing Then a scar is formed Then the tissue is remodeled to make as good a match to the original tissues as possible When the tissues are healed, the pain should diminish However, as we know, this is not always the case If we are still having pain after the injury is healed, then this pain is more likely associated with the nervous system than the tissues themselves As we’ve discussed already Please remember that we do not always have to have had a definitive injury for this to happen Unfortunately, something can set things off without us realizing what we actually did We tend to find this in the case with chronic pain, but it’s still the same We had a tissue tolerance line and a protect by pain line, and now things are different Changes After Injury or Persistent Pain After an injury or after we have had pain for a while, the tissue tolerance line is moved to a lower level This is due to the fact that we haven’t been moving the way that we did before We may even have been avoiding movement This means that our body or specific parts may not be as healthy and as strong as before the injury or before the persistent pain started We fatigue quicker and we just feel weaker This is why pushing through the pain or dosing up on painkillers → which obviously only mask the pain → is not such a good idea Overprotective Brain and Danger Systems The brain switches to overprotective mode The body adapts with the danger alarm systems becoming super sophisticated and hypersensitive The protect by pain line is also moved to a lower level The danger sensors become more sensitive Our body just doesn’t want to go through this again It does everything it can to protect us further We start to experience pain at a lower level of activity than we did previously This is to protect us from being injured again For some people, that means feeling pain all of the time The Flare Up Line In between the tissue tolerance line and protect by pain line, there is a line that we refer to as the flare up line This, as you can probably guess, is where the problem will flare up if reached Think inflammation or more pain or anxiety sometimes This is just another way that our body is trying to protect us It doesn’t mean that there is necessarily any damage being done It just means that the body perceives a threat It’s a warning that we are approaching the tissue tolerance line again ## ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-20.jpeg|women & Pain Part 4 slide-20.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-21.jpeg|women & Pain Part 4 slide-21.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-22.jpeg|women & Pain Part 4 slide-22.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-23.jpeg|women & Pain Part 4 slide-23.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-24.jpeg|women & Pain Part 4 slide-24.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-25.jpeg|women & Pain Part 4 slide-25.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-26.jpeg|women & Pain Part 4 slide-26.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-27.jpeg|women & Pain Part 4 slide-27.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-28.jpeg|women & Pain Part 4 slide-28.jpeg]] --- ## Watch the lesson %%