Pain

Intro

Beauty is in the eye of the beholder.
Pain is in the brain of the sufferer.

Pain is inevitable, especially in martial arts training. However, suffering is optional.

Everyone will experience pain, but one does not have to suffer, one can just deal with the pain and get on with one's life. Martial arts students need to understand pain so they may effectively deal with it when it occurs.

Pain is…

Pain is a paradox. It may protect or destroy. It may warn of something wrong and thus protect life or it may devastate the will to live and thus destroy life. In a self-defense situation, pain may drive you to survive at all costs or it may cause you to surrender and die.

Pain is relative. What is unpleasant to some is pleasurable to others. Some avoid pain, some seek pain. It is common for all people yet unique to each person. This makes it difficult to define pain precisely. Students of martial arts know pain. The pain of a wide stretch, the pain of an errant kick, the pain of an unbroken board, and the pain of a failed promotion test. As the saying states "That which doesn't kill you, makes you stronger," although it still hurts.

Pain is learned at an early age

In 2007, doctors in Toronto found that baby boys circumcised without local anesthesia were far more sensitive to pain six months later than their uncircumcised peers. A new study has found that painful trauma during infancy seems to rewire the nervous system permanently.

Neuroscientist M. A. Ruda and her colleagues at the National Institute of Dental and Craniofacial Research in Bethesda, Maryland, investigated this effect in newborn rats. The researchers injected the animals' hind paws with an irritant that causes several days of pain and swelling. When they reached adulthood, the rats experienced distinctly above-average responsiveness to pain. Autopsies revealed that their spinal cords had 25 percent more pain fibers linked to the hind paws than those in rats that were left alone.

It is possible, says Ruda, that similar processes occur in humans exposed to painful medical procedures soon after birth. "There are a number of chronic pain states for which the physical causes are hard to identify," she says. "This is total speculation, but if your responses to pain are altered, you may be at a higher risk for some kinds of persistent pain."

How pain is perceived

Pain results when nociceptors (nerve endings) are stimulated by mechanical, thermal, or chemical stimuli that have the potential to cause tissue damage. A pain impulse is transmitted from the nociceptors to the spinal cord along either A-delta or C-delta fibers.

Because they are covered with a sheath of insulating myelin, A-delta fibers transmit impulses quicker than the smaller C-delta fibers. A-delta fiber impulses are perceived as sharp, localized pain, such as a nose hit by a punch. C-delta fiber impulses are perceived as a diffused, dull, aching pain, such as the residual pain of a bruised nose.

Nociceptive fibers enter the spinal cord through the dorsal horn, synapses in the spinal cord, and then descend as the spinothalamic tract, which has two divisions. One, the neospinothalamic tract, ascends to the thalamus and projects to the somatosensory cortex where it transmits information about the quality, intensity, and location of the pain stimulus. The other, the paleospinothalamic tract, occurs at many synapses and transmits impulses through the reticular system to terminate in the thalamus, with projections to the limbic and subcortical areas. The brain then processes the impulses for a physical response.

Transmission of pain impulses depends on the intensity of the stimulus causing the pain. The greater the intensity of the stimulus, the more pain is transmitted. However, some chemicals produced by the body inhibit the transmission of painful impulses.

How pain works

Endorphins and enkephalins. The term "endorphin" is a combination of two words: endogenous and morphine. It means "morphine within." Endorphins and as related enkephalins are peptides found in heavy concentrations in the central nervous system. They relieve pain by the same mechanisms as morphine and other narcotics. They are thought to inhibit pain by blocking pain impulse transmission within the brain and spinal cord. these substances explain why different people feel different amounts of pain from the same stimuli. Individual differences in endorphin levels, as well as situational factors, such as anxiety, influence pain transmission. People with more endorphins feel less pain and vice versa. Certain techniques, such as mental imagery, may relieve pain by increasing endorphin and enkephalin levels.

Martial artists use these techniques and others to deal with pain.
Reactions to pain. A kick to the groin is painful to practically every male but individual responses to the pain may vary considerably. Reaction to pain has physiological manifestations that are constant in most people, such as high blood pressure, muscle tension, loss of appetite, vomiting, nausea, irritability, and restlessness. However, behavioral responses may vary widely between individuals. A person's physical condition, emotional state, diet, sleep patterns, and, most importantly, the way a person has been conditioned to respond to pain, will influence reactions.

Martial artists learn to control their reactions. They tend to not overreact to sudden stimuli, such as a loud noise or a sudden pain.
Pain threshold. Pain threshold the point at which a noxious stimulus is perceived as pain. It is influenced by psychological and sociocultural factors, but primarily by physiological factors. It depends on the duration and intensity of pain that a person will accept before making an overt response.

Pain thresholds may be high or low. People with neurotic disorders or a lack of interest in conditioning themselves to pain have a low pain threshold and will give in to the pain sooner. People who subject themselves to increasing amounts of pain stimulus can condition themselves to resist pain. They can withstand pain and push themselves to continue during painful experiences. Other factors affect pain thresholds, such as age, male or female, physical conditioning, emotional state, and attitude. Factors that may increase pain threshold include anxiety, fear, anger, depression, introversion, sympathy, and analgesics.

Martial artists learn to ignore pain when necessary, such as when fighting for one’s life. You can quit resisting and die, or you can ignore the pain and possibly survive.

Types of pain

Pain is not always associated with trauma. Pain from martial arts training may result from activity intolerance and fatigue. Activity intolerance is when a person has insufficient physical or psychological energy to endure or complete a required training activity. The frequency, intensity, and duration of training that people can withstand depends upon a balance between available energy and the energy required to complete the training.

Pain may be divided into two types: acute and chronic:

Acute. Acute pain is relatively short-lived. It normally follows trauma and is experienced by everyone at some stage of their martial arts training.
Chronic. Chronic pain is persistent pain and can be disabling. It may hinder or even prevent martial artists from further training.

Fatigue

Fatigue is not pain but it can have some of the same effects. It is a feeling of being overtired, with low energy and a strong desire to sleep that interferes with normal daily activities.

Acute physical fatigue has a rapid onset and is a normal response to high intensity and short duration activity. It occurs when insufficient oxygen or nutrients are delivered to muscles. It serves as a protective mechanism and is usually relieved when the activity ceases.

Chronic fatigue differs from acute fatigue in terms of onset, intensity, perception, duration, and relief. It has a gradual and insidious onset, may last for days or weeks, and is not relieved by the cessation of the activity.

Dealing with pain

When pain strikes, we seek pain relief. Relief may come from removing the source of the pain, such as removing a splinter, or from ingesting or applying some substance that offers relief.

Although intense martial arts training may decrease your sensitivity to pain, genetics mostly determines your pain threshold. Therefore, the best choice in pain reliever and the dosage required to relieve pain will vary from person to person.

During martial arts training, acute non-debilitating pain must be endured. However, pain from serious injury must be obeyed. If pain from an injury causes you to stop fighting for your life, you may die; however, training is not a fight for your life. When injured, you should stop training and seek medical attention so you may resume training as soon as possible.

Muscle soreness or joint pain, caused by intense training should decrease or disappear completely within a week or so. Pain lasting longer could be a symptom of a more serious injury that should be looked at by a physician.

Ways to gain pain relief

Psychological sources such as:

Distraction. People who are distracted by other stimuli may forget about their pain.
Relaxation. Relaxation reduces tension and thereby reduces pain.
Physical touch. The touch of another person has been used to relieve pain for centuries.
Imagery. Imagining a situation that is devoid of pain may help relieve pain.
Meditation. Deep relaxation and concentration on a single thought help neutralize stress and strain.

Adaptation

We can learn to adapt to pain. People with chronic pain learn to deal with a certain level of pain every day. Also, when our minds are preoccupied with deep thought or our bodies are involved in intense physical exertion, our sensitivity to pain diminishes. Many times, while sparring you do not realize you have a cut until someone points it out to you. A study at the University of Wisconsin found that people could withstand painful pressure on their index fingers significantly longer after a vigorous 30-minute workout than before the workout. Our pain receptors tend to “dull” during long periods of training. It is only when we finish, and start to cool down and stretch, that we feel the full effects of our activity.

Conditioning

Physical conditioning may delay the onset of pain. Physical conditioning, a healthy diet, and the correct amount of rest increase pain tolerance.

Over-the-counter pain relief

For fever or pain, use aspirin or acetaminophen. For joint pain, use ibuprofen or naproxen. Each of these pain relievers can ease muscle and joint pain, however, each has its characteristic risks.

Prescribed medications

Qualified medical personnel can prescribe medications for acute and chronic pain. Some medications are mild and others are extremely powerful.

Natural pain relievers

Natural pain relievers may help certain types of pain, especially if you think they can (placebo effect).

Arnica and ginger. These herbs are good for inflammation of the joints and sore muscles. Not to be taken internally, these remedies are applied directly to the unbroken skin for relief. Possible side effects include redness and itching caused by an allergic reaction.
Glucosamine and chondroitin. These supplements can be found together in many popular brands such as Sundown’s Osteo Bi-flex. Both glucosamine and chondroitin are a nutritional approach to maintaining the fluids needed to lubricate joints and cartilage. Sundown states that our bodies produce enzymes that can be a factor in cartilage breakdown and that these two supplements, taken regularly, may inhibit this breakdown, enabling our bodies to maintain and promote new cartilage and connective tissue.

Glucosamine is an amino sugar found in the body that stimulates the growth of new cartilage. In studies, patients using glucosamine experienced as much joint pain relief as those taking over-the-counter medications. Due to possible blood sugar irregularities and an increase in insulin resistance, diabetics should consult a physician before starting a glucosamine regimen.

Chondroitin has been shown to improve joint mobility by maintaining the fluid needed in the core structure of cartilage, which protects cartilage and promotes healing. There are no known side effects, although there is an ongoing debate on how well the body can absorb this supplement.

Antler velvet. A natural source of glucosamine and chondroitin, Antler Velvet comes from domesticated animals (no harm comes to the animals) and has been used in Asia for thousands of years. It is known to reduce pain and recuperation time, in addition to increasing strength and stamina.
Methylsulfonylmethane. A supplement naturally occurring in plants and milk. It can help reduce muscle soreness after strenuous training.
Liniments. Although not all liniments are “all-natural,” these topical pain relievers tend to be most effective when they contain methyl salicylate (wintergreen oil). This oil can have the same effects as aspirin, without the side effects that may result from aspirin digestion. Wintergreen oil penetrates the skin to deaden the sensation of pain.

Zheng Gu Shui is a Chinese liniment that may be effective in the relief of soreness. The active ingredient is menthol (a type of alcohol), which warms and stimulates the area where it is topically applied, masking the pain caused by overexertion. If used too often, it can irritate the skin. Capsicum oleoresin (red pepper) has the same medicinal qualities of menthol in that it warms and soothes the area in which it is applied.

Side effects

All medications have side effects. Pain relievers affect everyone differently; they may cause side effects ranging from mild to severe depending on dosage and your body’s genetic makeup. When deciding on any pain reliever, the best choice for you is the one that relieves the pain the fastest, with the least amount of side effects.

Natural pain relievers also have side effects; you don't get something for nothing. Be careful of claims made by proponents of natural pain relievers and be careful of taking any that have been proven harmful and have not been proven effective.

Training with an Injury

If you train in martial arts, you will get injured. Permanent injuries are rare, but minor injuries happen all the time. Minor injuries not just painful and inconvenient, if neglected, they can have a lasting negative effect on overall physical and mental health. The first thing a martial arts student with a minor injury considers is "Will it interfere with my training schedule?" When evaluating a training injury:

Firstly, any serious injury or any injury causing acute, unfamiliar, or sustained pain must receive prompt medical attention. A doctor will be able to prescribe the necessary treatment and make any special recommendations regarding reduced physical activity.
Secondly, get to know your injury and the limits it places on you. Your doctor will be able to help you with this, but with a little effort, you will develop an intimate and detailed knowledge of what makes "it" hurt.
Thirdly, avoid doing whatever it is that makes "it" hurt! Rest your injury and work around it during your regular training. If you have twisted an ankle, concentrate on the timing of your punches, and forget footwork for a while. Although this step appears reasonable, it is often the most difficult to follow, and overlooking it could prolong the healing process or even make the injury worse.
Lastly, it is important to persist with your efforts at recovery and to be patient. Remember, it takes time for your body to recover. Depending on the injury and your age, recovery may take anywhere from a couple of weeks to many months.

If it becomes necessary to take a few weeks away from training, then do so, but stay involved with your martial arts school by going to all the events and giving other students your support. If you are able, practice breathing exercises. You can also go through the step in your patterns in your mind.

Overcoming obstacles is a fundamental part of the challenge of learning martial arts. Recovering from an injury will make you a stronger martial artist both mentally and physically. Pain is a part of life; pain is a part of martial arts training. Deal with it!

Accepting injury

A range of emotions such as anger, shock, depression, etc. may be associated with sustaining an injury. The level of these emotions depends on the degree of the injury and the person's attitude in dealing with the injury. The following are ways to mentally deal with an injury:

Consider the injury a challenge. Just as you have faced and conquered other challenges in your martial arts training, consider an injury as just another challenge that must be conquered. Determine to deal with the injury and do not let it get you down.
Accept responsibility and keep a positive attitude. The injury happened, it happened to you, it happened while you were doing something you enjoyed. Stuff happens; deal with it. Take responsibility for your rehabilitation and set goals to achieve throughout the rehabilitation process.
Research your injury. Ask questions of your doctor or physical therapist about what type of injury you have, how long you can expect to be out of practice and competition, and what activities you still participate in to keep physically and psychologically fit? Research the injury on the Internet.
Use other types of training. Do things to keep yourself mentally alert, practice relaxation and mental imagery techniques, use modified weight training, maintain your flexibility, and participate in other sports that you can perform.

Sources

Autton, N. (1989). Pain: an exploration. London: Dalton, Longman, and Todd.
Evans, G. (2000). Essay on Pain.
Porth, C.M. (1994). Pathophysiology concepts of altered health states. (4th ed.). Philadelphia, CT: J. B. Lippincott Co.
Smeltzer, S. C. and Bare, B. G. (1992). Medical surgical nursing. (7th ed.). Philadelphia, CT: J. B. Lippincott Co.
Starner, A. (2002). Natural Pain Relief, Pain Relief—Naturally.

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