Pain in the …
Understanding your injury or pain can be complicated. That is why we often use simple analogies as a strategy to help people understand and therefore cope better with their pain experience. In this blog post, I am going to share with you “The cup” analogy, which is a wholistic approach to explaining “the macro” or “big picture” of treating pain.
This analogy utilizes an evidence based approach to pain, using a biopsychosocial model. One that is adopted by the world’s best pain experts , . We adopt this model in practice because it is client-centred and it is more evolved than the traditional biomedical model to explain pain.
Everyone has a different cup! The cup represents all the possible contributing factors that may be occurring at one point in time during a pain experience. These examples of physical, emotional, and mental stressors go into your cup. This analogy suggests that pain occurs when all the stressors/loads in our lives is greater than the space we have in our cup. When we overflow, we have pain.
It’s worth pointing out that in this analogy, stressors/loads that can overflow your cup are more than just physical loads you put your body through. For example, fear, anxiety and worry can all pile up to fill the cup. The good part is, most of these factors that influence pain are modifiable factors that we can change through various interventions!
This cup analogy is an actionable analogy because it shows we can help in two ways:
- Decrease some of the stressors or loads in the cup
- Build a bigger cup
By reducing stressors or loads in your cup, as well as building a bigger cup, you can better cope with your pain or recovery from an injury. An example of how to build a bigger cup would be through strength training to improve your body’s resilience and load tolerance as well as making healthy choices to improve sleep, nutrition, and lower stress in your life.
As a chiropractor, I often reflect on this story that I’ve seen in clinic countless times now. I’m meeting someone for the first time and they are experiencing severe low back pain that has this person left in some sort of disability. This client has already been to the ER and has been “cleared” by the physicians but is still very worried about their back pain. After a thorough assessment, this is important, I’ve rule out any major pathology (non-MSK, disc herniation, fracture, etc) and I communicate this with my client. I will repeat myself 7-8 times within the hour interaction to make sure that I have effectively communicated that I have ruled out any major pathology. I explain that the pain they are experiencing is real, and I provide as much reassurance as I can. By the end of the session, I would have likely done some manual therapy techniques, and prescribed whatever pain-free exercises and activities that person could currently tolerate. Majority of the time that client comes into the clinic 2-3 days later feeling quite a bit better. In my humble opinion, 50% of that successful first treatment is from the manual therapy + exercise. The other 50% I believe comes from education, reassurance and instilling positive beliefs about their type of back pain. All of that comes from a place of kindness and building trust in the patient-practitioner relationship.
To really bring home the point to this story, do you think this person lifted a car off a child to injure their back? NOPE! It was washing dishes. Something they have done millions of times, as we all have. They had just lost a loved one the week prior and were dealing with very high stressors. The cup overflowed and the body responded as it is programmed to do.
I was there to provide support and remind them that our body’s are incredible at adapting, and that I knew they would recover. And they did!
Maybe you’re reading this thinking I have persistent pain that’s been around for 10 years, how can this analogy help me?
I would argue that this is MORE helpful for those dealing with persistent pain. Those fears of re-injury and negative self-beliefs have deeper, more established roots, which could be getting in the way of doing some of the things you love to do.
It might be time to have your body assessed by a practitioner that is truly looking to build you a bigger cup. Willing to get into the weeds if it’s needed to help reframe your pain and your beliefs about your body. While also working on your tissue’s and gradually, safely, getting you more active.
Looking for more information on this topic we recommend you read Explain Pain Super Charged by David Butler and Lorimer Moseley.
(1) Greg Lehman – Reconciling Biomechanics with Pain Science Course
(2) NIO Group – Pain Science Education for Health Professionals Course
Written by: Dr. Eric Nelson, Chiropractor + Co-Founder of Function101 Chiro + Physio