Pain can change how we look and act

Functional behaviours are concerned with how your pain physically manifests (e.g., postures, altered movement etc.). While your diagnosis (whether ‘specific’ or ‘non-specific’) can inform ‘what is wrong’, functional adaptations can inform ‘what should be done about it’. 

There are two things to understand to successfully assess functional adaptations: 

1. Below I’ve outlined the most common functional adaptations (altered range of motion, pain responses and deconditioning [as utilised in O’Sullivan and colleagues 2018, MCTF]), but this analysis is not exhaustive and you may exhibit functional behaviours that are not listed here. 
2. The functional adaptations below can be helpful (ie., a normal part of recovery) or unhelpful (ie., aggravating symptoms, prolonging recovery etc.). 

Altered range of motion (ROM)

Restricted ROM can be helpful (e.g. to protect a damaged structure, to avoid excessive provocation etc.) or unhelpful (e.g., incorrect beliefs that hurt equals harm, fear avoidance, movement habits that provoke pain [e.g., bracing your core when bending forward etc.] etc.)

Consider these examples: 

1. Restricting overhead movements of your shoulder when this causes high pain scores (>5/10), flare-ups (24-48hrs afterwards), poor sleep that night etc. is helpful. 
2. Restricting overhead movements of your shoulder after injuring it 6 months ago due to fear avoidance, incorrect beliefs (e.g. hurt equals harm), overprotective muscle guarding etc. is unhelpful.

Impaired pain response

Observable behaviours related to pain or the expectation of pain (e.g., grimacing, breath holding, groaning, demonstrative displays of pain, use of other areas of the body to support painful area [e.g., using the arms to help sit down] etc.). Consider these examples: 

1. Avoidance behaviours with acute onset of severe low back pain where normalising the movement makes pain worse seems helpful. 
2. Breath holding, avoidance behaviours and overt displays of pain with chronic low back pain with high levels of catastrophising, hypervigilance and fear of movement seems unhelpful. 

All of human experience comes from your brain.

Reframing pain – the brain is boss

Does love come from the heart? Does lust come from our genitalia? Does anger come from the fist? Does happiness come from the smile? Does pain actually come from the back? The answer to all these questions is ‘no’. Now, I’m not a philosopher (and I’ll leave complicated ‘philosophy of mind’ to the experts like J. P. Moreland), but just as anger, lust, love and happiness are features of conscious experience, so too is pain. While some information from the back is used, it will only provide limited information regarding your pain experience. Ultimately, the brain is boss, not the back. 

Physical deconditioning 

Physical deconditioning (ie., noticeable reduction in strength, ROM, endurance, or other physical capacity) can again be helpful or unhelpful. Consider the following:

1. A complete tear of the MCL and ACL in the knee treated with a knee brace that restricts ROM. While the tissue heals, reductions in strength, ROM and muscular endurance are helpful and expected adaptations. 
2. Chronic kneecap pain with associated fear avoidance behaviours and sedentarism causing a loss of leg strength and endurance is unhelpful. 

Again, there are a lot more possible functional adaptations we can exhibit as a result of pain. If you need the help of a physio who understands these and more, please check-in!