Updated: Oct 20, 2020
Over the summer, I suffered a fairly bad ankle sprain that knocked me out of any decent training for the best part of 6 weeks (normal for a moderate sprain). Thankfully three months on I am back into full training and even hitting some PR times, sessions are going well!
Strangely enough this is not the full story: I am still getting PAIN in the ankle that I sprained, right where the initial injury occurred. Pain is highly nuanced, it goes far beyond a simple response to direct tissue damage. The pain that I feel is focal and it comes in short, sharp, burning waves lasting a maximum of 10 seconds. It ONLY shows up in the evenings, I have absolutely no pain in everyday life or when training.
How could this be? I am totally fine when engaged and focussed but the moment I relax I receive a shocking dose of pain!? At first glance it may sound like a very strange phenomenon however looking at our hunter gatherer origins this is really not a surprise at all. The neural circuits involving pain, danger detection and then emotional response are engrained deep into our biology. These circuits are extremely hard to understand and therefore manage.
To begin piecing the puzzle it is useful to take a step back in time to some 100,000 years ago on the planes of the African savanna. Early Homo Sapiens were not particularly smart or scary, our species were extremely low on the food chain. Therefore humans learnt to avoid danger at all costs. Our neurology has thus been pieced together in a way in which it keeps us the safest. There are no exceptions to this!
Our work within the tribe was carried out in daylight hours; foraging for berries, scavenging meaty leftovers, wrestling with mates and so on. Once these very important daily tasks were taken care of the body slowly began to settle down. The neuroendocrine system and circadian rhythm dictates these chemical changes and the brain essentially shifts frequency. It is time to wind down now.
Brainstem: What can I protect on Isaac’s behalf? What can I do to help him and the organism stay safe now and into the future? *Your brain actually wants to help! I know that it doesn’t always seem this way.
During a period of rest the brains deeper, protective, subcortical regions have time to send a few messages. These messages are not always positive, remember we are in the domain of survival here!
Brainstem: Isaac please don’t be an idiot and roll over on your ankle again. The tissues really didn’t enjoy it the first time and have taken a long time to heal.
Isaac: Ok yes, whatever.
Brainstem: No seriously we mean it and we are going to prove it.
*HAVE A LOAD OF THIS SHARP PAIN. This pain signalling is purely pre-emptive it is NOT a sign of current tissue damage. The neurology is protecting the tissue that was PREVIOUSLY damaged. This is just one example of how pain often has little to no correlation to tissue damage.
The pain in this instance is simply a strong REMINDER, it is nothing else. My ankle is fine and I am in fact currently running well.
This is however, more difficult for the conscious mind (the human) to understand. The default mode network picks up on the nociceptive warning from the brainstem and oftentimes sees it as a threat. What happens next is that the thinking brain essentially goes ape s**t. Tell me if this sounds like a familiar trail of thought when relating to your own body and to your own pain:
“Is my ankle still ruined? Am I causing more damage by continuing to train? Should I rest just one more week? But I don’t want to rest, I want to train again. I have ParkRun to get to and targets to hit.." Hello stress response nice to meet you, hello increased levels of pain. Welcome to a positive feedback loop. (This is often the moment that you will present to me, in a rather panicked state of affairs).
Understanding this process, understanding that our human biology is often a mismatch of input and response enables us to relax. Through education we can better understand that some of this scary, painful stimulus is simply a warning. It is there to protect us and on occasion it is ok to just smile and wave.
For the runners out there- Why do you think Kipchoge smiles when he is struggling?
This is his meditation, this is his practise to work with the pain: pain is not his enemy. He is urging his brain to relax the muscles, accept the fatigue signalling and to reply: “just be calm, we have got this.”
Oh and I maybe get this harsh reminder once per week now, whereas it was every evening in the past. My brain is learning, slowly that I am in fact listening and staying safe. :)