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Hurt vs Harm … And Tissue Sensitivity

One of the concepts often discussed during a physiotherapy session is Hurt vs Harm.  When an injury, such as a broken bone, torn tendon or sprained ankle occurs the pain experienced indicates that some HARM or damage has happened to the body. The pain serves an important role in warning the individual that they need to seek care for the injury. Once the person has received the appropriate care depending on the injury (fracture=cast, torn tendon=surgery etc.) there should be some education on how to avoid further Harm or damage to the area. This could involve reducing weight bearing or avoiding certain activities for a short duration of time while the injury heals.  Our bodies have an amazing ability to heal , sometimes taking only a few weeks, occasionally taking a few months.  During this period of healing the person may continue to experience some pain or discomfort. This type of pain/discomfort serves to protect the tissue while it is healing. This is when the concept of HURT comes into play.  It is normal to experience some HURT/discomfort while a tissue is healing, and person can safely engage in activities that produce mild HURT/discomfort without worrying about causing more HARM/damage. This is important to understand when person is given exercises by a physiotherapist, for example: exercises to increase range of motion after coming out of cast after fracturing an ankle or strengthening a shoulder after surgery. There will be some HURT/discomfort with both these situations but if the person follows the therapist’s instructions and the pain remains mild/moderate and doesn’t last, it is safe to continue. The exercises are important to promote normal tissue healing and restoration of function and the HURT/discomfort serves as a guide not to overdue things and aggravate the tissue.  Good communication between therapist and client will promote an understanding of how much HURT/discomfort is acceptable.  As an injury heals the amount of HURT/discomfort lessens because the movement and exercise builds tissue strength and tolerance allowing the person to return to normal activity. This is the ideal pathway of healing following an injury.

                Not all of our aches and pains result from an injury that causes tissue damage.  The soft tissues of our body (muscles, tendons, ligaments) as well as other structures like nerves, cartilage and bones all have pain thresholds. If these thresholds are reached, a person will feel pain. In the absence of an injury with tissue damage, our pain threshold may be reached because of mechanical stresses on the tissue.  This can be due to decreased mobility or weakness in an area of the body or normal age related changes of tissue.  If our pain threshold is reached then our tissues will become sensitive, similar to a ‘bruise’. Tissue sensitivity is normal for a short duration and improves with treatment (modalities, massage, mobilizations) but most importantly by incrementally introducing normal stresses (sensory and mechanical) onto the tissue. The most effective way of reintroducing normal forces on the body is through movement and exercise. Once again this is where education and communication between therapist and client is important.  Appropriate exercises will be given to address the underlying issues that are leading to the tissue sensitivity. Understanding why there is tissue sensitivity can reduce the fear associated with pain that often causes a person to limit their activity which may lead to more and longer lasting tissue sensitivity and possibly chronic pain. By slowly reintroducing normal sensations and forces to these tissues they will regain their tolerance and the tissue sensitivity/pain will reduce.

                An understanding of HURT vs HARM and tissue sensitivity is an important part of understanding the human body’s response to injury and painful conditions that will greatly improve a person’s recovery and restoration of function.

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