Active X Clinics

How pain works, and what I re-learnt from falling off my bike

I was out for a gentle cycle yesterday morning with my wife.  I cycle in and out to work 4 days a week, but this was a gentler affair; enjoying a sunny morning with a complete lack of lycra.  I had just had a new rear cable fitted to the gears on my bike and the gears were jumping a bit, but this would settle down soon.  On descending a hill I did my usual – accelerated down the hill and hit the bottom of the hill flat out (so much for the gentle cycle), and as it was a sharp ascent I changed gear, but within seconds had to stand up out of the saddle to put in a bit more effort – BANG!!!  My gears jumped and chain jammed; if you don’t cycle much the effect of this is basically like slamming on the front break.

I sailed over my handlebars, landing on my right hand, left elbow and both knees before rolling to one side.  The below is an account of my “non-painful crash”.

Why landing didn’t hurt

When you hit the tarmac on your hands and knees, you’d expect it to hurt immediately wouldn’t you?  The nerves in your hands and knees would fire signals of pain to your brain, wouldn’t they?  Well, that’s not quite how it works.  There’s no such thing as “pain nerves”; there are nerves called “nociceptors”, which send messages to the spinal cord telling other nerves to tell the brain that they have experienced some “noxious input”.  Noxious input is generally high (or very low) temperature (“your hand is burning”), or chemical changes (like inflammation).  This is why some people can be shot and not know it, or have a chunk taken out of them by a big shark and all they report is that “I think something big hit me”.  There’s a sensation of impact, but no actual pain perceived.  Pain only occurs when your brain registers a threat.

So, trauma does not cause immediate pain.  Pain requires the brain to process the noxious input before reaching a decision whether to alert you or not (with pain).

Why it didn’t hurt soon after landing

The first thing to go through my mind after the landing was “Is a car coming over that hill?”.  So my adrenalin surged (the fight or flight reaction) to allow me to get out of the way of any oncoming vehicle – still no pain.  At this point if my brain had provided me with severe pain I might not have been able to move out of the way of danger.  So the main threat at this point was whether I might die from being run over, rather than any concern over the impact.  Pain at this point would have put me in more danger.

Why it still didn’t hurt 30 seconds after landing

My brain said “Have we been in this situation before and what happened?”.  The answer was “Oh yes, this has definitely happened before… check to see whether any bits of bone are sticking out.”  There weren’t.  🙂

“Oh, that’s fine then, no broken bones.  These sorts of falls are no problem.  Couple of bruises but you\’ll be fine.  No need to sound the alarm bells.”

Why it might have hurt a lot

My lovely wife cycled up, jumped off her bike and rushed to my side “Are you OK?  Did you hurt anything?”  Fortunately the “mental tape” playing in my head was strong enough to resist this level of concern;  I played a lot of contact sports as a kid and have had many falls off bikes, most of them not resulting in any lasting injury.  “I’m fine” I said.  We tend to respond to others as we think we should respond; this is why friends and family are very important in potentially pain-inducing situations.  Interestingly people who participate in contact sports as kids are far less likely to become chronic pain sufferers later in life.

“Did you actually hurt yourself?”

Arguably I did; within minutes I had small lumps on both knees and one on my left elbow.  So I had suffered actual “tissue trauma/damage”; but despite this, all I was experiencing was a stiffness in both knees.  If you had asked me to rate the sensation on a pain rating scale of 0-10, I’d have given it a “1”.  And the next day, I had no pain at all, though a few bruises which are tender if you poke them.

“So, if you hurt/damaged yourself why didn’t it cause pain afterwards?”

Within 3 minutes of hitting the ground I was back on my bike cycling.  This required my muscles to work as normal, with lots of blood going to them rather than to the injured tissues – there might have been more swelling today if I hadn’t done that, and so it might have been painful today; it isn’t.  The “normal” activity of cycling also sent reassuringly “normal” messages to my brain “ahhh, cycling action.. legs pumping, heart rate elevated but steady; he’s cycling, everything must be OK.  No need for alarm.”

As I hope you can see above, pain is not a simple process.  It’s complex; and how we respond in our brains to the messages we receive from our bodies has a huge impact on what happens next – no pain / a little pain / lots of pain.   Don’t confuse this with “It’s all in your head”; what I’m saying is that although you feel pain in your body (or head if you’ve a headache), your brain is the “Big Boss” deciding what you feel and where you feel it e.g. if you’ve heard of phantom limb pain, you’ll know that it’s possible to feel pain in a body part that isn’t even there any more.

How this knowledge can help you

The description above is based on developing research in neuroscience.  It’s also based on my own real life experiences in the field of pain / no pain from things you might expect to cause pain.  If you’d like help understanding your pain further and regaining control over it, give me a ring or drop me an email.  These are exciting times if you’re suffering from long term pain.  We can help.