Video and Transcript - Why Do I Feel Weak with Persistent Pain

Hi, everyone! Dr. Orit Hickman here from Pain Science Physical Therapy. 

I wanted to address a really quick question that patients will ask me all the time. When I-we have patients who have persistent pain. One of the things they’ll say to me is, “Why am I feeling so weak, and why have other clinicians [and] other providers told me my muscles are weak?” They might say things like they notice that their muscles or their joints are uncoordinated. When they’re walking up the stairs, they might find that they trip. They might find that they drop things occasionally. They might find that their balance is not so great. 

We have a really simple answer for this, and that is that when you’ve had pain for a period of time, your sensory system and your motor system are not communicating well together. So, what does this mean? Your sensory system is your ability to feel where your body is in space. Touch, vibration, sharp versus dull, hot versus cold sensations, these are all sensory pieces of information. And, they’re pretty important to my ability to know where I am in space. When I lift my arm up overhead, there’s a certain amount of stretching that I feel in my arm. There’s a certain amount of pressure that I feel in the joints. Again, this is perfectly-this is really important information from a sensory standpoint. When you’ve experienced pain for a period of time in a body part or in multiple body parts, your sensory system is no longer communicating well with your motor system. 

And, if any of you have ever had Novocaine when you’ve been to the dentist, you know what this feels like. So, if you go to the dentist, and you get numbed up because they are doing dental work in your mouth, they’ve given you some Novocaine. And, you try to go-after you’ve left the dentist, [you] try to go drink some water. You try to go eat some food. You even try to talk. And, what you find is that you have a lot of difficulty with that activity-those activities. And, the reason for that is that your sensory system is not communicating information properly anymore, so your motor system doesn’t know what the heck to do with that. So-and, you dribble water all over the place. Maybe you accidentally bite your tongue. You sound really funny when you talk. Ok? Your motor system and your sensory system are super-duper interconnected, and you need both of those systems working properly for you to be able to move through space or to do something like drink water. The next time you go have Novocaine, by the way, I want you to try and visualize what your mouth has to do to drink water. Because, even though you can’t feel the cup, you could actually drink the water. I know because I’ve tried this. It’s harder-right-because you don’t have that same sensory information that you’re so used to having, but you can do it. 

So, this is an incredibly important concept. When you’ve had pain for a period of time, your sensory system is not behaving properly, so your motor system doesn’t behave properly. Now, when you go see a clinician who doesn’t understand this concept, what they’re going to say is, “Your muscles are weak. Your muscles are weak. We need to strengthen your muscles.” And, maybe you do a lot of core strengthening exercises if you have low back pain, or you do a lot of glute exercises if you have lower SI joint pain or hip pain. Maybe you’re doing a lot of chin tucks or a lot of deep neck flexion exercises if you have headaches and neck pain. And, the problem is is that if the issue is your sensory system, your sensory system is not working properly, and all anybody is doing is training your motor system, your pain is not going to get better because that’s not the root cause of the problem. If your brain can’t feel your body parts properly, it’s going to have a hard time controlling those body parts. Ok? 

This concept, which is known as cortical smudging, is one that is all over the literature when we talk about persistent pain. So, as soon as you have pain, even for a short period of time, your body parts, which you have pictures of your body parts on your brain, those body parts become smudged, or you lose focus with those body parts. And, if the body part is smudged, if the brain can’t really see the body part well, it can’t control it well. 

Again, this is really, really common if you have pain for a short period of time. It’s also something that we experience for long periods of time if you’ve had pain for-you know-persistent periods of time, so months, years. 

So, a body part being smudged, which means that your brain doesn’t see that body part clearly, is a sensory problem. But, if the sensory system is not functioning properly, your motor system is going to have problems, which means you’re going to have a hard time controlling your muscles and making movement occur.

So, I know the next question is going to be, “Well, how the heck do I fix that?” And, that’s a little bit more complicated. It’s not something that we can address in just one video, so I’ll try to address it in other videos as we go along. 

But, this is a really important concept. You want to try and remember that just because you feel weak, just because somebody has said to you, “Your muscles are not functioning properly and you appear to be weak,” it doesn’t mean that that’s the root cause [and] that your muscles are actually weak. It can be happening because your sensory system isn’t functioning properly. And, you want to find a physical therapist who is familiar with pain science who can address this.

Let me know if you have any questions. I’m sure that this is going to bring up a smattering of them. Definitely write those below. And, if you thought this video was helpful at all, give me a thumbs-up, and please subscribe. It would be great to have you come along with the-for the ride and hear more videos and learn more stuff when it comes to persistent pain. Have a great day!