Fear & Pain: Is There a Difference?

What’s the difference between fear and pain?

Well, not as much as you might think.

Denis enjoyed running but his first love was crossfit. He would go to his local crossfit box 3 or 4 times a week. They call it a “box” rather than a gym because it’s usually just a big empty warehouse with a bunch of squat racks and barbells. 

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I don’t know if you know any crossfitters but they are famously zealous in their love of the sport. It’s not uncommon to hear jokes about how crossfit is a cult. It might be a joke, but a lot of truth is said in jest. 

I think it’s awesome. The members often become very close friends and most crossfit boxes are like a little tribe. It keeps people coming back and that keeps them healthy. Which is fine by me. We see this a bit with running clubs, but crossfit takes it to another level.

That’s how Denis saw his crossfit buddies. His little tribe. The problem was that he’d been struggling with low back and hip pain for about a year. He’d had to cut his crossfit way back and he wasn’t running much at all.

Denis had been working with a local Sports Doc and Physio. He’d seen some early success with injections and dry needling as they really helped reduce the pain. However, he found that he still had to take it easy. If he pushed himself with deadlifts or ran too far, the pain would flare up.

Again, if you know any crossfitters, you know that “taking it easy” is not a big part of their culture. So Denis found that he couldn’t go to the workouts as much as he wanted to and when he did go, he couldn’t enjoy them because he was worried about his back.

This sucked. Denis was working out less and running less. He was seeing his friends less. Understandably, this was making him feel really crap.

Beginning the Journey

When Denis and I connected for his free call he walked me through all of this. We talked about what he was able to do and where he felt limited.

When Denis chose to work with us I told him that he’d have to cut crossfit out entirely for a month. I have nothing against crossfit, I think it’s fantastic, but one of the key ingredients in crossfit is variety. They do a different workout every time. That makes it really hard to quantify the mechanical stress and determine exactly what Denis’ back could handle and what it couldn’t.

Denis wasn’t keen on this idea but he understood the logic. He was so frustrated with the pain he was ready to try anything.

At this point you may be wondering “what the hell does any of this have to do with fear and pain?”

Well, I’m getting to that.

Physiological Pain and & Psychological Fear

Denis really had two problems that were feeding into each other. The first was the pain in his back. When we feel pain in an area of our body, it’s like a little “danger” alarm. We feel the pain to alert us to the danger. We take action to avoid the pain and we survive. The system works!

When we feel fear, it’s not all that different. We look at our situation and determine that we’re in danger. Fear is a danger alarm. Just like pain.

Said another way, pain in the body is a physiological danger alarm. Fear in our mind is a psychological danger alarm. Both systems are designed to detect danger and motivate us to take action to keep us safe.

The dry needling, injections and other therapies that Denis had tried helped with the physiological pain in his back, but he still had fear in his mind. 

The problem is that fear and pain are two sides of the same coin. We have one body and one nervous system. We like to divide things up into brain-stuff and body-stuff but they’re all part of one thing, you. 

The Body-Brain Connection

When Denis feared that the pain he felt in his back meant that he was damaging his back, his nervous system made the pain worse. After all, he was in danger.

This is not some fringe thing that only happens sometimes in special cases. Every time you feel any pain whatsoever, your nervous system will analyze it physiologically and psychologically. It asks the question “how much danger am I in?”. If it decides you’re in lots of danger, you get to feel lots of pain.

Many people chalk this up as a “placebo effect” or say that “it’s all in their head”. But that’s a bit like saying University is a place you go to “learn stuff”. It’s kind of true but oversimplified to the point of just being wrong.

We needed to address both problems for Denis. The physiological pain in his back, and the psychological fear in his mind. Let’s start with the easy one, the pain in his back.

We got Denis lifting weights and running regularly. We figured out how much he could handle, and then just added a little bit each week. The idea was that we’d gradually add more and more mechanical stress to his back. The tissues in that area would adapt to the stress as long as it wasn’t too much, or too little.

Simple, not easy.

Facing the Fear

We also had to tackle the fear problem. When I say fear in this case, I don’t mean that Denis was scared. I mean that he was subconsciously worried about what the pain really meant. 

Did it mean that he was damaging himself? Did it mean that he was doing something wrong? Did it mean the injections didn’t work? Did it mean that he would have to quit running? Did it mean that he would have to quit crossfit? Did it mean that he was going to lose all his crossfit friends? Would it get worse? If it did, would he be able to work?

You see what happens here? This is a worry-spiral that I’m sure we’re all familiar with. It usually happens on a subconscious level, but we’ve all experienced something like this. I know I have.

When we experience pain we are fearful of what the pain means. 

If the pain is pretty mild and hasn’t been there too long, there is only a tiny amount of fear. If the pain is really bad and has been going on for ages, lots of fear. If the pain has a massive negative impact on our life – such as being unable to run, workout, work – more fear.

More fear = More pain

Remember, they are two sides of the same coin.

Understanding the Pain

So how do we fix this problem? How do we reduce Denis’ fear? How do we get his subconscious brain to stop running the worry-spiral?

Have you ever heard the saying “We fear what we don’t understand”?

I think it’s true.

You know when you go camping in the woods and have to get up in the middle of the night to pee? You step out of the tent into the endless darkness. Your flashlight illuminates a few trees up close but beyond that, nothing. It’s terrifying!

But that same spot in the middle of the day, not so scary.

When we can see where we are, we understand where we are, we feel safe.

So this was my plan with Denis. Help him understand what the pain means.

This comes down to support. When we work with injured runners, they can message us anytime, as much as they like. We always reply. 

The reason I’m so convinced that fear was a big part of Denis’ trouble is that he had lots of questions. He would message me most days explaining what he was feeling and wondering what it meant and what he should do. He also seemed to have a really good grasp on the anatomy and pathology he was dealing with. He clearly wanted to better understand what was going on.

Conquering the Fear

After a couple of months in the program I noticed Denis wasn’t messaging so much. And when he did, he didn’t seem so worried, he was more just checking in. I took this as a really good sign. I knew if he was less worried, it meant his subconscious mind was less fearful. 

Less Fear = Less Pain

Denis understood what his pain meant and what it didn’t. He understood that he had control of it and he wasn’t damaging himself. He understood that it would get better and he wouldn’t have to quit running or crossfit. It wouldn’t get worse and he wouldn’t lose his job or his crossfit tribe.

If we fear what we don’t understand, the opposite must also be true.

We don’t fear what we understand.

After three months Denis was back to going hard at Crossfit. He was running half marathons and feeling great. When I asked him how his back was doing he said 

“Fine I guess, to be honest, I don’t think about it that much anymore”

Job Done.

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