Many pain sufferers struggle to discern between what really causes their pain and what simply triggers their underlying pain issues.
Triggers are always external forces and events, like bad sleep and awkward lifts. Whereas causes can be environmental, but are often internal challenges, like having a weak core, for example.
The true causes of pain are always a very big and important deal. Pain triggers, on the other hand, are very helpful to know but often trivial in the grand scheme.
To truly understand the difference between a trigger and a cause, it is worth looking at heart disease.
Tennis can trigger cardiac arrest, yet it most definitely isn’t the ’cause’ of cardiac arrest. The actual causes of cardiac arrest are lifestyle, stress and genetics, which leads to artery blockage. Tennis just triggers a heart attack after a long slow decline in blood flow to the heart muscle. This is why cardiologists clearly don’t lose much sleep over tennis.
The heart attack example highlights the huge distinction that can exist between triggers and true causes. Similar distinctions exist between many pain triggers and the true underlying causes of pain.
Performing an awkward lift or sleeping in a bad position can trigger pain. But triggering is not always the same as causing. The cause of the pain after an awkward lift is more probably something like a weak core or a gradual overuse mechanism.
If your office workstation causes you endless problems and needs endless fine-tuning, look around at your colleagues. If they seem more at ease with the imperfections of their workstations, it could be that your workstation is a pain trigger rather than a pain cause.
Knowing your pain triggers is a vital part of the process in gaining some momentum towards the goal of a pain-free existence. The long-term goal should be to have a body that is healthy enough to withstand simple triggers.
It is important to work at discerning between triggers and causes whilst holding the whole topic lightly. Because there are many grey areas. And in many ways, the trigger vs cause question is a complex spectrum where firm distinctions often don’t exist. And where curiosity and open-mindedness are both wise and helpful.
Differentiating pain triggers from pain causes is a vital step that potentially informs and eases the entire journey. But it isn’t easy, and there are so many pain triggers that can seem causal.
Chocolate does not ’cause’ migraine headaches. It triggers them. Migraines are caused by deeply entrenched mental, biomechanical and emotional patterns that usually stem from childhood trauma or chronic stress. Millions of people enjoy chocolate without headaches.
Bad sleep does not ’cause’ neck and shoulder pain. It aggravates the underlying mechanical issues that neck and shoulder pain sufferers are afflicted with. Hundreds of tummy sleep can eventually ’cause’ neck pain. But a single bad sleep that leads to pain is just a trigger.
Moderate dehydration does not cause tension headaches. But it does trigger headaches in headache sufferers. Only chronic headache sufferers suffer from headaches that are easily triggered by dehydration. Dehydration makes many health conditions worse.
Workouts that lead to back pain are often (but not always) perfectly good workouts. Most often, there is a significant weakness in the person’s spinal tissues. The weakness is the ’cause’ of the pain; the workout is just the pain trigger. A useful step to start teasing out your triggers from your causes is to reflect on how your pain-activating variables affect other people.
First, bear in mind the fact that healthy tissues are pretty resilient. Even in older people
If a specific activity or event brings on your pain, reflect on how the same action impacts others. If you’re sure it would have brought on pain for almost everyone, it probably caused pain. If virtually all the healthy people you know would have been unaffected by it, it may just have triggered a deeper, more complex pain issue.
Snake venom is a great example of how life’s causes work. If you give a big dose of brown snake venom to 100 people, it results in a minimum of 99 dead bodies. That’s what causation looks like.
Compare this to chocolates’ role in headaches for instance. If you give chocolate to 100 people, you may only get one migraine; you might get none. That’s what a true trigger looks like.
Admittedly there are factors that tread the line between causality and triggering. A bad deadlift can trigger episodes of back pain. But done often enough, it can ’cause’ back pain too. Stress can trigger headache episodes, but over time, it can also act as a causal factor.
The wisest way to proceed with factors that clearly lead to pain is to keep an open mind about whether they are truly causal. Many of them will be, but others will just be triggers.
Trigger avoidance is a double-edged sword. It can be beneficial for improving the quality of life while we are in an unrehabilitated state. It can also be good if our triggers are genuinely not good for us. Yet, trigger avoidance can present grave dangers in the long term, especially if our triggers are healthy life activities.
Megan was 30, and she had figured out exactly how to ‘fix’ her knee pain.
She just completely stopped running and limited her walks to no more than 40 minutes on flat terrain. It doesn’t take much imagination to foresee where this type of strategy tends to lead in the long term.
Once Megan had the scar tissue that was trapping her IT Band broken down, strengthened her gluteus medius and made some better footwear choices, she was able to resume running. Because she had worked on the causes of her pain.
Working on our pain solely at the level of triggers can be extremely treacherous. Not only does it tend to ignore deeper truths about our pain and deeper healing that the body requires; for as long as we are focused on triggers, the source of our pain is always outside of us. Which is not healthy, nor is it very often true.
Avoiding triggers is important, but it’s not a comprehensive strategy for managing chronic pain. For many, it leads to significant constriction of fitness, health, socialisation and general quality of life in the long term. The real key to opening up the reconnection and freedom of a pain-free life is in eliminating and/or healing its true causes.
Trigger avoidance is a double-edged sword. It can be beneficial for improving the quality of life while we are in an unrehabilitated state. It can also be good if our triggers are genuinely not good for us. Yet, trigger avoidance can present grave dangers in the long term, especially if our triggers are healthy life activities.
Megan was 30, and she had figured out exactly how to ‘fix’ her knee pain.
She just completely stopped running and limited her walks to no more than 40 minutes on flat terrain. It doesn’t take much imagination to foresee where this type of strategy tends to lead in the long term.
Once Megan had the scar tissue that was trapping her IT Band broken down, strengthened her gluteus medius and made some better footwear choices, she was able to resume running. Because she had worked on the causes of her pain.
Working on our pain solely at the level of triggers can be extremely treacherous. Not only does it tend to ignore deeper truths about our pain and deeper healing that the body requires; for as long as we are focused on triggers, the source of our pain is always outside of us. Which is not healthy, nor is it very often true.
Avoiding triggers is important, but it’s not a comprehensive strategy for managing chronic pain. For many, it leads to significant constriction of fitness, health, socialisation and general quality of life in the long term. The real key to opening up the reconnection and freedom of a pain-free life is in eliminating and/or healing its true causes.
There are many grey areas, but the following list is of factors that tend towards being the causes of pain. If a factor that activates your pain is either not on the list or doesn’t resemble anything on the list, it may simply be a trigger.
Scar tissue (which can be caused by both injuries & repetitive strain).
Excessively sedentary lifestyle.
Prolonged exposure to hard surfaces.
Weakened ‘frayed; tendons (tendinopathy).
Unhealed injuries ‘that never came right’
Cartilage tears/osteoarthritis.
Years of tummy sleeping.
Extreme over-training for long periods.
Extreme overthinking for long periods.
Rotator cuff muscle wasting, usually due to postural habits.
Core muscle wasting, usually caused by old injuries or bad movement habits.
Gluteal muscle wasting , usually caused by movement patterns, environment, and inactivity.
Flat feet and high arches combined with exposure to concrete and tarmac
Bad lifting technique over long time periods leading to repetitive strain.
Weak ankles (or a tendency to sprain ankles) cause instability in the lower limb.
Extremely poor general health / self-care/obesity.
Depression which leads to inactivity, poor posture and changes in the brain.
Chronic anxiety which causes excessive muscle tension and changes in the brain.
Unaddressed bereavement and grief have a powerful effect on the
PTSD which is known to predispose people to pain in a host of different ways.
Unaddressed childhood trauma acts a lot like PTSD.
Toxic relationships cause a huge amount of tension in the body and changes in the brain.
Toxic work stress/environment, which acts a lot like toxic relationships
If you avoid the awkward lift or position, all you have done is remove a trigger. But if you strengthen the spine or heal a tendon, you have addressed the underlying cause of the problem.
Countless people have found that reducing stress and strengthening their spinal muscles has led to a normal relationship with their workstations because the stress and the weakness were the causes of their pain. The workstation was just a persistent trigger.
Treatment, healing, rehabilitation, therapy and self-care are more often the real answers to chronic pain, along with the elimination of any true underlying causal factors.
With the right healing tools and rehab in place, most pain sufferers find that their superficial triggers fall away very quickly. Leaving only deeper causal factors to work on in the longer term.
Pain is a symptom. Symptoms are the feedback that the body generates when it faces problems with its delicate internal balance (homeostasis). Without symptoms like pain, thirst, nausea and fevers, it would be very difficult for us to maintain a healthy body in the same way that it would be hard to drive a car safely with no dashboard display.
John is one of those rare gentlemen who has continued to play competitive soccer well into his late 50s. He is in really good shape, which you need to be to play football at that age—good shape except for his left leg. His left leg is not in good condition at all. In fact, once you get to know his left leg a bit better, it becomes apparent that it’s miraculous that he’s able to run at all, Let alone the type of running required to play competitive soccer against younger men.
Psychosomatic Pain
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