Understanding Pain for Athletes and Movers with Arthur Woznowski-Vu

Understanding Pain for Athletes and Movers with Arthur Woznowski-Vu Total Performance with Siobhan Milner

What is pain? Does pain always equate to tissue damage? And does pain always mean I need to stop training?

In today’s episode, I have the honor of speaking with my friend, Arthur Woznowski-Vu, who has a master’s degree in physiotherapy and is currently working on the last year of his Ph.D. in Rehabilitation Science with a focus on pain management. So to say he knows what he is talking about is an understatement. We are getting into understanding what pain is and how it works, how the mind, brain, and body are truly inseparable, and how much our thoughts do indeed matter. Plus, we discuss how systems are very important- but only if they are set up with you in mind. 

This is a very important conversation because all of us experience pain at some point in our lives, and research has shown that an understanding of the science of pain can help reduce pain- so this podcast is a great place to start! 

Did you learn something new about pain in this podcast? Does anything you’ve experienced in your training or injury history make a little more sense now? Let me know over on IG!

Learn more about Arthur Woznowski-Vu:

Arthur Woznowski-Vu is a proud dad, husband, and lifelong martial artist from Montreal, Quebec, Canada. He has competed regionally and nationally in Karate, and when 18 suffered a knee injury resulting in surgery and a lengthy rehab process. He got back to competing afterward, but only for a short while until he got busy with pursuing his university bachelor’s and professional master’s degrees in physiotherapy at McGill University.

After a few years of clinical practice and several continuing professional development courses, Arthur became very interested in understanding pain according to the latest science, and how best to manage it and provide rehabilitation. This led him to reduce his clinical hours and go back to McGill University. He is now in the final year of his Ph.D. in Rehabilitation Science, which focuses on chronic pain and sensitivity to physical activity.

Arthur currently also does some teaching at the university level and he volunteers at the Canadian Physiotherapy Association, as Chair of the Pain Science Division since the Summer of 2021. As for his plans after his Ph.D., Arthur is currently working on opening his own clinic, “The Chronic Pain Rehab Clinic”. 

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Transcript for Understanding Pain for Athletes and Movers with Arthur Woznowski-Vu

Siobhan Milner:

Hi everyone. I’m Siobhan Milner, and this is Total Performance, a podcast dedicated to all things athletic performance and injury prevention. Join me in my guess as we explore the many aspects that come together to build our total performance picture. Let’s get into it. So I’m super excited to welcome Arthur to the podcast.

Arthur Woznowski-Vu is a proud dad, husband, and lifelong martial artist from Montreal, Quebec, Canada. He has competed regionally and nationally in karate and when 18 suffered a knee injury resulting in surgery and a lengthy rehab process. He got back to competing afterward, but only for a short while until he got busy with pursuing his university bachelor’s and professional master’s degrees in physiotherapy at McGill University.

After a few years of clinical practice and several continuing professional development courses, Arthur became very interested in understanding pain according to the latest science and how best to manage it and provide rehabilitation. This led him to reduce his clinical hours and go back to McGill University.

He is now in the final year of his Ph.D. in rehabilitation science, which focuses on chronic pain and sensitivity to physical activity. Arthur currently also does some teaching at the university level, and he volunteers at the Canadian Physiotherapy Association recently having started a new role as chair of the Pain science division.

Welcome, Arthur. 

Arthur Woznowski-Vu:

Thanks, Siobhan. Thanks for this wonderful intro. 

 Siobhan Milner:

 I think we often think of pain as being inextricably linked to the injury. So what is pain? How would we define pain? 

Arthur Woznowski-Vu:

That’s a  big question to answer. You know, I could go with a dry definition such as from the International Association for the Study of Pain, but then there’s also another one that really resonates with me.

So I’ll share both with you. And we’ll go from there. So in 1968, McCaffrey said that pain is what the person says it is and exists whenever he or she says it does. And I think that’s kind of the definition that resonates with me the most. But just to kind of paint a full picture, I’ll share the official definition from the International Association for the Study of Pain or, or the ISD, which has recently revised its definition in 2020 to being, ‘pain is an unpleasant sensory and emotional experience associated with or resembling that associated with actual or’.

Tissue that, so let’s, let’s unpack that a little bit. When Taking these definitions under the magnifying glass, we realize that it’s, it’s not about it being strictly associated with tissue damage. There’s often this misconception that pain is this. Perfect thermometer or this perfect measure of how much tissue damage there is.

And, and you know, sure enough, in many cases, and for many people, pain is a reliable indication that there might be tissue damage, but not necessarily. And so it, it’s, it’s really important in my view to, to really kind of separate the two because sometimes we can have. Without tissue damage, which is often the case in cases of chronic pain where although there may have been tissue damage at the start that has long since healed, yet the pain persists.

One of the things that I’m curious about, In the athletic example, often this happens that after an injury, there’s kind of this initial healing process, and then it gets to the point where it feels better, but sometimes there’s just a feeling like there’s some discomfort or, or you just know something’s different.

What kind of indicators Might we feel in our body or, or maybe even, what questions should we be asking our physiotherapists and things like this, but how, how can we know if we’re experiencing either signals of its chronic pain, it’s pain that’s been learned by our system, or it’s actually something that we need to be aware of and stop the activity.

Yeah. So what I’m gonna do is I’m gonna backtrack a little bit and, and talk a little bit more about what, what pain is. So from an evolutionary standpoint, scientists are starting to think more and more of pain as being more so a way that we detect threat rather than detect damage. So it’s about perceived levels of threat.

Of damage rather than being a measure of damage. Now, what does that mean from an evolutionary standpoint and, and survival? Is that, you know, throughout our life experiences, we learn what can be potentially dangerous for us, you know, we fall, we scrape our knees, maybe we sprain our ankle.

 We can have a number of experiences through our life and the people that we Grow up with, really kind of influence what we learn pain to be. But ultimately it’s for the body to protect itself from a survival standpoint by recognizing what’s threatening to the body and what could be a sign of damage.

However, that. Process, where you know, the body learns, when to, produce pain and when not to, is not necessarily a perfect one. And you can have this kind of alarm system come out in situations where it’s more of a warning that they’re, that you are about to enter into a threatening situation or that you’re kind of pushing the limits and that should you go any further.

Then the threat value increases because now you might actually be going into a risk of tissue damage. So let’s, let’s kind of connect that back to what you asked as a question. So let’s say someone is training and they’ve got this nagging pain that keeps kind of coming back and there’s two, two, you know, scenarios here.

Either there really is an injury that’s not healed and, and that seems to be aggravated with too much training. Or it could be that maybe you’ve previously had an injury that’s recently healed and, and so the body is still kind of, has a memory of that and still a bit threatened by that experience that it might recur.

And hey, be careful. Don’t kind of push it cuz you keep doing you might get yourself in danger. What’s really helpful I. Is to kind of take this whole explanation that I took and translate it into maybe a metaphor and, a really common metaphor that’s used in, in the community of, , people who, who work in pain is the metaphor of an alarm system.

So say you have a fire alarm at home that, well, it’s supposed to detect, you know, like a smoke detector, let you know there might be a fire. Well, sometimes there is an actual fire that triggers the alarm and then you know that, hey, you gotta get out of the house, look out for your safety. So in this metaphor, the alarm system is pain, the fire is actual tissue damage, but sometimes you just burn a toast and, there’s no fire.

There’s a little bit of smoke that’s just kind of creeping up and triggers the alarm. The burnt toast is, is not actually a full-on fire in your household, but just the burnt toast and, and nothing more yet it was enough to trigger your. And you, and, and so you can have kind of this alarm blaring yet, , there not being any actual damage or fire occurring.

It can also be seen as like a car alarm, and when a past experience makes you more worried, the car alarm metaphor works real well. So say you, you just moved to a new neighborhood and your car has a car alarm, but , turns out it’s a bad neighborhood and someone stole your and your car alarm didn’t go off.

So that’s a situation where maybe you got tissue damage, right? That’s the theft, but your pain didn’t go off. So sometimes we get, we get injuries and, and we didn’t really have pain until much later we realized that something happened. But then with that experience, the body learns from it. And, and in this metaphor, well the next car you get, you get a better car alarm.

But you cranked that sensitivity right up. But you, but you, you might have been  a little bit too worried, and so you may have cranked it too high. You know, there might have been just some kids playing in the neighborhood and their basketball, just kind of bumped the car lightly and the alarm goes crazy.

But that’s just because you have kind of cranked that sensitivity up. 

 Siobhan Milner:

The latter example, reminds me a lot of, particularly what I see in athletes, Usually, younger athletes who end up with shin splints, or medial tibial stress syndrome, and they just get that pain along that inside of the shin that the second they start doing something, and even if it’s a really low amount of load, and even if they’ve been doing all their strength and everything, and is?…  obviously we can’t say “yes. This exact example is that,” but, how do you identify if you’re in the latter group and it’s that sensitivity. And how do you, can you desensitize? 

Arthur Woznowski-Vu:

Yeah, so I, I think what I was trying to say so far, kind of the picture that I was trying to paint is that it’s not so black and white to say that I got pain, I got damaged, or that when I have damage I must have pain or, or.

Or whichever way you, you phrase it. And so it takes a little bit of detective work, essentially, uh, where, where you have to kind of consider, uh, you know, what’s at play in the situation and, and what, what is the most likely explanation for it. And not just taking pain as the only source of, uh, information for, for kind of coming to your conclusions.

So if you’re taking the Shin splint example, You know, and, and you consider someone that’s maybe doing track, but, uh, they’ve kind of increased their training loads way, way, way too fast. They’re maybe not sleeping enough, they’re not maybe progressing, uh, in a way that is controlled enough and, and balanced with enough rest.

And, then you kinda look at the intensity of the pain and how persistent it is. And you gotta ask yourself, you know, is it a shin splint or is this a stress fracture? Or, you can have another example, right, where there has been no change in, uh, training load. You are getting sufficient rest. You haven’t done any, uh, particularly hard training.

You haven’t had any falls or accidents or impact, and you know, and you’ve. You’ve organized your overall training program in a way where you cycle through periods of rest and all that, and so it becomes less and less likely that you’ve kind of caused some, some real, worrisome damage.

So where’s that pain coming from? And so maybe here’s a situation where it’s just getting sensitized for other reasons. Maybe it’s just at the level of inflammation. And of course if, if something is really kind of in that gray zone, you can consult a medical professional. Maybe you wanna do some tests, maybe some extras, maybe some bone densometries to really be sure whether there’s a stress fracture or not.

And, then you, you could get some clarity on that. But it is essentially a bit of detective work. And, and, and at the end of this you might realize that hey, all. Test results came out normal and yet the pain is still there. And where you, where you don’t wanna be is, is stuck in this thinking of like, ODI must have missed something because it could just be that that area got sensitized and, and, and you’re just kind of having these, warning signals kind of going off, just kind of like the alarm system going off with just a, a tad bit of smoke, but there’s no actual fire from there.

You can go through some strategies to desensitize. Right. So you, you, you can, you know, you wanna make sure that you consult a health professional who’s qualified, comes from a regulated profession that ensures that they’re using good up to date science to guide, you know, how they do treatments as opposed to outdated ideologies that, that may have been already, I don’t wanna say disproven, but, [been] unsupported by science.

 Most cases, a physiotherapist is a good bet. And if you have a physiotherapist who’s, you know, well trained, well informed with the pain science, and then yeah, you can have some good strategies in terms of how you modify your training and build back. Not to oversimplify things, but part of it is about kinda recognizing, you know, what’s too much, what’s too little, what’s the right amount, and just as with training, it’s about kind of building.

A consistent progression so you can kind of build yourself back up so you have a bigger threshold so you can do more before you kind of get those warning signals. So you kinda recondition your body to only trigger an alarm later on rather than too early on. 

 Siobhan Milner:

What I often see when people come to me, People, people obviously come to me later in their rehabilitative process because I’m not a physiotherapist, I’m a strength and conditioning coach and an exercise physiologist.

But I, I often see that what has happened is people have not loaded appropriately, they’ve just gone straight up rather than grading things

Arthur Woznowski-Vu:

And, and you can’t forget that, uh, you know, pain is influenced not just by how you do your training or what’s happening physically. There’s psychological factors, social factors any type of factors, that are a part of your life will influence pain experience.

There’s this, sometimes this misconception that pain is, is just this nerve signal. Coming from that body part and all your brain does is, just read that signal. But that’s not true. We’ve, we’ve got a lot of research and science kind of showing that, in fact, it’s more so that the brain kind of collects a bunch of information and one of those areas that it collects information from are the nerves that are connected to your body parts.

But it also kind of takes into context, what’s kind of going around your past experiences. It’s influenced by how your body is in general. And when you think about, you know, psychological stuff, You know, thoughts and feelings are not just something that exists in thin air. Thoughts and feelings are action potentials.

They’re nerve signals as well. They are biochemical reactions in the body. They influence your hormone levels. They influence your nerve activity, activate different parts of your brain, even influence how your immune system and your inflammatory system works.

So all that to say is that, Whole bunch of things that the brain kind of takes into account to decide whether or not you should experience pain at that very moment. Training load is of course, really important to take into consideration, you know, getting the load just right so that it’s not too much, not too little, and especially as we’re kind of doing this process of retraining, you know, a sensitized body part.

But it’s not the only thing that matters, when, when thinking about pain, the pain experience is influenced by a whole bunch of other things as well. And, and when we were talking earlier about how, you know, the body learns to detect threats with the pain system. Well, the social factors play a huge part in that where you kind of get a sense of, you know, what, what is threatening and how threatening.

Just kind of by the culture around you, the people around you, your, your teammates, your family members, and you know, and, and you might learn that, hey, you know, that pain there that you get with training, don’t worry about it. It’s not a big deal, you shouldn’t feel threatened about it. You know, just keep training.

Or you might have the other kind of thing being said where, oh, you gotta really be careful about that because if you push through it, it’s, it’s going, you know, you might as well retire your whole like sport. So social factors, psychological factors are super, super important. Someone’s pain experience, but even just kind of thinking about my, my own work in, in clinic with my patients, you know, yes, you want to kind of take into account like kind of what your thoughts are to things are stress levels, you know, how, how your peers are influencing the process, but oftentimes even just sleep and fatigue are just such a huge wall to their recovery. What I mean by that is that we can do all the right stuff in terms of the training loads. We can even come up with some strategies, to get, to keep the thinking more positive and, and more in line with what’s actually happening. So, so that, you know, you don’t think of things disproportionately.

But if you’re still getting really poor sleep, you’re not managing your fatigue level as well, then until you address that, you might not make progress.  

Siobhan Milner:

This is a really important message for a lot of athletes to hear because I think kind of what you alluded to earlier, we have this idea- when we’re talking about thoughts being, you know, in thin air – we have this idea of the mind and the body being really separate. And so I think even though a lot of athletes here, like you need to sleep well, you need strategies for managing stress, you know, you need to manage your load appropriately when there’s stressful things going on in your life outside of training, I think a lot of people don’t really believe that – they really think like, no, no, it’s just the training. Like that’s what’s happening to my body. So that’s what actually, you know, affects how my body feels. But really, yeah, we’re a full system. We’re not just the body and we’re not just the mind or the brain.

Arthur Woznowski-Vu:

Yeah, and I mean, even the example I used is just one example. It could be turned the other way around. It’s very unique to every individual. It’s very unique to each pain experience. You know, it could be that this individual is managing their sleep really well, their fatigue is managed real well, and even their training loads are, are, optimized, but then they may have, for example, a lot of fears associated with the pain. Maybe kind of fitting into that fear is stuff that, you know, they’ve heard or seen from their peers or their family.  and until that fear is addressed, they might not be able to make any real progress.

So, so different people can, can hit different kind of walls. And it’s about recognizing that you and your buddy might be having what seems to be a similar injury. Maybe you’re even experiencing at first what seems to be a similar pain experience, but it might still be very, very different. And each of you might hit a different kind of wall and might need different kind of things.

And just because one is hitting a wall that’s maybe more physical and one is hitting a wall that’s maybe more related to thoughts or. Doesn’t make one any less real or any less important. 

Siobhan Milner:

There’s kind of this sporting ethic of like no pain, no gain. But by the same token, when people come back from injury, there’s often a lot of fear to move.

Is there ever a time that athletes should quote, unquote, push through the pain, or should we always be recognizing that it’s a warning signal, even if it’s just a threat, not an injury yet and pulling back.

Arthur Woznowski-Vu:

I feel kind of, this is a thing that I’m coming back to from time to time, here is to move away from any, like black and white thinking.

To thinking more towards kind of these, more like nuanced and  messy ways of thinking about it, that, that are closer to reality and just as much as… Delineating pain versus tissue damage is a bit of a messy process. Takes a bit of detective work. Even just deciding do I train with pain or without pain, is not such a simple question.

Ultimately though, it’s okay to be training with some pain. As long as you take a step back and look at how it pans out over the days and the weeks and the months, that, it makes sense. So what I mean by that is that, say you, you’ve kind of went through this, you know, bit of a detective process and you figured out that, hey, My pain is this warning signal.

It’s this alarm that’s going off. But I think it’s kind of going off like in a way that’s, you know, too sensitive. It’s kind of coming off with, with just, smoke and there’s no real fire. And so you decide that it’s okay to, you know, with the guidance of a physical therapist, for example, you decide that it’s okay to train with some level of pain.

Then there’s a couple of scenarios that can happen from there. When you take a step back and look at the big picture, maybe you’re training with some pain, and then every other time, you know, the next day you train and the next day after that you train. There’s more, it seems like the pain comes on more easily and more strongly, and as the weeks roll by, you start to notice that it takes less and less to trigger as much pain, if not more.

And so now you’re, you’re kind of falling in this pattern where, even though you thought it’d be okay to train with a bit of pain, clearly there’s this sensitization process going on and your pain is getting worse and worse and worse. You can have another scenario where you’re training with maybe quite a bit of pain.

Maybe one of your teammates is dealing with training and accepting to do it even though there’s quite a bit of pain, but they have this. Perfect recovery between trainings and it doesn’t carry on. And every time they train, they have, you know, the same tolerance and the same threshold or maybe.

Ideally, that tolerance and threshold is even growing. And, so as their, as the days roll by, as the weeks go roll by, they can do more before the pain comes on. And when it does come on, it’s not as strong. So it’s about kind of picking up on, on the pattern, the long term. So it is in a way a kind of trial and error.

It’s about having this willingness to. Explore what, what is the amount of pain you can train with, but at the same time, making sure that every once in a while you take a step back, take a look at the big picture and see, Hey, do I seem to be on the right track? am I picking up on a good pattern here?

Am I, you know, does it seem to be getting better and better and better? Or does it seem to be getting worse and worse and worse? And of course, as anyone who trains, you also don’t wanna be stuck in the middle where it’s just the same all the time. And sometimes we just kind of get comfortable in a certain zone and, and we don’t wanna push it a little bit, especially if it comes with some pain, but sometimes that’s what you gotta do to see some improvement.

So yes, you, you can’t just say no pain, no gain, because for some people, you, you gotta work into the pain.  You  Can’t just say, you know, you can’t just put like a, like a black and white statement and assume it’s gonna be true for that person. You, you gotta experiment with it. You gotta figure out what works for you and, and ideally with, with the guidance of, you know, someone who is qualified to, Guide you in it to, help you keep an eye on things to make sure that not only is there a good pattern with your, your pain levels, but that overall there’s no clues or indications that, that maybe you are driving yourself towards risk of injury.

Siobhan Milner:

I really appreciate you saying what you say about, you know, avoiding the black or white statements. Cuz I think that’s seductive to athletes and scientists sometimes. But you’re right, real reality is messy and everyone’s different. 

Arthur Woznowski-Vu:

And, and I think what, what, what really kind of, , complicates the picture is that…there’s a lot of individual variants. So what I mean by that is that from one person to the next, there’s a bunch of factors that will influence, you know, what’s the right approach for that person. You know, we talked about psychological factors, we talked about fatigue, sleep, we talked about training load.

But of course, you know, genetically, that also is a huge part of what determines how our, how our body functions, how we function. The pain system and risk of injury. You know, I, I think we, it’s sometimes more easy to think of that in terms of training, where you think like, oh yeah, this person got some good genes.

They’re getting strong real fast, they’re really kind of built for this sport. And, , oh yeah, he’s got like, you know, really good mindset, he’s training real consistently and found what works., found the kind of training that works for him. You know, some other person will go and try to do the exact same training and they’re not gonna get the same results, or, or they’ll get injured.

Well, this same idea applies to pain as well. Different people will have different thresholds for what’s gonna, you know, trigger pain or different tolerance for how much they can do Before. There is injury and, and it’ll also be very different in terms of you have pain, but does it mean injury? Right?

For some people, it is a very precise system and for some people, It’s, it’s, you know, completely, inaccurate. And so it becomes real tricky if you start kind of talking to your teammate who maybe had a similar injury and you’re trying to kind of,, just figure out that way. Oh, well he was able to train with a bit of pain, so I’m gonna try to do that too.

But then you might have two completely different outcomes as talking about this topic of like black and. I’m going off on a tangent now, but I like tangents. So I, you know, I have a one-year-old running around the house. You know, every new parent is, at least in my perception is quite obsessed with like, milestones and, and just thinking like, oh, you know, at 12 months you should see like that, that, that your baby is, is walking.

And, and that’s just,, you know, such a misrepresentation of, of the actual research behind, like, you know, these numbers. It’s not a dry-cut specific number, maybe if you’re talking about like what’s the average age at which walking works? Sure. But it’s usually a range, right? ? Yeah. If we’re, if we were to get a little nerdy, right?

We’re thinking about,, data and data is distributed over like. Distributions. And, maybe at the peak of it, you know, you could call that in the middle, you can call that, you know, the average value of let’s say 12 months. But in fact, what’s normal as an age  for a baby to start walking is anywhere between eight and 18 months

And so this obsession with looking at, oh, your kid just turned one. Is he, she walking is just completely. Inaccurate. It’s, it’s false. it should be more like, your kid is between eight and 18 months, is he or she walking? But it just doesn’t sound as, you know, snappy and nice. 

Siobhan Milner:

I think this is the thing as well sometimes with, you know, knowledge translation, when we’re trying to take the science to the general public, sometimes things are really oversimplified and then sometimes they’re not simplified enough at all and it’s, yeah, it’s always finding that balance.

Arthur Woznowski-Vu:

So if we were to kind of. Make our way out of this tangent and back into the world of like pain and training and all that. That’s, that’s the reason why I can say that, hey, you know, if you rate your pain on scale zero to 10, where you know zero is no pain at all and 10 is the worst pain measurable, I can just say that you have to have no more than three on 10 TA and you can train without, within that.

Because that’s the same as saying that your kid has to walk at 12 months, as opposed to saying that, you know, there’s this big range that’s between eight and 18 months, and there’s a lot of individuality in terms of what’s normal for, for that individual and, and a whole bunch of factors playing into it.

Genetics, thoughts, feelings, the environment, social, but then ultimately creating what for that individual is normal, and it falls within a range. So for one person, Maybe it’s a three on 10, maybe it’s a one on 10. Maybe one person really needs to train without pain and maybe another can train with a solid eight on 10.

But it’s maybe for that person a very temporary experience. It makes things a little messy cuz you can’t just give like a, a nice number for everyone and just be like, oh yeah, that’s it. This is what you gotta do. And like, just look at that number when you train and don’t worry about anything else. No, you, you gotta take a step back.

Look at the overall pattern. How does it affect you? Yeah, maybe we need to do a bit of trial error and figure out what works for you. But hey, you think about training, you think about nutrition, you know what go, what goes on over there. , not, not too different either actually, a lot of individuality there.

You can’t just, apply the exact same formula for everybody. 

Siobhan Milner:

You know, following patterns, especially within yourself is super important because I usually find athletes at the higher level, you know, they’ve got all these systems in place where they’re tracking their wellness, they’re tracking their fatigue, they’re tracking their sleep, so they’re seeing patterns over time and usually with a coach looking at them, with them.

But often there’s a really big gap in this tracking. Even kind of just one level below. So kind of maybe the talent squads or the squads below where they’re not following their own training at all other than, yeah, I know that we train this many times a week, but they’re not actually checking in with how their body feels and also how they’re recovering and everything.

So I think it’s another vote for me for people tracking their training and also keeping notes on their training rather than just the data. Hours and, and modality and things.

Arthur Woznowski-Vu:

Also for the tracking point of things, like you gotta, even that you gotta find what works for you. Cause if you’re the type of person that you know, really hates tracking, and, and you are, are you really, really busy?

And if you’re presented with like, you’ve gotta use the sophisticated system. And it’s like an all-or-none type of thing. Guess what’s gonna happen? You know, you might do it for a while, but you’re not gonna stick with it. So, even then you gotta be like, you know what, nowadays with smartphones, all that, I, I can kind of find the app that works for me.

Maybe the level of detail that works for me. Maybe I hate apps. Maybe I just want to use my little, like notes,  and, and kind of figure out like, what can I stick to consistently? You know, I, I think ultimately there’s, there’s. A couple of key principles that really stand out to me. And one of them is, is really consistency and just as much as in training, consistency is important for tracking to work, and kind of figure out on what path you are. Are you on a path where things are getting worse and worse and worse? Or are you on a path where things get better and better, better while the tracking itself has to be done consistently? The rehab you do for any- let’s say you realize that’s, that you have this persistent pain that’s there and it’s, it’s not necessarily,, you know, you, you realize with, you know, reasonable confidence that it’s probably not related to an injury.

And so you’re going on this rehab process to desensitize a painful body part. Well, that too needs to be done very consistently. And consistently Doesn’t mean doing the exact same thing all the time, necessarily. What it, what, what you want to think about is, is kind of. Upward slope where you’re consistently doing something with the intention of progress.

So yeah, so I think it’s about having consistency, thinking about what path that puts you on. So you really wanna be intentional about making sure it’s going on a path toward it’s better and better and, and just recognizing that just as much as. How you determine your training, how you determine your nutrition plan, your pain experience, and what you do to make it better, uh, is very individual as well and influenced by a host of factors.

Siobhan Milner:

We’ve gone in a whole lot of directions, which I really like by the way. But, is there anything that you feel like you wanna drive home to people who are listening. Before we wrap up?

Arthur Woznowski-Vu:

What I’m gonna do is, circle back to an earlier point I made and it’s, it’s the fact that pain and, and tissue damage are, are two different things.

And pain is, is not just this nerve signal from your body part saying that there’s tissue damage. Rather, what it is, is that you’ve got nerves in your body that have a certain threshold for when it thinks that something is potentially dangerous or threatening. And then that’s gonna go and be one source of information that your brain considers, along with the very real, biological process of having thoughts and feelings, and really just how your, where, how your body is and mind is in general.

 I guess you could say health and wellness in general. And then together, all of that will, the brain will, will take that into account and. Pain as an output. You know, when, when we’re thinking about this is where, where you can crack a bottle of wine, but when you’re thinking about consciousness, and the human experience that exists, in our conscious mind, it’s something that according to the latest sciences, is seemingly produced more so as like something that’s an output of the brain based on all the information that, that it collects rather than it just being a representation, uh, of just like this, of what’s coming in.

Siobhan Milner:

I’m suddenly  feeling very aware of being conscious

Arthur Woznowski-Vu:

I guess where, where I’m going with this is, is that there can be a whole bunch of information that the brain takes into account to produce the output of pain, to produce the experience of pain, and yeah,  a good chunk of the time, it’s correlated to, to tissue damage, but, not necessarily.  sometimes it could be there without it. If you have pain and there’s no tissue damage, or if you have pain that is there for, you know, whatever reason, it doesn’t make the pain less real. You can’t have someone else decide for a person whether or not they’re in pain.

If a person says that they’re in pain, They’re in pain and there’s no way to disprove that. There’s no brain scan that can prove whether a person is in pain. There’s no blood test. , there’s no, you know, X-ray or MRI that can say whether or not a person is in pain. Only the person experiencing the pain can tell you that they have pain and how much of it that they have, you know, and what contributes to it.

What, underlies that pain. It’s not a question of what makes the pain more real or not, it’s just about finding the clues of how can we help you get better with that pain experience. You know, what are the walls you’re hitting? What are the big drivers of your pain experience? But we really need to kind of move away from situations where we think people are faking. There might be some stigma associated with, kind of chronic pain conditions, , or conditions where maybe psychological factors are an important contributor. Where I’m going with is, is maybe the first quote that I opened with is that pain is what a person says it is and exists whenever he or she says it.

And we need to respect that and we can never decide for another person what it is. And as we think about training, as we think about recovery, as we’ve talked about today, it’s all about the person experiencing it, and what, what seems to be relevant for them and what seems to be working for them.

And, we have to be flexible about how we think about their pain experience. We have to be flexible in how we think about them getting better. It’s not black and white.

Siobhan Milner:

thank you, Arthur. I’m really glad you came and chatted to us today. 

Arthur Woznowski-Vu:

Yeah, it was lots of fun. Thanks for having me.

Siobhan Milner:

I will also just share that, you know, , for those people listening, I’ve known Arthur for a while and I still reach out from time to time with questions about pain because I feel like Arthur is such a genius and such an awesome clinician.

So I’m, I’m really, really happy to have had you talking. Thank you so much. 

Arthur Woznowski-Vu:

Thank you, Siobhan . That’s too kind. 

Siobhan Milner:

Thanks so much for listening to today’s episode. I hope you enjoyed it. Just a reminder that you can find further podcast episodes at   https://www.siobhan-milner.com/podcast, and this is where you can also find different ways of working with me, if you head over to http://www.siobhan-milner.com. Enjoy!