How to Move with Chronic Pain Step 3: Visualization

Imagination, Visualization, and Pain

Sometimes just thinking about moving can worsen pain. Many of us have experienced watching someone else get hurt, and winced as if the pain were affecting us. We describe this as feeling another’s pain, yet the reason it hurts to watch is that we imagined how it would feel if it happened to us. That’s strange. We didn’t do it on purpose.

Our brains and bodies are always working to keep us safe. They work to protect us from problems inside us like disease and from potential threats around us.

One study showed that looking at pictures of disgusting skin lesions for just a few minutes increased the amount of immune system cells in the blood. It is as if the brain, without our conscious involvement, imagines what might happen to us, and then responds almost as if it were actually happening.

Imagine a lemon resting in the palm of your hand. It’s fresh so you can smell it. You can feel its weight, indicating that it is really juicy inside. It’s cold and it’s damp.

Now imagine taking the lemon up to your nose and smelling it vigorously. Inhale the aroma.

Now place the lemon on the imaginary table in front of you. Imagine holding it with one hand, while you pick up an imaginary knife with the other, and cut it in two with one quick cut. The juices spray out and the aroma becomes even stronger. Now pick up half the lemon. You can feel the juice, cold and wet running down your fingers. Lift it to your nose, and smell it again. Now open your mouth wide. Place the lemon inside, and take a bite.

If you take your time and vividly imagine, your body reacts almost as if what you are imagining is truly happening. You might even feel the sour bite and pucker your lips.

This doesn’t happen to everyone, all of the time. Things like stress and tension can interfere with really engaging with an imagined lemon!

But most relevant when it comes to the topic of pain, this ability to visualize is a skill. If you have not practiced imagery, like high level athletes do, you might need many repetitions before the image will start to make notable changes in your body and mind.

Putting Calm Breathing into Practice

Alex had made great progress, but he still couldn’t lift his bike onto his car rack without an intense increase in his neck pain. Nor could he ride on a bumpy downhill single track without feeling sharp pain between his shoulder blades after he stopped.

His PT asked him to close his eyes and visualize lifting his bike, but to imagine that it hurt less or not at all. And then to imagine that he finished a downhill ride without the sharp pains after, or with significantly less intense pain.

It didn’t work at first. So Alex’s PT asked him to start by going back to the methods of breathing and relaxation he had become comfortable with. Alex calmed his breath and calmed his mind. The PT then guided him to notice how he felt right in this moment, and to imagine that this is how he would feel after he had lifted his bike or rode downhill. Alex told him it was working. So far so good.

But it didn’t work when his PT asked him to imagine lifting his bike onto the rack. Alex had such a strong association with that activity and pain, he couldn’t help but grimace from the mere thought of it, even when he was trying to be calm.

PT: “Okay, try something different then. This time, don’t imagine the feelings in your body when lifting your bike, imagine that you are watching yourself lift the bike. See yourself lifting it up smoothly and painlessly.”

Alex: “I’ve never tried it like that before. So you want me to imagine watching myself rather than imagine what it feels like. And then what?”

PT: “It’s like what you should do when lifting a heavy weight is aggravating your body. Just imagining the feeling itself is too much to start with, so you should visualize yourself doing it with less pain at first. Start with what aggravates the pain less, then progress to imagining yourself doing it with less and less pain. So you might start off by visualizing yourself just lifting the bike off the ground, and gradually build up to actually imagining yourself placing the bike in the rack. Lastly, you add back in the physical part of the activity just like you would normally to get stronger and fitter.”

Alex: “Okay, I’m glad you said that last part. And happy we’ve talked about how to work through the pain. Otherwise this wouldn’t make sense. I still need to actually lift the bike, right? Visualizing myself lifting the bike and then imagining how it feels as I do it are steps I can take so I can be more successful with lifting my bike onto my car.”

“When I feel safe doing the visualizations and can do them with no pain or even less pain, then I can start trying to lift my bike into the rack again. If that’s uncomfortable at first, I can try doing partial lifting movements with the bike, or even practice doing the same movement with a something lighter.”

If thinking about something hurting can increase pain, it must be possible that thinking about something becoming less painful can reduce pain.

Just like becoming skilled in calming our breathing, monitoring the tension in our bodies and relaxing our minds helps to decrease pain, so can imagery. Our expectation is that each of these can provide some relief. When we add them together, we often get even better relief. Pain is complex. Often the paths we need to take to decrease pain and recover ease of movement need to respect this complexity with a multi-faceted approach.

Alex, like many others, found that some movements became easier when he asked himself if they were really dangerous, which you learned about in part 1 of this series. Other movements and activities became easier when he added the techniques of  calming his breath and body tension. For the the most painful movements, he needed to add the exercise of visualizing himself performing the action, then imagining the feeling of it hurting less before these same techniques helped him practice the activity in real life and work towards recovery.