September 10, 2020

“Pain is, hence, the entirety of your environmental setting (i.e., a calm or stressed environment; a battleground, hospital, home), the degree of danger signal (nociception), your beliefs, your expectations, and your past experiences, as well as many other factors.” Lars Avemarie

The interview was conducted with Lars Avemarie: physiotherapist, writer, internationally acclaimed lecturer, teacher, and personal trainer.

Jamie Hale: What are some key takeaways from an article you wrote titled “Why Most People Are Wrong About Injuries and Pain”?

So in my article, I tried to break down a lot of the new cutting edge research and summarize a lot of what we have learned from research the last 2-3 decades. My key takeaways are outlined below.

– Many people believe that pain means something is wrong in their body, in the location where they have the pain. It is intimately linked to what we learn during childhood; mainly, that pain always has an exact cause. We bump our toe, and the effect is a painful toe.

– Pain is a natural response, and it’s a good thing, too, because it makes us guard the damaged region and avoid hurting it more. It causes us to act, and it favors healing through rest. However, this leads people to assume that, if they have pain, it is because they have tissue damage in their muscles, tendons, or joints. Sadly, this judgment is sometimes incorrect; even some health professionals think the judgment is right.

– Pain is not merely a response caused by an injury, inflammation in the body, or tissue pathology. Pain is a multifaceted experience that is produced by multiple influences and factors. Injuries do, however, often hurt because they stimulate distinct receptors in the body called nociceptors. Nociceptors are specialized neurons that alert us to potentially damaging stimuli; they detect extremes in temperature, pressure, and compounds produced by an injury. A non-technical name for them is danger receptors.

– Pain is, hence, the entirety of your environmental setting (i.e., a calm or stressed environment; a battleground, hospital, home), the degree of danger signal (nociception), your beliefs, your expectations, and your past experiences, as well as many other factors. You will experience pain when your body senses a large-enough threat.

I would recommend anyone who wants the full picture to read the full article, to get all the details. I genuinely feel that it is essential reading for every health professional.

JH: What does modern pain research say about pain, and what can we learn from the last 30 years of research on the experience of pain?

A remark made by world-leading pain researcher, Professor Lorimer Moseley, can serve as a gateway to this innovative pain research. Professor Moseley is a professor of Clinical Neurosciences and Chair in Physiotherapy at the University of South Australia, and he is at the lead of this new research field.

His numerous scientific investigations have greatly enhanced our knowledge of what pain is, and it is not. A particular statement he has made can serve as a summary of the last 30 years of pain research: “Pain is an unpleasant conscious experience that emerges from the brain when the sum of all the available information suggests that you need to protect a particular part of your body.”

JH: Why is modern pain research findings an important topic for fitness enthusiasts and athletes?

Most people and fitness enthusiasts and athletes will sometimes have pain, and that it’s a good thing. Pain is a natural protective response. Pain motivates us to protect the injured area and avoid hurting it more, and it also promoting healing through rest.

Being pain-free is not a good solution. We want to feel pain, for instance, if you touch a hot stove. Because pain makes us act and motivates us to pull our hand away. In layman’s terms, we could reconceptualize pain as the body’s alarm system, which reacts to threat, danger, and injury.

The pain-alarm is often activated when we get an injury, but the alarm system is highly intelligent and has the ability to warn us before we get an injury, thereby increasing the probability that we avoid the injury. It can even help reduce the amount and degree of injury that we get, as with the hot stove. The faster we pull our hand away from the hot stove the less tissue damage will we endure.

JH: What does the research indicate regarding people’s capability of changing their pain experience?

Since pain is modulated (influenced) by multiple factors and is context-specific, it is possible to change our pain experience. Even the specific meaning of pain is a very potent modulator of pain. There are numerous examples of this in the research.

Pain is impacted by our degree of anxiety, stress, our feeling of safety, insufficient sleep (sleep deprivation), pain-related fear, fear of movement (kinesiophobia), expectations, beliefs (like the meaning of pain), and much more. Many of these factors are modifiable by ourselves.

JH: What are some of your favorite sources for exercise and pain research information?

So due to the nature of my work and the research-based course I teach on modern pain rehabilitation, most of my reading is from academic journals. But before I got my bachelor’s degree in Physiotherapy and worked full-time in the fitness industry, I was an avid reader of The Alan Aragon’s Research Review (AARR), Chris Beardsley’s Strength & Conditioning Research, and the Examine website.

I still do follow a lot of evidence-based health professionals like Alan Aragon, Dr. Brad Schoenfeld, James Krieger, Dr. Jason Silvernail, Nick Tumminello, Dr. Spencer Nadolsky, Dr. Austin Baraki, Alex Leaf, Dr. Anoop T. Balachandran, Greg Nuckols, Dr. Brad Dieter, Georgie Fear, Mike Howard, Armi Legge, Eric Helms and of course yourself.  I would highly recommend to read their content, to get reliable, high-quality information

I remember reading, “Should I Eat the Yolk?” Many years ago, I have re-read it more than once since. Also, your latest book “In Evidence We Trust” has my highest recommendation.

JH: What is a typical day in your life- from the time you get up in the morning until bedtime?

I usually get up around 0600 hours, have a coffee, and read my e-mails. Then I take a quick shower and drink a protein smoothie. Then it’s off to work; currently, I work full time in sub-regional rehabilitation (in Sweden) as a physiotherapist.

In my work as a physiotherapist, I see a wide range of people with mostly chronic diseases. But also people with hip fractures, foot fractures, pelvic fractures, proximal humerus fractures, or chronic pain. Most of my patients are in the second half of their life and typically have several functional or physical disabilities. Typically I see between 5-6 patients in a day.

I usually get off work around 1600 hours, get home, read some research papers, work on updating my course, or work on a continuing education program I’m doing.

On the weekend, I typically play a tennis game or go on a hike in the Swedish countryside. 10-12 weekends a year, I’m teaching my course mostly somewhere in Europe, like Italy, France, Sweden, Switzerland, Nederland, United Kingdom, or in Malta. My course aims to reimagine and to reconceptualize pain rehabilitation, according to current pain research. My goal is to help clinicians bridge the gap between research and people’s pragmatic treatment with pain.

If I’m not working, I typically eat a burger with some friends, or grab a beer at a local bar, or visit friends in Denmark.

To learn more about Lars  visit his site