'Pain is inevitable. Suffering is optional.'

August 28, 2012 at 12:11 AM

Playing violin causing pain is a given.

There are good pain and bad pain. Pain on the tip of my left fingers after a tough practice session, for instance, gives me some pleasure rather than making me suffer. Not because this pain is not real, but because the significance of the pain.

My right shoulder recently developed rotator cuff tendinitis. Now this pain can cause me to suffer a lot. Again, by suffering, I’m not talking about the pain itself; the pain is not so bad after all. Yet I would suffer if the pain is associated with negative emotions, such as, frustration, fear, impatience, etc. That is, if I allow myself to add or "feed" these emotions to the pain itself.

In this sense, having to suffer is a choice, and I believe it is entirely within my control to feel pain and choose not to suffer. How? Thinking alone may be insufficient. Do something and get help.

For the past two months or so and for twice a week I have been receiving the treatment called “active release". Each time I experienced the kind of pain more than I would like to take. Lately, I also tried Shock Wave Therapy on top of that. Not pleasent at all, but I didn’t suffer a bit during these treatments. The reason being I understand that this kind pain means something good is happening to me.

“Pain is inevitable. Suffering is optional.” ~ Haruki Murakami: What I Talk About When I Talk About Running

If only this principle can be more regularly applied to everything in life, but why not?

From Anne-Marie Proulx
Posted on August 28, 2012 at 2:12 PM

Hi, interesting thoughts!

I agree in a way and disagree in another...

I agree that most pain has an utility. When one has a tendonidus or so, one knows there might be a technical cause to it and usually, with ice, a break, physio cream and maybe anti-inflammatory pills, one recovers very very quickly (a few days). The finger tip pain after a hard practice session doesn't last forever either.

But for those who have some chronic nasty pain issues such as a neurological problem caused by practicing (or simply something non related to the violin such as a disease or hand injury that hinder their playing ability), that must cause much suffering (psychologically) even if they try to think "positive".

I've had many easilly curable violin pains over the years. I was convinced that with will to follow the right cure and to fix wrong habits, everything could heal...

But natural selection (if I may call it that way) put me back to my place lately hitting what I always knew would happen one day as the peices become harder and harder... my fragile pinkie! My pinkie fourtunately doesn't hurt badly but it sure tells me its limits. I feel it, I know it... after all it's my body... I was dearly hoping that it would "surrender" a little later on in the repertoire and my journey!!

I beleive pain means something. As you said, it can be something good or bad.

But when it's associate with something bad such as "I can't take this anymore", "this is my limit" or "I'm old and sore" whatever... it's heart breaking and I'm not sure if suffering is optional there for anyone who througly love their violin playing.

Of course, one can lower their standards, expectations, see the glass half full, accept their fate etc. but... seems to me that it will somehow leave a mark.

I would say, physical suffering caused by violin can be optional (up to an extent) but heart aches caused by these physical pains... a little less...

I'm not saying to pack it all and quit though! It's just my two cents about this issue :)

From Yixi Zhang
Posted on August 28, 2012 at 4:07 PM

"I can't take this anymore", "this is my limit" or "I'm old and sore"

This is exactly what Murakami called suffering, which I believe is not inevitable if I work hard on myself.

But I agree with you, Anne-Marie, thinking positively alone is insufficient and our will power has its limits. What we need is practice, not unlike practising the violin: first separate the issues, then tackle them one at a time over and over until issue is resolved and a good habit is solidified.

The first issue regarding suffering to me is to see a clear line between pain and suffering in each case, which shouldn't be that hard once we put our mind to it. Then ask myself honestly: Is this suffering really inevitable? Or is it something caused by certain habit of my mind that I should get rid of? If the latter, then the fun begins.

Granted, some sufferings, such as grieving the loss of loved ones, are inevitable. Even so, are such sufferings greatly reducible? I think only hope and practice will tell. Do you agree?

From Paul Deck
Posted on August 28, 2012 at 4:30 PM

Very interesting and thought-provoking blog. Since my thoughts were indeed provoked, might as well write some of them down. Some of them are other people's thoughts, recycled.

There are Eastern mystical and meditative traditions in which it is believed that pain only affects the outer physical part of a person, not the true "me" part. A good place to read such things is in "Autobiography of a Yogi" which is a wonderful book in many ways. There is a strong ring of truth in this.

"Why do you hit yourself on the head with a hammer?" "Because it feels so good when I stop." Source unknown (to me).

"Pain and suffering are always inevitable for a large intelligence and a deep heart." Dostoyevsky.

"No pain, no gain." Jane Fonda.

"Unearned suffering is redemptive." Martin Luther King, Jr.

"Painful pleasure turns to pleasing pain." Spenser.

What I tell my daughter is that feeling tired, weary, or mildly achy in the fingers and arms are acceptable indicators of hard work. Pain is an unacceptable signal of impending physical damage.

From homayoun nedjah
Posted on August 28, 2012 at 6:19 PM

very true.I am suffering from panic attacks and what you wrote is exactly what my doctor told me.
he said that if I want to I can control the attcaks.All I have to do is to think about the real pain.pain is only in our mind.

From Yixi Zhang
Posted on August 28, 2012 at 9:01 PM

Interesting, Homayoun. Did your doctor tell you how to think about the pain in your mind in order to stop it? Is it working? I’m most curious about any technique for stop suffering.

Paul, the yogi and meditative traditions are highly relevant to what I’m trying to articulate. Although the eastern thoughts can be lost in translation sometimes so I tend to not take the words too literally.

I think the physical pain we experience is every bit as real and true as I see my own hand when I put it in front of my eyes. Yes, physical pain is a signal of impending physical damage. But some physical damages are necessary for growth (such as strength trainings) and are therefore acceptable. Indeed, "No pain, no gain.”

Emotional pain is quite a different story. Some of which is part of our habitual way of thinking when things don’t go our way (“I can’t stand it!”, “I hate this!”, “Why me?” etc.)and I think we can practice them out of our system if we really want to. In some extreme cases, emotional pain/suffering are forced on us, such as, being abused/tortured or grief. I need to give some more thoughts on this type of suffering. Your Martin Luther King, Jr. quote ("Unearned suffering is redemptive.") probably touches on it... most intriguing. What is your take on this quote?

From marjory lange
Posted on August 29, 2012 at 1:23 AM

A wise Jungian psychologist, Helen Luke, wrote a fine article called "Suffering." Using the Latin origin of the word--which is 'to bear up under,' as opposed to depression, affliction, or grief, which are more to "bear down upon," she argued that simply enduring (or complaining about) pain is NOT properly 'suffering' because it's based on some sort of evasion. In other words, Yixi, she is taking exactly the opposite view from you & Murakami--at least as far as her language is concerned--but you all arrive at a similar point.

However, not dealing with the pain/damage inflicted by tendonitis is not smart. It's frustrating to face our human weakness, but ignoring it is not wise--nor is it suffering! it's evasion of the most dangerous sort.

Real suffering, bearing-up-under whatever the problem is, is best fueled by another (Latin!) word--passion. Passion MEANS suffering. So, clearly, Yixi, your passion is fueling your drive to face the pain of your tendonitis treatments. I wish you well!

From Paul Deck
Posted on August 29, 2012 at 3:22 AM

"Unearned suffering is redemptive." This quote is from MLK's famous speech "I have a dream." Here is the context:

"I am not unmindful that some of you have come here out of great trials and tribulations. Some of you have come fresh from narrow jail cells. Some of you have come from areas where your quest for freedom left you battered by the storms of persecution and staggered by the winds of police brutality. You have been the veterans of creative suffering. Continue to work with the faith that unearned suffering is redemptive. Go back to Mississippi, go back to Alabama, go back to South Carolina, go back to Georgia, go back to Louisiana, go back to the slums and ghettos of our northern cities, knowing that somehow this situation can and will be changed. Let us not wallow in the valley of despair."

"Unearned" in this context surely does not refer to suffering that one brings upon himself, so I would have to say that it is not quite relevant to the person who suffers because she has practiced the violin too fervently. One must remember that MLK preached squarely in the Christian tradition in which Jesus is the most important and central recipient of unearned suffering. With this background the connotations of "redemption" become fairly clear.

From Jeewon Kim
Posted on August 29, 2012 at 11:57 AM

Interesting topic and discussion. Here's a new twist: Pain is an Opinion, by Paul Ingraham.

If you don't want to read the full article, Paul links to this 5 min. video, a pretty good summary of current pain science: Understanding Pain

Another good article: 7 Things You Should Know About Pain Science

Headings from the article:
1. Pain is a Survival Mechanism whose Purpose is to Protect the Body
2. Pain is an Output of the Brain, Not an Input from the Body
3. Physical Harm Does not Equal Pain. And Vice Versa.
4. The Brain Often “Thinks” the Body is in Danger Even When It Isn’t
5. Pain Breeds Pain
6. Pain Can Be Triggered By Factors Unrelated to Physical Harm
7. The CNS Can Change its Sensitivity Level to Pain

Related articles by the same author, Feldenkrais instructor, Todd Hargrove. What's really interesting to me is that fuzzy or confused brain maps can cause pain. Could fuzzy brain maps in our technique do the same? Maps are built by movement. Movement literally builds our brain. See also: http://www.brainhighways.com/ for some entertaining and very informative videos.
~~~

Sorry to hear about your injury, Yixi. Here are some other things you might try:

Mobilize!
Rotator Cuff Mobilizations

Paul is a massage therapist and science writer in Vancouver. He specializes in trigger point therapy. Trigger points are muscle knots which may or may not hurt in and of themselves, but cause referred pain elsewhere. Here's an article about infraspinatus trigger points. The infraspinatus is a shoulder stabilizer on the shoulder blade which also assists in outward rotation of the upper arm. I think violinists probably work it overtime. You can work them out with a foam roller, by leaning on the shoulder blade while rolling, or a tennis ball to really get at them (a blue dot squash ball might be less painful.) saveyourself.ca has a lot of free articles as well as some paid ebooks on trigger point therapy. Paul's review of ART and one of massage therapy.

I've discovered recently how 'stuck' my thoracic spine had become. T-spine mobility is crucial for shoulder-blade mobility. This routine for tennis players feels great. I've finally coordinated my whole spine so that I don't get stuck in a 'good' posture. Along with T-spine mobility, this long video featuring Esther Gokhale helped with spinal coordination: as the pelvis tilts forward (anterior tilt) the lumbar spine gets pushed up and extends; the thoracic spine extends in response, or it will get stuck; the cervical spine also extends pushing up through the crown of the head (which causes the chin to tuck in response; 'head forward and up' in AT.) The reverse would cause a slouch, which turns out not to be so bad as long as you don't get stuck there. So if you start from a full slouch (i.e. with head hanging forward and down, crown pointing forward) and extend through the top of your head, as if you were going to 'head' a soccer ball, you've got yourself a pretty good mobilizer for the whole spine. Coordinate with breathing to feel a really full inspiration, breathing with the whole trunk.

Here are some more ideas about mobility. Gray Cook, author and physical therapist, has developed a whole system for screening for and treating injury (widely utilized in the athletics world, but seems to be trickling down to personal training as well.) Cook says, "mobility before stability." And the kind of mobility we lose as adults (because of too much sitting and/or too much exercise without mobility) is the same mobility we learned as babies: head lifting/turning and thoracic extension, rolling like this or this, crawling, all help prepare us for walking. These guys have an ebook which summarizes these exercises (but also other interesting info, e.g. how rolling develops/maintains our vestibular system, important for balance and core stability, as mentioned on the brainhighways site.) They say doing their simple exercises is like pressing a reset button for your body. I've been doing them for a few days now and so far so good.

Here's a video about shoulder stabilizing through unilateral motions; pivoting the torso around one shoulder engages the stabilizers for that shoulder. A lot of our stabilizers are attached to the T-spine. Bilateral exercises might make existing problems worse.

In the end you might have to address your setup to optimize for shoulder stability for a more permanent solution. Sometimes rest might be the best option. When that's not possible, the above measures might help you manage. As Todd Hargrove says it's important to address pain, take corrective action, because pain breeds pain. As for dealing with the pain of therapy, I guess we have to always weigh the benefits.

Hope you're feeling better soon,
JK

From Yixi Zhang
Posted on August 29, 2012 at 4:46 PM

Wow, Jeewon, once again, you just blew me away by your wealth of knowledge and expertise! Super cool and really helpful stuff you’ve provided here. I’ll spend some time to sift through.

Paul, thank you for the follow-up explanation!

Marjory, thank you for your beautiful thought and writing!

From Jeewon Kim
Posted on August 30, 2012 at 1:15 AM

Hope it helps, Yixi. Let us know whether anything works or not. Or whether something was more effective. I haven't had any debilitating pain, although there have been those days - too much work, stress, and not enough recovery. I had some weakness years ago, where my shoulder was sagging forward, before I changed my setup. But I've found that massage helps with that tired feeling. Also, trigger points can really pinpoint those nagging 'something wants to pop but it won't' feeling. Especially on the infraspinatus.

Here's a pretty good resource which maps out trigger points for areas of referred pain. I tried palpating all the spots for the front shoulder. Most of them were ok. Rolling all of them on the foam roller felt pretty good, even areas under the arm, but nothing rang out, until... I hit the coracobrachialis. Yowza! It was hard to find but it's a zinger for me. It's the smallest of the muscles responsible for pulling the upper arm forward (shoulder flexion, along with the pecs and the anterior deltoid/front shoulder) and inward to the ribs (shoulder adduction, along with a bunch of others); so along with the supraspinatus, which also helps out with flexion, and which helps roll the upper arm out... there are your two trouble spots that control left-upper-arm violin motions and which refer pain to the front of the shoulder. To find it palpate the inside-lower edge of your bicep near the armpit with the upper arm held forward and up slightly. Start rotating out as if you're about to hold an invisible fiddle and you'll start to feel the biceps tendon tensing. Just start poking along the tendon towards the bicep and you might be in for a shocker. Lower your arm and keep the pressure on for as long as you can take it.

Good luck!

From Yixi Zhang
Posted on August 30, 2012 at 6:32 PM

Yup! Coracobrachialis is one of the muscles my physiotherapist worked on during each session. She would lift my arm and slowly fan it out, meanwhile she was pressing the sore point under my armpit and telling me to breathe deeply to reduce the pain. After that, the shoulder and arm always felt good.

Just purchased Paul’s eBook on trigger points. I’ll go through it carefully along with other links you provided. Really good stuff and I wish I had known them sooner. Much appreciated, Jeewon!

From Raphael Klayman
Posted on August 31, 2012 at 3:25 AM

An excellent book is "Playing Less Hurt" by Janet Horvath

From Anne-Marie Proulx
Posted on August 31, 2012 at 6:02 PM

Hi,

"Granted, some sufferings, such as grieving the loss of loved ones, are inevitable. Even so, are such sufferings greatly reducible? I think only hope and practice will tell. Do you agree?"

Yes, I do agree that much sufferings are reductible! Just to be aware of physical dammage that can lie under an injury... as someone told here... In that sense, not overpush oneself when it's clearly one of these nasty pains that tells you something's wrong.

Interesting blog again :)
Anne-Marie

From Jeewon Kim
Posted on September 1, 2012 at 6:02 PM

I wish I knew about this stuff a lot sooner too! I'm gonna continue a bit on your discussion post, in case people decide not to read Paul Ingraham's great article and misinterpret the brain stuff in the old school way, i.e. 'it's all in the body,' or, 'it's all in the head.' The legacy of Descarte's mind-body dualism still haunts us today; but at the dawn of this new century we might finally see it laid to rest, with neuroplasticity breaking first ground.

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'Pain is inevitable. Suffering is optional.'

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