Once upon a time, there was a little girl named Goldilocks and she went for a walk in the forest. This is the start of a very famous story first written by Robert Southey, published as “The Story of the Three Bears” in 1837.
The story has undergone changes over the years with Goldilocks moving from an older, dishevelled character to the young, golden haired girl recognisable today.
The original moral of the story was the importance of self-control and respecting others. More recently the goldilocks principle or “porridge that is just right” has been used to describe an ideal situation, ratio, event or load. For example exo-planets that can potentially harbour water and therefore extra-terrestrial life are described as residing in a solar systems “Goldilocks” zone.
Very interesting, but how does this relate to pain management?
Well one of our most common strategies to manage pain symptoms in clients is a concept called pacing.
Pacing is the pain management version of the goldilocks principle. It uses activity patterns to manage symptoms and allow an optimal environment for progress and reduction in peaks of pain symptoms.
Let’s use a bit of context for this. Introducing Mrs B, Miss G and Mr U. These 3 people are suffering with ongoing pain and have been trying to use walking as exercise to help improve their fitness and activity levels.
Mrs B has always been a real go getter. She is of the opinion that no pain is no gain and so she takes a solid 30 minute walk. Walking for 15 minutes before getting quite sore, taking a minute break and then pushing herself to get back home in the same 15 minute timeframe. This leads to a significant increase in her pain levels. These last through the next day and into the following and so she doesn’t feel up to walking again until 2 days later. Mrs. B just does too much.
Mr U. Is very cautious he isn’t confident in his management of pain and gets quite distressed when his pain levels increase. He exits his house and walks for a few minutes before his pain levels reach a level he is unsure about. He turns back saying he will try again tomorrow and when he gets home takes a short rest so his pain levels settle back to his normal baseline. He was able to walk again the next day.
Miss. G understands the pacing and goldilocks principle and she is confident in applying it to her walking. She decides to walk for 10 minutes. She gets a bit sore but after a short 5 minute break. It settles a bit and she continues to walk back home taking a further 10 minutes. She arrives home slightly more sore than when she left, which she expected. This lasts the rest of the day but is settled back to baseline the next morning and she feels comfortable to walk again.
So which person applied the goldilocks principle?
Mrs B falls into an activity pattern that we call “Boom and Bust”. Mrs B pushes herself through her pain symptoms, which, in of itself is not necessarily a problem. However, she only utilises a short rest and then convinces her-self to push more to make it back in the same time frame. The total cost for her being 2 days with increased symptoms and feeling unable to do her walk again until it settles.
Mr. U falls into an “undershoot” activity pattern. He found his pain as too distressing to continue and turned back with his pain settling again after a short rest. He did not reattempt his walk but decided it would be better to wait for the next day as it might be better then.
Miss G. however pushed a little, rested a while and finished up without trying to do too much nor too little. The Goldilocks approach. The cost for Miss G. was a slight increase in symptoms for the day but a return to baseline the next day.
It is important to recognise that every individual responds differently however the goldilocks principle is a key part of pacing your activity and achieving incremental gains in function.
In the long term Miss G. was able to walk every day and with applying the “just right” stimulus her pain system was able to adapt and tolerate adding a minute on to her walking duration every few days. Over the course of 1-2 months Miss G was able to double her walking tolerance.
Mrs. B was unable to consistently walk due to her escalation in symptoms and so was unable to give her pain system the consistent “just right” stimulus it needs to adapt positively. Mr U. tried again the next day but with a similar outcome leading to him to frustratingly apply Mrs. B’s principle which as we now know was not helpful in the long term.
In summary; try and aim for the goldilocks principle in any activity or pursuit that you find you are struggling with due to pain. Walking is just one example and it can be easily applied to showering, playing with the children or your return to work and sport.
It can be frustrating at first but it is the best way to gradually improve your tolerance to your specific goal without the big ups and downs that are hallmarks of “boom bust” and “undershooting” activity patterns. The frustration initially is worth it in the long run.
Dan Sainsbury
Physiotherapist – Pain Management