Research Shows Our Body Image Can Influence Pain

Zachary Walston

No one is immune to body image challenges.

Despite having bodies most people would envy, even elite athletes at the collegiate and professional levels, have body image issues.

Body image — how you see yourself in the mirror or your mind — can influence your mental wellbeing and diet. A poor body image can result in disordered eating and extreme exercise habits. 

Since body image is relative, there is no ideal body. The goalposts frequently move. There is always someone stronger, thinner, or more shredded. Athletes compare themselves to fellow athletes. They may perceive their body being a limiting factor in athletic performance. They need to be 6% body fat instead of 8%. They need more muscle, despite already finding clothes shopping challenging. If they lose one more pound, they can finally break the 4-minute mile mark.

The comparison game affects everyone. 

One issue with body image not often discussed is how it can affect pain and recovery from injury.

How Body Image is Related to Low Back Pain

As a physical therapist, pain is frequently on my mind. The complexity of pain perception is fascinating and daunting. There is never a quick fix, despite what the over-the-counter pain medicine commercials wish you to believe.

When assessing the risks for low back pain and treatment approaches, biomechanical factors — such as strength and flexibility — often take center stage. Yet, the transition from acute to chronic pain is largely attributed to emotional factors, such as anxiety and fear of movement.

The Avoidance-Endurance model of pain contends we respond to pain in one of four ways initially. Our brain either responds with catastrophizing, thought suppression, focused distraction, or coping.

Catastrophizing leads to fear, anxiety, and eventual avoidance of activity causing muscles to weaken and endurance to tank. Thought suppression and focused distraction — known as eustress endurance behaviors — leads to constant activity used to either distract or defy pain. While maintaining a positive mood in the presence of pain can be useful, it can result in muscle overload. Coping, however, allows for a flexible balance of avoidance and endurance, leading to the resolution of pain.

Body image is one of the factors that may determine which path an individual takes.

There are two aspects of body image to consider: perceptual and cognitive.

Perceptual aspects of body image include misperceptions of the painful body part (e.g., “I can’t find it,” “It feels as though it has shrunk”). 

Cognitive–affective aspects of body image include negative evaluations of one’s own body with respect to self-acceptance (eg, “I have more physical deficits than others”), health (eg, “I often reach my physical limits”), and physical efficacy (eg, “I am strong”).

I have heard these statements from my patients and in my own head.

Have you ever said these things to yourself?

Comparing Athletes and Nonathletes

This study sought to compare the influence of body image on athletes and nonathletes with LBP.

To avoid confusion with the subjectivity of being an “athlete,” the researchers recruited the participants for the athlete group from German Olympic training centers. They didn’t want to leave any doubt.

The results suggest that the participants with eustress endurance response and adaptive response revealed a more positive body image compared with the participants with a fear-avoidance response and distress-endurance response. These findings were consistent for all three body image dimensions — physical efficacy, self-acceptance, and health. So, do athletes or nonathletes more often fit these categories?

In this study, athletes and nonathletes had similar frequencies. They differed in body image though. 

Athletes showed a more positive body image of physical efficacy compared with the nonathletes, however, the athletes and nonathletes did not differ in the body image of self-acceptance and the body image of health.

It gets more interesting when looking at low back pain risk factors.

Overall, athletes more often adopt a eustress endurance and adaptive response, leading to lower body image issues and a higher likelihood of sticking with activity. While activity can lead to low back pain, it is necessary to rehabilitate and recover. Athletes are more likely to complete the recovery.

This drive to be active through pain may come from several sources, including success in their sport and societal expectations. When athletes compare themselves to other athletes, body image is negative. Conversely, when they use societal body ideals, the body image is positive.

So What Does This Mean For You?

There are short-term strategies you can use to make pain less important

  1. Ignore or actively silence the body
  2. Disrespect the pain (determine it is normal and become numb to it)
  3. Keep the pain a secret out of fear of criticism
  4. Welcome pain (a sacrifice to achieve goals)

Athletes frequently use these strategies and they are detrimental in the long term. These strategies create an unhealthy relationship with pain. It welcomes the notion that pain means you are broken and inferior. This perpetuates the message you are not strong, fit, or thin enough.

This leaves me with a couple of recommendations.

First, having a better understanding of pain can separate the pain experience from body image. While some characteristics of our bodies can contribute to pain, they are only part of the equation.

Second, exercise is vital for preventing and treating pain. If you are uncomfortable with exercise or have questions, seek a trained professional. When dealing with pain, a physical therapist can be the perfect guide

Lastly, if you want to change your body image, focus on the small victories. Progress could be feeling more comfortable in certain clothes, adding a couple of reps to an exercise, or having more energy at work.

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I am a physical therapist, researcher, and educator whose mission is to challenge health misinformation. You will find articles about health, fitness, medical care, psychology, and professional development on my site. As the husband of a real estate agent, you will also find real estate and housing tips.

Atlanta, GA

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