Training with pain

Read time 4 min

Check out the first part of the blog here.

Two persons can train the exact same way, but only one gets injured. Sometimes it can be a matter of luck but I believe it’s worth taking a closer look. Maybe the injured person wasn’t eating or sleeping enough, or maybe they had a lot of stress going on. Could these lifestyle factors affect the person’s injury risk and pain experience?

At least a study by Mann et al suggests that collegiate football players had a higher injury risk during periods of high academic stress (1).

But right now we wanna focus on how to manage your pain if you want to keep training at the gym.

I’ll start by saying that if you have pain, it’s best to consult a healthcare professional if you’re unsure about the situation.

Can I train with pain?

Should you avoid pain when training? You can, but it doesn’t seem to be any better than training with some pain. A meta-analysis found that rehabilitation protocols using painful exercises offer a significant effect over training without pain (2). I believe enabling you to do meaningful things is more important than avoiding pain altogether.

EDIT: As a caveat, there are some conditions where training with pain is not advised. For example, stress fractures are one of these conditions.

Back pain in training

So your back hurts in deadlifts. What now?

Based on what we now know about pain, movement variability, and training, we want to find an entry point for you to start training. We want to spice things up a little. Some options could include reducing the weight on the bar, range of motion (ROM), tempo, or something else. Once we find the entry point, we’ll progress from there by planning a route to your goal.

There are many ways we can approach your problem. It’s a process and it’s going to take time. There are good days and bad days when you feel like it’s not moving forward. In those moments it’s very helpful to have a coach to help you navigate through it.

Below are some example exercises for someone with back pain in deadlifts. These are individual but I’d start with something like this:

• Monday: Single-leg deadlifts

• Wednesday: Block deadlifts (reduced ROM)

• Friday: Tempo deadlifts (slower velocity)

We will monitor your pain response daily to make sure we are not aggravating the issue more. I believe a lot of you have been in a situation where it’s hard to take a step back and not push against the pain.

Graded exposure

Graded activity is a concept used in rehabilitation. The point is to progress training regardless of pain to achieve goals and increased activity. A very close concept is called graded exposure where the person’s feared activities are confronted step by step. These approaches have been utilized in chronic low back pain. (3, 4)

Although the effects in a systematic review and another meta-analysis have been small, I value these approaches because they enable you to keep training and still make progress. (3, 4)

So how can we know how much is okay? Enter the traffic lights.

TRAFFIC LIGHT MODEL

The traffic light model is widely used for figuring out how much pain is okay (5). It’s a subjective scale with 0 being no pain and 10 being the worst pain you can imagine.

• Green light is when your pain is 0-2, you can probably push a little bit more depending on the problem you are facing.

• Yellow light around 3-6 is still okay, but you probably don’t want to keep hitting your head against the wall if the light never turns off.

• Red light is 7-10. If you find your pain hitting it, it’s best to take a step back, let things calm down, and build it back up.

I have been in a situation where I’ve tried to figure this stuff out on my own. It has led to frustration and losing interest in training. Don’t be like me and miss months or years from your hobby. Let me guide you to find confidence and fun in training.

Sign up for a free coaching consultation below.

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References

1. Mann JB, Bryant KR, Johnstone B, Ivey PA, Sayers SP. Effect of Physical and Academic Stress on Illness and Injury in Division 1 College Football Players. The Journal of Strength & Conditioning Research. 2016 Jan;30(1):20–5.

2. Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017 Dec;51(23):1679–87. 

3. Graded Activity and Graded Exposure for Persistent Nonspecific Low Back Pain: A Systematic Review | Physical Therapy | Oxford Academic [Internet]. [cited 2022 Apr 28]. Available from: https://academic.oup.com/ptj/article/90/6/860/2737764?login=false

4. López-de-Uralde-Villanueva I, Muñoz-García D, Gil-Martínez A, Pardo-Montero J, Muñoz-Plata R, Angulo-Díaz-Parreño S, et al. A Systematic Review and Meta-Analysis on the Effectiveness of Graded Activity and Graded Exposure for Chronic Nonspecific Low Back Pain. Pain Medicine. 2016 Jan 1;17(1):172–88.

5. World of Hurt: A Guide to Classifying Pain [Internet]. Thomas Land Publishers Store. [cited 2022 Apr 26]. Available from: http://store.thomasland.com/musculoskelpain2015.aspx

Pain and Movement

Read time 4 min

When doing sports, the chance of getting hurt is more or less elevated. Many of the reasons behind injuries are still a question but we are figuring out the puzzle piece by piece. The complex nature of injuries and pain is something I find fascinating and at the same time frustrating.

Let’s take a look at pain and movement variability that I see as important pieces of the sports injury puzzle.

What is pain?

Let’s start by looking at what pain is. “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” (1) The key thing here is that pain is your experience with actual or potential tissue damage.

At times there is actual damage but a lot of the time, no. Your brain creates a perception based on the information it has and creates a pain response. Sometimes this response can be out of tune (2).

Chronic stress

For example, chronic stress can cause the response to be out of sync by changing the regulation of the hypothalamus-pituitary-adrenal axis (HPA axis). This axis in your body is activated when there is a stressful situation (3). This can trick your brain into thinking you’re in greater threat than you actually are (4, 5). This can lead to more pain than then you would experience in a low-stress situation.

This is essential to understand since a lot of people in 2022 are under stress and it can affect their knee, shoulder, back, or whatever pain they are having. Cool thing is that you can work on this stuff.

Body as a machine

This multifactorial aspect of pain is the reason why saying your body is a machine is inaccurate. Your body is capable of amazing things through all these interleaved processes. Your body adapts to a lot of things like exercise and physical load (6). This is also why I have a problem saying running or lifting technique is the reason for someone’s pain. It might have something to do with it, but it certainly isn’t the whole story.

Lifting with a rounded back

A common myth that is still alive and well is that you shouldn’t lift with a flexed back. This is loosely supported by studies done on cadavers (they don’t adapt to load). A meta-analysis done in 2020 didn’t find a relationship between lifting with a bent back and low back pain (7). And there's a bunch of other evidence pointing in the same direction as well. 

Although it has been noted that people with low back pain lift differently than people without pain. This is probably due to an attempt to protect the back. The belief that you have to lift a certain way is often shared by health or fitness professionals, but it is not true or supported by current evidence (8).

Some back pain episodes might start when lifting with a rounded back, but often times the load is excessive in relation to the person’s abilities. This is probably more relevant than the flexion of the spine.

Movement variability

I wouldn’t throw the baby out with the bathwater either. If you are experiencing pain in some activity, it might be a good idea to change your technique to give your body a chance to recover from the stuff that’s hurting you.

Movement variability is a widely researched topic in the field of sport and exercise science. Many studies have shown that an injury or pain can reduce your movement variability. In other words, you always move the same way. Hamill et al suggested that this monotonous way of moving can lead to overuse injuries through repetitive loading (9, 10).

On the contrary, one systematic review concluded that injured athletes have more movement variability compared to the healthy controls although the results varied based on the injury types (11). Both of these articles mentioned that there is probably a window of variability that you may want to have (9, 10, 11). Not too much but not too little either.

Optimal movement

I want to emphasize that people move very differently and there is no one optimal way for everyone. In my opinion, there is no one optimal way for an individual either based on the literature. There are countless options on how to perform any movement and our nervous system chooses one from a spectrum of alternatives.

Pain should not be an obstacle interfering with how you want to live. Let me help you through it.

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References

1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The Revised IASP definition of pain: concepts, challenges, and compromises. Pain. 2020 Sep 1;161(9):1976–82. 

2. Garland EL. Pain Processing in the Human Nervous System: A Selective Review of Nociceptive and Biobehavioral Pathways. Prim Care. 2012 Sep;39(3):561–71.

3. McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev. 2007 Jul;87(3):873–904. 

4. Timmers I, Quaedflieg CWEM, Hsu C, Heathcote LC, Rovnaghi CR, Simons LE. The interaction between stress and chronic pain through the lens of threat learning. Neurosci Biobehav Rev. 2019 Dec;107:641–55. 

5. Abdallah CG, Geha P. Chronic Pain, and Chronic Stress: Two Sides of the Same Coin? Chronic Stress (Thousand Oaks). 2017 Feb;1. 

6. Hamilton MT, Booth FW. Skeletal muscle adaptation to exercise: a century of progress. Journal of Applied Physiology. 2000 Jan;88(1):327–31.

7. Saraceni N, Kent P, Ng L, Campbell A, Straker L, O’Sullivan P. To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2020 Mar;50(3):121–30. 

8. Nolan D, O’Sullivan K, Newton C, Singh G, Smith BE. Are there differences in lifting technique between those with and without low back pain? A systematic review. Scand J Pain. 2020 Apr 28;20(2):215–27. 

9. Hamill J, Palmer C, Van Emmerik REA. Coordinative variability and overuse injury. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 2012 Nov 27;4(1):45. 

10. Hamill J, van Emmerik RE, Heiderscheit BC, Li L. A dynamical systems approach to lower extremity running injuries. Clin Biomech (Bristol, Avon). 1999 Jun;14(5):297–308. 

11. Baida SR, Gore SJ, Franklyn-Miller AD, Moran KA. Does the amount of lower extremity movement variability differ between injured and uninjured populations? A systematic review. Scandinavian Journal of Medicine & Science in Sports. 2018;28(4):1320–38.