Getting hurt is a drag.
It’s even harder when you’re someone who’s used to being active and an injury prevents you from training consistently or training as hard as you’d like.
There are generally two approaches that many people take:
1. Complete rest.
2. Channel their inner Jason Bourne and grit their teeth through it.
Neither is ideal in my opinion.
I realize that injury (or training with some degree of pain <- sometimes) is inevitable. As I’ve jokingly (but not really) said before…
…”Weightlifting isn’t supposed to tickle.”
Pain, the science of pain and how to educate around pain is a very complex and complex topic. This is a blog post, not a thesis.
To that end, today I want to take a moment to discuss some strategies for how to train for pain that doesn’t revolve around the extremities: Sit on the couch watching Netflix or plan to hit the Treadstone.
Full disclosure: Much of what I will cover below can be found in Dr. Michael Mash, Barbell Rehabwhich is currently my new spirit of favorite continuing education courses.
Also: Just as a heads up, much of what I discuss below will be covered in more detail in mine and Dean Somerset’s latest IN-PERSON Continuing Education workshop – The Complete Fit Pro Blueprint – Coming to Boston (June 6-7) and Dublin (October 3-4) later this year. More dates coming soon… ;o)
Factors to consider when training around pain
Let’s start with the definition of “pain”.
Pain
/pan/
substantive
1. A localized or generalized unpleasant physical sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress and usually results from a physical disorder (such as injury or illness).
2. That feeling you get when your significant other wants to talk about feelings, or what your eyes see when you see someone doing pull-ups with kicks.
More specifically, we often associate pain with real damage. However, pain does not always have to revolve around this denominator.
Pain can also be equated to a smoke alarm alerting the body that something is wrong:
- “Hey, biceps here: I think I’m close to hitting, can you tone down the bench dips?”
- “Hey, kneecap here: I’m going to end up on the other side of the room if you don’t fix your squat.”
- “Watch out – a ninja!”
More specifically, pain is multifaceted and can manifest itself in many ways, so it is imperative that we educate people that it is not always centered around a physical injury.
Take for example this cup analogy highlighted in a 2016 study from the medical journal Physiotherapy: Theory & Practice titled “The clinical application of teaching people about pain” by Louw, et al.
Pain is like a cup and there are many factors that can fill it.
Additionally, you can deal with people’s pain in one of two ways:
1. Reduce the contents of the cup.
2. Make the cup bigger (through proper strength training)
As addressed by Michael Barbell Rehabthere are several ways to build a training framework around pain that do not involve passive behavior, subjecting you to corrective exercise in purgatory, or, worst case, surgery.
1. Technical Control
When someone comes to Core Collective for an evaluation with me and they clarify how the bench press bothers their shoulders, instead of taking 30 minutes to assess their shoulder range of motion, wax poetic about the myriad exercises they can do to improve chest expansion and/or go to the weeds in the diaphragmatic position instead of asking them where mechanical breathing is. to…
…wait for it.
…wait for it.
… is coming.
…show me their stall.
Many times, all it takes is a subtle technical tweak to the set-up and execution of the lift itself, and their shoulder hates them less almost immediately.
This is not to say that we would completely ignore other factors such as thoracic mobility and breathing mechanics. particularly of deficits exist. However, I have found that most people are less inclined to want to set their face on fire from the tedium of corrective exercises if I simply narrow down the issue at hand.
Their bad technique.
2. Scheduling Control
This is a point I remember Dr Quinn Henoch driving home when I heard him present a few years ago.
How often do you check your programs?
Has it ever occurred to you that maybe, just maybe, the reason you (or your clients) are hurting is because you were a little overzealous with an exercise variation—or, more often, you were too aggressive with the loading—and that that was the culprit of your (or their) lower back pain?
…and not because your left ankle didn’t have two degrees of dorsiflexion or, I don’t know, it was windy yesterday?
Load management (or the lack of it) is the lowest hanging fruit that we often overlook.
Here is an example of what I mean.
Using the same person over the shoulder bothers them when he/she bench presses: Let’s say they like to bench press 1 time a week, on Mondays of course.
Like clockwork, the day after benching, their shoulder looks like Johnny Lawrence used it for target practice with his fists. It feels like this for a few days, it dissipates, and then, by the time the next day hits the bench, it feels better, and the same cycle continues.
A more convincing approach might be to spread the same volume over TWO workouts instead of one.
Here’s what they usually do:
Monday: Bench Press: 6×5 @ 185 lb
(Total Capacity = 5,550 lbs.)
Here’s what they should do:
Monday/Thursday: Bench: 3×5 @ 185
(Total capacity = 2,775 lbs) x 2
Wipe the leg.
via GIPHY
3. Change modifiable factors
Looking for the above, when something hurts or is painful, always, always, always look at volume/load first.
From there you can ascertain at what load something hurts – what is the symptom threshold? A find that and when you do, train right underneath to build tolerance and resilience. The result will be twofold:
1. You will encourage a real training effect.
2. Eventually, you will exceed the original symptom threshold because you forced an adaptation.
An easy example here would be squatting. If someone experiences knee pain at a certain depth – perhaps parallel or just below it – have them do a box (or free) squat ABOVE that point.
Similarly, maybe all it takes to make the squat less painful is to change the width of the stance or the degree of toe-out? You can also experiment with the position of the bar or even the tempo. The point is: Assuming we’ve ruled out anything malicious, I’d rather someone continue to squat with a variation/tweak that dramatically reduces their symptoms than skip it altogether,
4. An Exorcism
But only as a last resort.
