How to train around pain.
Pain. It is kind of a pain in the ass. Or wherever it hangs out these days.
Which one do you currently have?
This one could be the shoulder and/or your neck.
Hopefully you do not have all three.
If you exercise long enough there will be some point in time where some type of pain attempts to limit what you are trying to do.
You might be trying to set a PR on your squat or deadlift.
Maybe you are trying to progress a certain exercise or movement.
Maybe you want to go on a slightly more intense hike than you have been on in awhile.
Maybe you are getting ready to dance at someone's wedding.
The fact of the matter is, pain can bring each one of these situations to a grinding halt. Even worse, if the pain is left unchecked it usually gets worse and can even cause pain in different parts of the body.
It is not uncommon for a right ankle or knee issue to cause pain in the low back or the opposite hip and knee. I will explain how at a later date. The short answer as to how this happens is that everything is connected.
That is about as concise as I can be without boring you with joint angles and words like pronation and valgus and how motor control is blah blah blah.
Like I said. Later.
So what are we to do with this current, painful, situation?
Number one. Top of the list. In general, movement is the key so keep doing things.
I know that sounds contradictory as we just discussed that doing things is painful.
The key is to do things differently and to modify activities when you have to.
Start by looking at things as 'need to' versus 'want to'. Initially, we minimize the want to and modify the need to.
Part of getting better is removing the irritating factor. Not like a wife irritating factor ;), but the movement(s) that are actually increasing your pain.
For example, let's say you have some shoulder pain. You notice an INCREASE in pain when performing movements that have the hands over shoulder-height. But when you do other movements that keep the hands at or below shoulder-height you have no INCREASED pain.
Why did I write increased in all caps?
This is a very important concept to understanding when you should stop and when you can continue with what you are doing.
If I have some generalized shoulder pain but whatever I am doing (exercise, making dinner or cutting the grass) does not INCREASE my pain then I am not irritating the problem and should be able to continue.
If, however, any other those activities actually causes my pain to go up then I have to stop or find a different way to do it.
This comes back to the 'need to' versus 'want to'. Prioritize.
So what's next?
Slow down.
Seriously. Perform your painful movements slower.
I have seen a lot of patients and clients mention that a certain movement was painful. When they performed the same movement very deliberately and slower, the pain was at least minimized but often was gone.
All gone.
This idea applies to both exercise and daily activities. Most people just do things at work, the gym, or around the house without actually focusing on HOW they are doing it.
If you do not change this particular habit, it is truly difficult to get complete resolution of your symptoms.
A third option to assess what's going on is to deload. This helps to determine whether a joint is an issue or the muscles and other movement-related business are to blame. You could be really screwed and have both joint and muscle issues.
If you have a hard time performing a movement, or the movement is painful, we can deload the movement to see if your range of motion and/or pain change.
Check out the videos below.
A deloaded squat will help to see if the knees can actually tolerate a squat motion or it may allow you to squat without any low back pain.
The active-assisted shoulder flexion will give us an idea if the shoulder can move farther, and with less pain, when we assist the movement.
This video shows three different progressions for getting the hand back down to the bottom position. Sometimes bringing the arm back down can be painful so use whatever option does not increase your pain.
Even if the pain is still present when deloading, it gives us valuable information going forward.
To summarize:
1. Keep moving but modify when you have to.
2. Slow down dammit. Sometimes the speed at which you move is the problem, not the movement itself.
3. Deload to assess joint versus muscle problems.
Sometimes pain can come from "tight" muscles. Most times you do not want to stretch them. Find out what to do here: Stop stretching your tight muscles.
Until next time,
Dr. Tom
