Safely Exercising With Pain
Dr. Jordan Seda, PT, DPT, OCS, CSCS, FRCms, CCPC, CSAC
Pain. It is something that can either keep us from an activity we enjoy doing or can severely impede our quality of life. From my experience as a strength athlete having to recover from a back injury after deadlifting in 2018, it was difficult for me to enjoy trips to the gym when tying my shoes had become an ordeal! Pain is also one of the most difficult things to measure; mainly because no two people have the same experience with pain.
Pain is an experience! It is our body’s perception of danger! Now I say perception as pain can present without any actual danger! “How is this possible?”, you might be asking yourself. Studies have shown that people who had meniscus surgery and those who had sham surgery were not significantly better off. Furthermore, in a 2014 study, only 8-15% of individuals with low back pain had an actual diagnosis based on imaging results. That means everyone else with low back pain had no definite cause! This is not to say that injuring a body part does not cause pain. Try telling that to someone who just stubbed their toe! Nevertheless, tissue injury is just one contributor to the pain experience.
Pain is not something that you need to fear. It is feedback just as heat and cold provide us feedback or a bright light shining in our eyes makes us squint. If we use a pain as a guide that something requires our attention rather than something that detracts from our quality of life, we can confidently delve deeper into the root causes of a pain response. Now that is where it can get tricky!
As I alluded to before, pain can stem from many factors. Let’s start with the brain. It is an incredibly complex structure that is the powerhouse of our daily ability to function. Different areas of the brain correspond to different functions. For example, we have a somatosensory cortex responsible for receiving and processing information from our environment. Not too far away from there is our amygdala; a major center for emotion and fear. If our amygdala is going crazy because we are stressed and/or fearful, it might begin to smudge our somatosensory cortex. This could impede our body’s ability to perceive and process information and, thus, alter our pain response. Imagine yourself at the gym and you’re trying to hit a bench triple and you’ve had an incredibly stressful week. On top of that, you caught a cold. It would not be uncommon for that bar to feel just as difficult, if not more difficult to move, than the previous week. Furthermore, as I will explain later, when training through pain, it might create an even greater setback to progressing weight.
Our response is to protect. With perceived danger, we become hypersensitive to triggers. It requires less of a stimulus over time to trigger a pain response as our brain has adapted to put us on high alert. We want to keep ourselves from harm. However, this could lead to fear of movement and an exaggerated response to a lesser stimulus than one could usually tolerate.
One of my favorite guides to helping advise people on how to manage the factors that contribute to pain and suboptimal performance is Greg Lehman’s cup. Essentially, the cup serves as our capacity to tolerate everything that can impede our ability to perform. The contents of the cup are the factors like stress, tissue injury, fear, etc. The goal is to keep the contents of the cup from overflowing by limiting the contents or creating a larger cup, or capacity to handle those factors.
Lastly, I would like to touch on pain and exercise. Historically, many of us have avoided exercise when we feel pain. That may be the best course of action when pain levels are considerably high, but exercise has pain-relieving benefits and more! Through exercise, we can help build a resilience toward our body’s perception of danger. We do this through graded exposure; a concept about gradual reintegration of a movement, load, activity, speed, etc. Since pain is a feedback mechanism, we can determine the harm of any given movement with it. If pain, which is a subjective experience is less than a 5-6/10 pain and not worse after an exercise, PROCEED, but with caution. Any less than a 3/10 pain, PEDAL TO THE METAL!
Let’s put this into context. Many of us could be training for competition or simply to be as resilient as possible to meet whatever life throws our way! In this scenario, let’s consider a competitive strength athlete. You have been training for a meet that is 6 weeks away and have been absolutely owning your program. Then, one day, out of nowhere, you pull that bar off the ground on your last repetition and...there goes your back. After this, it hurts to sit and bend forward. Even trying to set up for your deadlift hurts. Fear not! Here is how you will get back on track:
Gradually regain your ability to move. This will likely require a collaboration between your coach and a healthcare professional. Your range of motion needs to be restored and pain mitigated. It is likely that a series of rehab exercises here will do the trick, but this could take a few days before daily activities start to become more tolerable. Be patient!
Perform variations of the deadlift. I believe that some load in in a deadlift variation is better than none (again, as long as pain does not exceed a 5-6/10 AND does not worsen). For example, a Romanian deadlift, resisted hip hinges, or glute/ham raise could be a good option to get your body prepared for returning to the bar.
Return to the bar. If you can set up at the bar with, at most, a mild amount of discomfort, try to lift it! Did it hurt? If not, did it feel worse afterward? No? Load the bar again and repeat! Continue to increase the load until you reach one that will allow you to perform with no more than the amount of pain we have previously discussed.
Excel! Eventually, you will hit the numbers that you want! It will take continuous communication between yourself, your coach and possibly others to program effectively during your recovery, but you will get there. And! You will likely end up with better numbers! Why is that? Use your recovery as a time to enhance your performance. Spend time thinking about weak points in your lift and hone in on where you could better maintain and generate force.
Do you have more specific questions about pain and how to navigate it as you exercise? Feel free to reach out to me at any time!