Pain in the Gym? Here’s 3 things you should know
Is pain holding you back in the gym?
Maybe you have a shoulder flare up every time you bench press. Perhaps you have knee issues when you squat. Or back problems when you deadlift.
Or maybe your pain has progressed to the stage where it is beginning to negatively affect daily activities that are meaningful to you, such as the competitive sport you play, or things like holding your grandchildren, doing housework or maybe even walking to the shops. Pain, especially when chronic in nature, can be an extreme physical and emotional burden on ones life, and if not addressed properly can begin to seriously derail fitness goals, and can even result in long term disability in some individuals.
Many of the common presuppositions surrounding the nature of pain, and the best way to deal with a pain experience have the opposite effect than intended, and may actually inadvertently facilitate a cycle of pain disability, preventing individuals from participating in activities that are meaningful to them. For many, training is something that is extremely meaningful to them, and the prospect of being unable to get to the gym and continue making progress due to pain can be very distressing. However, hope is certainly far from lost! Pain education is an incredibly valuable tool for helping people to not only cope with, but ultimately overcome pain and continue to make progress in the gym.
With that said. Lets get into the 3 things you currently don’t know about pain. I will be touching on all three of these areas in far more detail in my upcoming FREE seminar on 8th March. This article will provide you with an introduction to the topics, and will hopefully get the cogs turning ready for some productive discussion at the seminar!
1: Pain doesn’t always reliably correlate with tissue damage
Perhaps many peoples biggest barrier to successfully dealing with a pain experience is their conceptualisation of pain itself. Society as a whole still has this very mechanical, biomedical view of pain, which views the body as primarily responsible for eliciting a pain response. In other words, the body is viewed as a machine; if pain exists, then there must be an identifiable structural cause.
If your computer wasn’t working, you would expect an IT technician to find the part of its internal hardware that was faulty and fix it, which in turn would fix the computer as a whole. Likewise, when we experience pain, we expect a healthcare professional to identify the internal problem, whether it be tissue damage, misaligned joints or tight muscles, subsequently fix the structural problem and thereby completely eliminate our pain.
The problem is, human beings aren’t machines. This theory begins to break down very quickly when analysing the lack of correlation between pain and structural damage or structural abnormalities. For example, a large percentage of individuals with lower back issues may have no identifiable underlying tissue damage when they get an MRI scan,. This had led to the term ‘non-specific lower back pain’ has become a commonplace diagnosis.
On the flip side, we see significant structural abnormalities and tissue damage in completely “asymptomatic” individuals. Rotator cuff tears, cartilage and meniscal damage, bulging discs and arthritic changes are all commonly found amongst a wide variety of individuals experiencing absolutely no pain whatsoever. This obliterates the notion that pain is always an experience that can be rooted back to the body.
In addition to this, we have the knowledge that there is huge variance between individuals’ rating of pain when they are exposed to exactly the same heat stimulus. In other words, it’s highly subjective. If pain is an output resulting from structural stress, we would surely see the same experience when exposing people to the same input?
But we don’t. We see levels of variation that are so large they are actually pretty hard to believe.
2: Psychological and social factors influence pain
Reducing an individuals experience to being purely a product of structural damage can be a little over simplified, as this ignores that fact that human beings are complex organisms with a first person experience that includes prior experiences, beliefs, societal beliefs and expectations, thoughts and emotions, all of which can influence the development and maintenance of a pain experience.
For example, we know that individuals that are more fearful of specific movements or issues, spending their energy worrying about possible causes and consequences, are more likely to suffer with (and remain) in pain for longer periods of time than those who are less fearful. This “Catastrophic thinking” such as ‘I can’t do that because it hurts, and there’s nothing I can do about it’ or ‘I am worried that something serious is wrong with me’ have been consistently shown to predict greater long term issues.
In this way, the nature of our thoughts and feelings play a direct role in the magnitude and the duration of a pain experience. We also know that we replicate these beliefs and coping mechanisms from friends and family. The more fear-avoidant behaviours and catastrophic thinking you have observed throughout life, the more likely you are to replicate this response. This suggests that coping with pain may be, at least partially, socially learned.
We simply cannot untangle ourselves from our own subjective, first person experience, however hard we try. The things we have experienced, the relationships we have had, the way we have been influenced socially and our subsequent thoughts and feelings surrounding pain all have a significant role in its development.
3: Pain can be a response to excessive stress
I’m defining stress pretty broadly here. That is, any level of stress placed on a human being that occurs inside or outside of the gym. This could be doing too much in the gym, a busy exam period, relationship problems, depression, social isolation, sleep deprivation or poor nutrition. Anything that increases the physical, psychological or emotional stress on an individual beyond levels they can tolerate can lead to a pain experience.
Imagine that your capacity to deal with stress is like pouring water into a cup. The cup is your stress capacity. The water is your stress. You can make your cup bigger by improving your fitness capacity, getting plenty of sleep, eating high quality nutrition, and generally finding other effective ways to improve your psychological well-being and cope with stress. In this situation, you are well prepared to deal with the incoming water (ie stress) and your cup does not overflow.
However, if you don’t take care of all of the above, you have a smaller cup, therefore you have less capacity to deal with incoming stress. All of a sudden you have an argument with your partner, or you lose your job, or you get a few poor nights sleep in a row. Your cup begins to overflow, and you are in a heightened state of stress. This can trigger pain.
To summarise, pain is a complex experience that includes many different inputs.
The resulting output can vary from person to person, and does not always reliably correlate to actual tissue damage. When determining the cause, we shouldn’t be looking for the all-encompassing ‘root cause’, but rather taking a holistic view of our own lives and determining where can make changes, whether it be the stress we are placing on ourselves, or the narratives about pain we are exposing ourselves to internalising.
So how do we go about implementing a plan to begin to successfully deal with our pain? Well, that’s for the seminar! I hope this article has provided you value, and I hope to see you on 8th March!Find out more about our seminar!
Thanks to Matt Brown MSc for putting this article together! As always, if this is something you struggle with, don’t wait for it to go away on its own. Contact us today– you’ll be glad you did!
P.S If you’re interested in this topic, check out our pain podcast with Matt discussing this in more detail!