by JOSHUA ZAVERTNIK
Pain is a very normal experience that often occurs as a protective response to some type of stimulus to our bodies.
Pain is in the brain 100% of the time. Let me say that again, with several dramatic pauses. Pain. Is in the brain. 100% of the time. This statement isn’t meant to offend or call anyone “crazy.” Well, given the level of self-inflected torture that most of us put ourselves through, we are likely a little off somewhere. But that is a different conversation for a different day. This statement comes from Lorimer Moseley, one of the leading researchers in a field of study that is commonly referred to as neuroscience. Dr. Moseley and David Butler have spent the vast majority of their careers trying to understand the complexity of pain and how it has such a wide variance amongst people.
Pain is a very normal experience that often occurs as a protective response to some type of stimulus to our bodies. Sprains, strains, broken bones and sore muscles can all signal a cascade of events in our bodies that create the pain experience that is ultimately registered in our brains. This highly complex, primitive process is designed to alert us to what the brain perceives as a threat and to get us to take action to protect ourselves. The concept of pain and pain management is a widely studied area of medicine and can get very dense very quickly. I will do my best to keep the “nerdiness” to a minimum and provide you with a straightforward idea of how we generate pain, how that impacts performance, and what you can do about it.
The Types and Stages of Pain
[T]he process to generate a pain response is unique based upon the type of stimulus and structures that are involved.
Cuts to the hand, muscle tears and low back injuries all share one thing in common: they hurt! Although they are all described as “pain,” the way in which the body has generated the pain signal is significantly different in each situation. To better understand pain and how this relates to us as athletes, we need to define several key components. Pain is a very general term, since everything from a sprained ankle to a paper cut is often referred to as being “painful.” But the process to generate a pain response is unique based upon the type of stimulus and structures that are involved. Nociceptive pain, neuropathic pain and visceral pain are all terms used to describe the types of pain we experience; acute and chronic reference the amount of time pain has been present.Nociceptive Pain
is generated by stimulating specialized nerve endings called nociceptors. There are two subgroups of nociceptive pain: somatic and visceral. Somatic pain is a type of nociceptive pain response that is common with injuries such as a sprained ankle or a muscle strain. Visceral pain is brought on by stimulation of nociceptors in organs and can be described by aching and squeezing.
Neuropathic Pain
is often the result of nerve damage or irritation. Symptoms are often described as burning, tingling, electrical and stabbing. A true case of sciatica, irritation to the sciatic nerve, is an example of neuropathic pain.
Acute, subacute and chronic pain
is defined in terms of duration. While some authors will vary on their definitions, it is mostly accepted that acute pain is 0-3 months in duration and anything greater than 3 months is considered chronic. Subacute pain will sometimes be referenced as a subset of acute pain and is defined as anything greater than 6 weeks but less than 3 months.
The Pain Process
There is no “pain center” in the brain, so this process requires rapid communication amongst various parts of the brain. Ultimately your brain will need to come to a decision about the situation and whether or not the experience warrants a pain response or not.
Our bodies are equipped with a vast neural network that serves very unique roles and functions. Chemical, thermal and mechanical stimuli can trigger the millions of tiny sensors that line a nerve. In order for a nerve to be stimulated, a specific threshold needs to be exceeded. That means that the nerve needs to receive a sufficient amount of a particular stimulus in order to be triggered. To see this in action, picture a ten-pound kettle bell resting on your foot. Uncomfortable yes, but not enough mechanical stimuli to generate a pain response. But what happens if the same kettle bell is dropped onto your foot from only a few inches up. The weight of the kettle bell stimulates a ton of these mechanical sensors that activate the nerve that will produce a signal that travels to the spine and then up to the brain. Now here is where it gets really “groovy,” as Dr. Mosely likes to put it.
The stimulus from your foot alone is not enough to generate a pain response. Once the signal has reached our brain, it will go through an incredibly detailed process to determine an appropriate response. Within milliseconds your brain will take in information about the situation from your eyes, nose and ears. It will recall past experiences that may be similar in nature. Even our current mood, state of stress and perception of the situation is factored into the equation. There is no “pain center” in the brain, so this process requires rapid communication amongst various parts of the brain. Ultimately your brain will need to come to a decision about the situation and whether or not the experience warrants a pain response or not. If the answer is yes, a painful response is produced and action is taken. In this case it will likely be a quick jerk of the foot followed by the not so graceful “walking it off” limp. If the brain doesn’t feel the situation requires any significant type of response, then there is no pain and the kettle bell rolls to the floor.
Perception is key
Sounds simple enough, right? I drop something on my foot, foot hurts, I move foot and curse wildly. Well, not exactly. Did you catch the part about perception, mood, and stress influencing the pain experience? The amount of pain you experience doesn’t always reflect the amount of tissue trauma. A key element to what we feel is dependent on how we perceive the situation. We have all heard of stories of military personal returning back to base after taking enemy fire only to then realize they had been wounded. But how is that possible? Didn’t those mechanical and chemical nociceptors produce a pain signal that went to the brain? They sure did, and lots of it. But the brain, in its infinite wisdom, recognized that there were more pressing issues at hand (an understatement) and produced a response that diminished the pain response to allow the soldier to attend to what was necessary at that moment in time.
[I]t is vital, as an athlete, to have a good sense of what is going on with our bodies and seek quality information about any injury or physical issue.
Another way to think about this concept is with the idea of hurt vs. harm. During any given day we will find a variety of things that we would say hurt. Work activities can hurt, stretching can hurt, even therapeutic exercises can hurt. That doesn’t mean any tissue trauma has occurred, though. Harm is when we see trauma occurring to a region of our body and this is what we want to avoid. That is why it is vital, as an athlete, to have a good sense of what is going on with our bodies and seek quality information about any injury or physical issue. A well-trained physical therapist, coach, chiropractor or athletic trainer can not only help you better understand what is going on; s/he can also limit your Google searches, which can lead to misinformation and/or inappropriate treatment.Pain and Performance
If the pain persists long enough, muscle atrophy may occur, tolerance to fatigue is decreased, and balance/coordination can diminish.
If the preceding information got a little nerdy and dense for you, you will want to perk up and take note as we explore how pain can impact performance and why we don’t want to wait to address pain problems.
We all know from experience that when something is painful, we tend to move differently. The way we walk, how we reach for something, and even our posture is altered to avoid pain. These changes occur on both a conscious and a subconscious level. Muscle inhibition refers to the idea that a muscle’s activity is decreased with the presence of pain. It is theorized that this occurs as a protective mechanism to reduce further trauma to an area. Several studies have looked at maximum voluntary contraction in painful muscles and found that output was significantly less than the non-painful muscles on the opposite limb.
Studies also show that when pain is present in a particular region, there is an increase in activity of the functional antagonist, or muscle group(s) that produces the opposite action (think relationship of biceps to triceps). This can lead to changes in movement patterns and motor control and trigger a whole set of different issues. If the pain persists long enough, muscle atrophy may occur, tolerance to fatigue is decreased, and balance/coordination can diminish. What does this look like at the box? The inability to lock out the clean and jerk may not be related to shoulder range of motion but the persistent shoulder pain that is experienced every time the arm is raised overhead, resulting in a weaker and uncoordinated system. Perhaps a muscle-up becomes significantly more difficult during the transition and dip phase because the triceps are weaker on one side due to elbow pain.
The bottom line: pain can lead to poor performance both physically and mentally. Pain has the ability to impact our ability to concentrate, sleep, alter mood, and decrease our appetite. All of which will further impact performance. Do you see the dangerous little cycle we can get into when we don’t address pain? A persistent, nagging, unaddressed issue often times won’t fix itself and has the ability to quickly snowball into a much larger problem.
Responding to Pain
The question then becomes this: what do we do if we have pain? The answer: well, it depends. A let down of a response, I know, but it is important to remember each pain experience is fairly unique, and all variables need to be taken into consideration to determine the best possible treatment. However, there are several things that we can do to reduce pain and return to optimal performance as quickly as possible.
1. Treatment
Even if you missed that acute phase and cruised through the subacute phase without talking to anyone, you should remember it is never too late to get good quality advice and treatment.
Or at least a consultation as soon as possible. In the acute stages of an injury, there is a cascade of events taking place to help protect the injured site as well as assist in recovery. Things such as swelling, redness, bruising, weakness and of course pain are often associated with acute trauma. It is important that we accurately and quickly provide a clinical diagnosis that will start you on an early intervention protocol. Early treatment can make the difference between an ankle sprain that takes seven days or seven weeks for recovery. Connect with a qualified health care professional such as a physical therapist, chiropractor, athletic trainer, or coach. If that person is not sure how to manage the condition, they’ll likely have a great network of people who can get you on the right path.2. Consultation whenever possible
Even if you missed that acute phase and cruised through the subacute phase without talking to anyone, you should remember it is never too late to get good quality advice and treatment. Chronic, persistent pain states have a myriad of factors associated with it, but sometimes a few simple suggestions can make all the difference. On the flip side, a quality evaluation provides you the level of detailed treatment and the self-management tools needed to get you on the road to recovery.
3. Avoid painful activities or movements
If reaching back into the backseat of your car brings on shoulder pain, don’t do it. If stairs make your knee throb, take the elevator for a little while. The more frequently we stimulate the area, the more sensitized it can become. This can lead to elevated pain levels, pain lasting longer then it should, and delayed recovery. If a particular lift produces pain, modify the technique or find an alternative.
4. Stay active
This is true in most cases as long as you are adhering to the concept of avoiding painful activities. The body thrives on movement, so you can stay active and let the painful area of your body get some relative rest. There is no reason why you can’t stay in the box and train as long as you are attentive to how it makes your body feel. Refer back to the hurt vs. harm concept. There will be times things won’t feel that great, but it doesn’t mean you have caused any long-lasting trauma to your body.
5. When in pain, deal with it
The fact that your shoulder hurts with overhead squatting may have more to do with the poor mobility of your thoracic spine and your hips than with the shoulder itself.
Don’t put off taking care of that ache in your shoulder or knee for three or four months only for it to be getting progressively worse. Refer back to the section on chronic pain. Acute pain often is a much easier animal to deal with than a persistent six-month-old problem.6: Know that what you feel isn’t always what you get
Kelly Starrett has done an incredible job getting people to recognize some of the positional and movement issues we see in training. These concepts are also valuable for painful conditions. The fact that your shoulder hurts with overhead squatting may have more to do with the poor mobility of your thoracic spine and your hips than with the shoulder itself. So while you take time to actively rest your shoulder, you should also consult someone who can give you a good assessment of your mobility problems and strategies to help manage those as well.
7. If you ain’t sleep’n, you ain’t recover’n
This goes without saying, but it is very important that you recognize the importance of proper sleep when it comes to recovery. If you are dealing with a particular issue that disrupts your sleep, you may need to look at your sleeping position to avoid rolling or laying on your side. Pillows and blankets can be used to place your body into a position of comfort. Icing for about 20 minutes several times before bed can help as well as over the counter medication such as Advil and Tylenol. Please note that prior to taking any medication, please do consult with your physician.
8. Eat well and hydrate
Not listening to what our bodies are telling us can only get us into trouble later.
Both of these are the cornerstone to anything physical. Regardless of the type of nutritional intake you subscribe to, our bodies need to be fed and hydrated to recover. High quality fats, antioxidants, proteins and amino acids are vital for tissue healing. Maintaining proper hydration levels can allow for proper tissue hydration levels and fluid transportation.
This is an incredibly exciting time with the Games right around the corner. This is also the time of year when we see athletes pushing themselves through their various body aches and pains. I’m there too! I get it! However, as I have pointed out above, the old adage “no pain, no gain” doesn’t fly anymore. Not listening to what our bodies are telling us can only get us into trouble later.
References
Waddell, G. The Back Pain Revolution. Churchill London, UK: Churchill Livingstone; 2004
Mersky H, Bogduk N. “Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms.” Seattle, WA: IASP Press;1994
Boyling J, Jull G. Grieve’s Modern Manual Therapy. London, UK: Churchill Livingstone; 2004
Butler D, Moseley L. Explain Pain. Adelaide, Australia: NOI Group Publications; 2003
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