A couple of weeks ago, Max published a blog, Beating Your Back Pain, detailing his experience with back pain and the strategies he used to get himself out of pain. In it he describes how different disciplines, from western medicine to the movement culture, view and treat chronic pain. If you haven’t read it, I suggest you read that before digging into this article as my goal is to build on some of the ideas he presented and provide practical tips to help you train through pain or around injury.
If you work with high-level athletes long enough, it is inevitable that they will at some point experience injury. It is the nature of high-level competitive athletics that athletes push their bodies to the limit of their recovery capacity, and often times we (speaking as an athlete) are too stubborn to heed the warnings. I’ve had my own struggles with injury and chronic pain and have learned a host of valuable lessons as I went through the process of getting out of pain. What I find most interesting, is that the steps that Max described in his blog on back pain are eerily similar to what I found worked for my knee pain and I’ve implemented the same system in progressing my athlete’s recovery from pain and chronic injury. In the end, it wasn’t just surgery, changes in training, improving my movement, or altering the way I thought about my pain that led to the its resolution, it was a combination of all of these factors, applied consistently that truly solved my problem.
Pain vs Injury
One thing that is important to note is that injury and pain are not always synonymous. Injury almost always presents an athlete with pain, but pain does not always signify injury. A back or shoulder injury that is fully healed should no longer cause pain, but all too often the pain lingers long after the recovery process had been completed. There is plenty of research that shows that there is at best, only a weak connection between disc herniations and lower back pain. In large scale studies of backs less than 50% of the people presenting with clear disc herniations experienced lower back pain. Research has found the same thing with shoulder injuries. In fact, some research suggests that the chronic pain experienced after a labral tear in the shoulder is more closely related to markers of mental health than it is the size of the tear. In other words, your mental state and relationship with pain likely determines how well you will deal with injury and the recovery process. Understanding this concept - that pain and injury are not necessarily linked is critically important when you are trying to train through and around pain.
With this basic framework laid out, I’m going to dig into some practical tips for training with and around pain or injury that I’ve derived from my experience as a coach and athlete.
- Don't try to come back from an injury too quickly. For many of the athletes I’ve worked with, this can be a major challenge. They feel an almost constant need to be training and improving, and desire to return to training too soon. Pain is usually a good guide for when it is safe to return to training. Initially, pain is part of the healing process, it indicates that inflammation is occurring, and serves as a feedback mechanism that tells our brain that what we are doing may be making the injury worse. Typically once the pain has subsided from a soft-tissue injury it is a good indicator that you’re safe to begin a progressive rehabilitation program. In my experience it is very important to take the time to gradually build back into training after an injury. Another issue that can occur if you try to train on an injury too soon is that you are reinforcing pain pathways, the nerve connections that run between our limbs/spine and brain, and are making it easier to sense pain in that area. For example, if you've injured your lower back and every day for a week you feel a pinch every time you bend over - your body is getting better at sending a pain signal down that pathway. If you try to train through this pain, your brain may become over-sensitive to these pain signals and may interpret a minor stretch as something dangerous.
- Try to maintain a positive outlook. In my experience both as a coach and athlete this is one of the keys to making progress to getting out of pain. Start by accepting that you you’re in pain, that there is no magic bullet, and get to work fixing your problem day to day. It can really help to keep your focus on what you can do and not lament about what you can’t do. For example, if you have a left shoulder injury, do your rehab work and then you can still train your right arm, trunk/core, and lower-body, although you may have to get a bit creative. There is even some research that suggests that training your right arm while your left arm is injured can actually lead to greater retention of strength and endurance in your injured left arm than ceasing training all together. I’ve utilized this concept while rehabilitating athletes who have an injury in one arm or leg with great success and have seen a reduction in their recovery times. Keep in mind that if you’re dealing with a chronic injury, or long-term pain situation, that only training one limb for extended periods of time (4+ weeks) can potentially lead to movement compensation patterns that favor the trained limb over the untrained.
- Be patient with your body. There will be ups and downs in the recovery process. Our bodies work in alternating cycles of inflammation and repair so expect to make some progress and then see it undone. Do the rehab and movement work you need to do every single day to rehabilitate your injury or get yourself out of pain. When you wake up the next day and feel like you’re right back where you were, know that this is what it takes to get out of pain, and get right back to work on your recovery program. Like Max wrote about in his blog on back pain, recovering from an injury or getting out of pain is not an easy process, and in most cases there is no magic bullet, there is just hard work, but that hard work is definitely worth it.
- Don't "look" for pain in places where you used to experience it. This is actually something that I’ve been dealing with myself now that my knee and hip are no longer causing me daily issues. I experienced the pain for long enough that it became something that I dealt with on a daily basis and now I sometimes feel as if I’m waiting for the pain to start back up again. Every time I squat, I’m still searching for that pinch in the outside of my knee or the icepick in my left hip. Part of the process of recovering from an injury or chronic pain is to develop confidence in your movements again. A good, progressive training design that gradually adds volume and loading is the best way to accomplish this. Start with basic movements that are pain free, and add repetitions session-to-session and week-to-week to slowly build your confidence. As your confidence in your movements improves begin to add load and finally speed, being sure to listen to the signals your body is giving you about recovery.
Recovering from an injury or training your way out of pain can be a frustratingly slow and mundane process. However, knowing some basics about pain and recovery can make dealing with the process much easier to handle emotionally. I’m certainly not saying that following these steps is a guarantee that you’ll be able to recover or beat your pain, rather, this is simply what I have found through my experience working through my own pain and helping other athletes do the same. In the end, you could resign to stop training altogether and accept that the risk of re-injury is too great or that you’ll never be able to squat again. Or you could take the steps to move more, build your confidence, seek out help where you need it, and get yourself back to where you want to be. To me that is certainly better than never being able to train again.