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No pain no gain – but can you gain if you already have pain?
In fitness we often envision ourselves fitter, faster, stronger – sometimes to the point that we picture ourselves as almost a totally different person.
Perhaps when you were younger you could run and run and run. That was before this aching knee came on the scene. Maybe you were picking things up and putting them down without any difficulty, but those days started to get further and further behind you when the bad shoulder started to feel unstable.
When our goal is still important to us, but also too is not further worsening the problem knee or the cranky shoulder, we can find ourselves conflicted. Do I try? But what if I get hurt? I tried the other time and it flared up so maybe I should just not bother… It can really become a bit of a cycle of try, fail and ultimately result with oneself feeling rather jaded about the whole experience.
Fast-forward to the future you. Imaginably, this ‘me’ from the future has reclaimed the skill, fitness and function that was lost along the way. The future you is now more enduring, more capable and more robust possibly than you have ever been.
The future version of you just may have overcome one of the biggest hurdles in fitness goals – losing the game before it starts.
Pictured: He thought that 1000 push-ups a day would kick-start his year – probably.(Photo credit https://www.menshealth.com/fitness/a28708457/sore-shoulders/)
The key is to start smart – know the stats and the common traps:
Before we throw the proverbial kitchen sink at our goal it is essential to know the risks.
Sometimes in human behaviour we act like light-switches. We are either on, or off. We are either all-in, or, all-out.
We are either drinking green broccoli and kale smoothies every-damn-morning at 5am then going for a run or hitting the fast-food drive-thru for the third time this week.
Unfortunately, these behaviours and mindsets are the types that not only limit us from having long-term success in training but frequently also contribute to negative outcomes such as pain and injury.
When you are in a pitch-black room and someone suddenly turns the light on, that is a shock to your system. It is like going from couch to concrete. If we are to achieve gains minus the pains, we are required to be less like switches and more like dimmers.
When we understand just how much force the body must deal with when running, this sort of statistic is not surprising:
“DURING THE RUNNING CYCLE, THE GROUND REACTION FORCES (GRF) AT THE CENTRE OF PRESSURE (COP) HAVE BEEN SHOWN TO INCREASE TO 250% OF THE INDIVIDUALS TOTAL BODY WEIGHT” (2.)
Two and a half times body weight! For a 60kg female that is 150kg going through a single leg. For an 80kg male that is 200kgs.
Now in order to successfully adapt to our training, we must stimulate (load), recover (rest), then super-compensate (come back stronger).
If our tissues cannot tolerate the load that is being applied, we may just break down, be it acutely in the session, or via death of a thousand cuts, or strides, in this instance.
My best recommendation? Do not leave it to chance. Have your movement patterns assessed before you start, that way if there are any weak links in the chain, we can look to addressing them early!
Assess how well you can move. If you cannot move it, do not load it (yet):
Human movement is tricky. There are a lot of moving parts, any one which, if slightly out of kilter, could have profound chain-linking affects on the rest of the kinetic chain.
Take for example the Joint by Joint (JBJ) Approach (3.), famously conceptualised by strength and conditioning coach (S&C) Mike Boyle. Mike has a resume that includes being the S&C coach of the Boston Red Sox Baseball team, the Boston Bruins Ice Hockey team and the US Women’s Olympic Hockey Team.
Pictured: Mike Boyles Joint-by Joint model (Photo credit https://www.continuumperformancecenter.com/blog/your-mobility-issue-actually-stability-issue)
To break down the image we are looking for a steady foot to support the ankle, A steady knee to support the hip, a steady trunk to support the spine and steady shoulder blades to support the humerus through multi-planar movement.
The thoracic spine and shoulders should have great range of motion and mobility, think throwing a ball or grabbing groceries from a high-shelf.
A ground-up example:
If your foot lacks the correct fascial tensioning through its arch, it may collapse, causing an area that should be able to keep you steady, to become wobbly and flaccid. This in turn will apply pressure up to the ankle which, instead of rolling and adapting with the foots position (being mobile), is now forced to compress in a bid restore stability to the distal end of your extremity.
What does the knee have to say about this? Well, if your ankle has stiffened up, somewhere must move, right? Bear in mind that too much lateral or medial knee movement could lead to big trouble. All because the brain could not control the foot! These my friends are what we call “victims of a system”. The sore knee would not have been a problem if it were not for the foot being unable to do its job; sometimes where your pain is, your problem isn’t’!
An assessment of ankle function can be done both passively and dynamically, locally and globally.
Passive ankle assessment:This is you on the treatment table, having someone else take your joint through motion. Assessing range, stiffness and flaccidity as well as the integrity of the supporting tissues and joint structures.
Pictured: Passive ankle ROM assessment (Photo credit https://www.physio.co.uk/what-we-treat/surgery/ankle/ankle-fusion.php)
Dynamic ankle assessment: This is where you are now in the drivers’ seat. Your coach or therapist says, ‘Pull your foot to your shin!” and you do this to the best of your ability. This can show what your brain is confident and or reluctant to do when your ankle is asked to move.
Not so much an official term, however having yourself performa simple knee to wall test can highlight what the ankle does and does not want to do with some, but limited other joint involvement, as opposed to a more global assessment.
Now for the good stuff. This type of assessment looks at a joints contribution when many other joints and forces are applied. A lateral hop to single-leg balance would be a great example of this, as the ankle, knee, hip, trunk and more will all need to provide feedback to the brain, and the brain then dictate a strategy for figuring out the stability and mobility requirements of this task! These types of assessments can really show where we have mal-adapted and highlight how we may be moving around a problem area.
If you can move it, load it, but do it gradually:
If your movement patterns have been assessed and their major deficiencies have been restored (odds are you are tired of using foam rollers and body weight exercises at this point) this is now where we get working!
The key concept that comes into play is called graded exposure.
Let’s take the example of a runner who after the first 20 minutes starts to get a sore knee.
With a graded approach we could have them back off from 20 minutes, but start to do more frequent runs of 10 minutes across their week, building up some tissue tolerance through volume over time.
Another approach could be to simply back off on total time or distance and then very slowly increase the time or distance, assessing along the way.
If you are looking to get back in to training and have a few niggles here and there, it is worthwhile having them assessed by an allied health or medical practitioner. Pain has the potential to be a sign of damaged joints and tissues, or perhaps your brain just acting like an over-protective parent.
Although personal trainers are not qualified to diagnose injuries or treat pain, they are however certainly qualified to assess muscular imbalances, conduct static and dynamic postural appraisals and create programs.
Ultimately if you are in doubt, you should refer out.
On that note I referred out to Accredited Exercise Physiologist Daniel Bullock (Masters Exercise Science) for some final suggestions for working on troubled movement.
“Trainers should look to gradually restore movement confidence, even in the movements that may have caused the injury through progressive overload. Consider also that volume is an important variable here; that is whether it is minutes per activity, per session or per week depending on the type of training, as clients with chronic pain may have avoided movement for a long time.
“Observe movements that have caused the initial injury and how the client moves through functional movements such as sit-to-stand, Turkish get-ups and the hip-hinge.”
Be sure to educate your clients about basic pain anatomy and physiology – the pain could be a signal that the tissue is damaged, or it could just be a signal left over and the pain is now long gone.”
Discuss the importance of muscle strengthening when pain is caused by muscular weakness, as a lot of Lower Back Pain cases are correlated with core and lumbo-pelvic muscle and motor weakness”
Lastly, remember that strengthening does not have to be 100% RM in de-trained clients. Slow progress is better than no progress or getting hurt by doing too much too early.”
- Purpose Driven Movement – A System of Functional Training Tarek Michael- Chouja & Dan Henderson
2.Mann RA: Biomechanics of running. In D’ Ambrosia, RD and Drez D: Prevention and treatment
- Joint by Joint – Mike Boyle www.continuumperformancecenter.com
- Graded exposure (article) by Todd Hargrave https://www.bettermovement.org/blog/2014/graded-exposure
WRITTEN BY BEN GUNN,