Pain and The Fitness Industry

Cill94 · 08-11-2022 2:18pm #1

Pain and The Fitness Industry

PLEASE NOTE: The below is not medical advice, it is merely my own opinion that's been informed from reading relevant literature, following leading pain and injury experts, and of course my own experience. Seek out a medical professional when needed.

If you're reading this and you've been training for more than a year, odds are you've experienced your fair share of pain. Maybe not full blown injuries, but aches and pains that are there when you're lifting or during day-to-day life.

The mainstream narrative proliferating in the fitness industry is that this is very bad and dangerous. I have some big problems with this take.

Fitness is In The Pain Science Dark Ages

For more than 20 years now, we've had plenty of research showing that pain is a highly complex experience, that has multiple factors which contribute to it. We also know that pain is often poorly correlated with damage, and that many people can successfully rehab while pushing into pain.

The newer, 'biopsychoscocial' model of pain, acknowledges that while people's movement and training matters, there is also significant inputs from their general health, emotional stress, personal beliefs, psychological trauma etc.

This doesn't mean 'pain is all in your head'. It means that pain can be triggered by, or made more severe by things other than an acute injury scenario.

An Elaborate Marketing Scheme?

The mainstream fitness take on pain is that it is biomechanical in nature, and something that means you're damaging your body. This model assumes that there are 'right' and 'wrong' ways to move, and that deviations from this constitute 'movement dysfunctions', which are supposedly at the root cause of pain.

Not only is this poorly supported by research, but it seems very convenient, given that the only solution in this scenario is for the client/patient to sign up for hands-on, detailed instruction from the coach/physio. They are now highly reliant on them to 'fix them'.

Yet research tends to show that the specifics of rehab protocols tend to matter less than the fact that you're actually doing some form of exercise for the area.

Personally I think that most who use the kniesiopathological model are kind of willfully ignorant. They're unaware of the research because they want to be. The biopsychosocial model takes power away from the coach and puts autonomy in the hands of the client, and that hurts their bottom line.

My Take on Pain

My major gripe with how things are currently communicated is that it basically gaslights people on their pain experience, while also terrifying them into thinking that pain = damage.

Absolutely everyone is going to experience pain, and some may always have a certain level of pain no matter what.

When we tell people they should expect to feel amazing all the time, if they'd only 'move right' or 'do this exercise', we completely delegitimise the actual experience of the majority of the population.

By all means, strive towards pain-free and try to train smart. It's up to each person decide when it's time to intervene and change things to augment their pain.

Black Sheep · 08-11-2022 5:42pm

The tendency to castastrophise injuries is undoubtedly something that causes people as much sleeplessness and worry as the actual injury itself.

I did it for years. Every thing that happened, I thought the sky was falling. I look back now and I see that even things like a knee ligament tear that put me on crutches was resolved within less than a year. I had a cervical disc injury that put me out much longer, I had to modify my training or was avoiding hard training for a couple of years, but in hindsight much of that was self limitation more anything else. I'm not saying a few years is not a long time when you're facing into it, but on the other hand, from my point of view now it is ancient history and my neck has been back to normal for 12+ years.

To stay with the example of a disc related issue like a herniation or bad bulge, of course it has the potential to affect your quality of life, the pain can be very real, but if you can make yourself stop panicking and actually read some clinicians working with active people, or active people who have recovered, even with pretty bad cases there is a lot of reason to believe that sooner or later it will resolve and you'll be able to move on with your life and training.

I've arrived at a fairly sanguine place where of course I don't want to incur another injury or be blasé about it, but short of something requiring multiple surgeries my tendency now would be to assume I will be able to continue training, or will be able to return to training quickly.

The one thing I would say about pushing through pain is that my personal belief is that I do think there are common training-related ailments that people both create themselves and sustain. If someone always curls supinated, and chins supinated, then depending on intensity and volume we often see them develop something like elbow tendinitis. That's usually not going to resolve without a break, letting the inflammation go down a bit, maybe going to some pronated alternatives for a while, then maybe semi supinated, and then when the pain is gone you can cycle back some full supination.

Talking about back squats with a straight bar is going to trigger some people but I feel like this is another situation where the reality is there are some people out there using a straight bar and they're in a pain. I'm not the big mobility proponent, but you've got endless amounts of these guys reporting that just getting under the bar is putting their shoulders and elbows in a position where they're screaming at them. I just feel like they need to be told that it would be OK to start using an SSB more, or front squat, or some other alternative that would let them get an almost identical training effect.

I do accept the general argument about pain, causation and research, and lots of people in the industry go too far with a cautionary approach, but at the same time sometimes there are specific situations where we don't have to have a study to know what is the problem and what gives relief?

Cill94 · 09-11-2022 12:40am

https://www.boards.ie/discussion/comment/119850206#Comment_119850206

Yeah I think everyone has a seperate relationship with pain and for non-catastrophisers, the overly cautious approach may not seem like a big deal. I was more like yourself in that I was convinced any bit of pain was a signal that something was drastically wrong and that my movement needed overhauling, so I have swung quite hard in the opposite direction as I know the impact that narrative can have.

To your latter points, I'd certainly agree that not all injuries will respond well to loading! With any injury, we're basically trying to find the sweet spot between doing nothing and doing too much. Sometimes that might mean taking a break from a movement altogether or going a lot lighter than we'd like.

These days, I see treating pain as a series of experiments with load, that needs to be weighed up against how much it's really affecting you. I have some aches and pains for years that I don't really care enough about to go down a rabbit hole on. If something is affecting my training or quality of life then I chase it up.

ILoveYourVibes · 13-01-2023 8:06pm

Anyone who tells people over 50 to push into the pain is misguided. Push beyond the fatigue ..fine.

Again not giving medical advice at all in this.

Adequate medical screening is something that is not pushed hard enough in the fitness industry. Nor is training PTs to work with 'special populations' which can include anyone from people in wheelchairs to people trying to exercise after recovering from a heart attack. Obviously you need the proper training for this and to be certified etc. But its a niche area that not many pt's are trained in.

I think pain is the wrong word. Push through the fatigue doesn't hit as hard though.

Also people can be in no pain whatsoever and drop dead or pass out during training. You can have people with low blood pressure and obv you have to design a program where they dont go from the ground straight up stranding quickly.

With people with certain back issues if you know the vertebrae number etc you can give them exercises on the correct body plane. You might avoid anything on the transverse plan and get them to really brace their abs or something depending. More often than not it's not about load but plane of motions and which muscles or joints are being engaged. Sometimes injured muscles need to be extended or lengthened but not flexed and that can be painful. Sometimes injured muscles can flex with no pain at all.

Thing is not many in the fitness industry work with these special populations. And particularly marketing online is aimed at young people who are healthy.

The mainstream fitness take on pain is that it is biomechanical in nature, and something that means you're damaging your body. This model assumes that there are 'right' and 'wrong' ways to move, and that deviations from this constitute 'movement dysfunctions', which are supposedly at the root cause of pain.

Not only is this poorly supported by research, but it seems very convenient, given that the only solution in this scenario is for the client/patient to sign up for hands-on, detailed instruction from the coach/physio. They are now highly reliant on them to 'fix them

No. Here is the issue.

There are right and wrong ways to move to get the maximum benefit from the exercise. Here is also the issue. If you are taking a personal one on one that is different. But if you are taking a CLASS you dont know who else is in the class with you. The trainer has to give a class that looks after the safety and health of everyone. And you might not be aware of somethings the trainer is aware of. Even basic things regarding age /gender profile. And so you can be left going why is he /she telling me this bs..it might not be FOR YOUR benefit personally. It can be for the person who is sixty beside you. People have a tendency to think they are the only type of body that exists.

Similarly things like knee drift during squats etc CAN cause injury . A lot the studies showing that they don't are using people who have squatted for years and they have an adaptation now in certain muscles that keeps them safe to cope with that knee drift. Many pro powerlifters have technically awful stances ..it doesnt matter their bodies have adapted ..but a novice trying that stance could do real damage even with a tiny load. The reason that lets say powerlifters have the adaptation is they focus on just lifting the weight ...its not like bodybuilding. The competition is the number and if the form is competition legit they will use it. So if the competition says you can swing the weight ..they will. But that doesn't give your body the full weight nor the full good of the exercise. And you might see powerlifters in training with totally different form than competition. And even if in training they dont have perfect form they don't need it their body is so fit etc and they have adapted.

You have to remember most PTs are trying to help the GENERAL population.

Most adaptations people want to make during push ups are adaptations to avoid taking the full load and to slack off. Or their form goes awry when tired. Which is when most injuries come up.

My take on pain is ....look long term ...if your knees hurt after a workout and you are NOT a beginner that is only going to worsen with age. And in my opinion that it would be remiss not to start doing things to help yourself NOW and rather than regret it later. And very often if it is not FORM ...its more to do with offsetting the training you are doing. BALANCING the muscles. If you keep doing lateral raises for years and do no face pulls well yeah you ARE going to have shoulder pain because your training has been totally out of balance. I have had people convinced they had arthritis in their shoulders from years of out of balance training. It would pain them in bed until they cried even after they gave up lateral raises for MONTHS . They didn't understand. They had a totally out of balanced shoulder. They neglected their posterior deltoids and the shoulder joint just gets tighter and tighter. They don't need to fix their form in lateral raises or train lighter they need to train opposite and auxiliary muscle groups to strengthen those too. They need to do loaded external rotation etc.

Also culture can affect the way exercises are taught. Im qualified to teach pilates and I did a lot of dance ideally when doing pilates you keep the knees in when raising the legs laterally. However my legs tend to turn out but from the actual hip. When i was training i asked the teacher if this was ok and she asked about my history and i told her. She said for ME it's ok. Because my body has adapted like that. But for a beginner it might give hip pain. If you have trained in one area of exercise this causes adaptations for other things. If your body is comfortable then that is fine. But it might not be for the average person. But HERE is the thing pilates classes tend to attract a LOT of dancers and they ALL have the same issue. So after years it affects the way things are taught etc. Also pilates tends to attract women and that also affects things. A lot the time muscular men feel awkward some of the movements because of the lack of experience teachers have with that body type. If you have a class full of ballet dancers doing pilates ..its going to look a certain way. Gradually this changes the actual form. Its the same with all types of classes.

And here is the thing if you can't do an exercise in the correct form a lot of the time you are not getting the full benefit of that exercise and there could be something else you can do that would be better. And most of the time people are not doing correct form it's to avoid the full load or in other words they do it to AVOID THE PAIN (THE GOOD KIND) ...to make an exercise 'easier' like not going fully down on a push up (bad example maybe) .. or swinging the weight etc. I dunno its not about avoiding a chronic type of pain but trying to avoid exertion ...and even if it IS to avoid pain ...most exercises don't really do anything if you have no form

Experience brings caution. Trainers who have worked with 60 and 70 yr olds have a lot they can tell 40 yr olds and even 20 yr olds.

Are some injuries benign?? Yes. of course but as a pt you don't need to worry about that a doctor will tell you. 'Yeah sure you can train on that its grand'. And of course Drs advice is final.

Also if you find out they do have a tear etc ..you will be glad you told them to do nothing rather than gave them a workout. IMO always wait until they are given medical clearance. Then you can tell them to work through the pain. Even if it's just to avoid the insurance claim.

And insurance claims do play a part in all this. And getting someone to sign waivers won't affect any type of negligence on your part as a PT.

My humble take. Maybe not for you but there. I can see both sides.

Cill94 · 14-01-2023 11:49am

https://www.boards.ie/discussion/comment/120104845#Comment_120104845

Appreciate you taking the time to write out such a detailed response.

I disagree with basically everything you said unfortunately. I don't believe we have sufficient evidence, anecodotal or empirical, to support a lot of the claims you made here.

And to be totally transparent, I actually used to strongly hold these same beliefs myself. I coached enough people with pain that I personally didn't see them reflected by what happens in the real world. I started digging a bit and was exposed to some great experts who really highlighted the lack of support for many our mainstream ideas around movement, pain and injury.

Greg Lehman is a wealth of knowledge in this area:

https://www.youtube.com/watch?v=cnLxcEMdjVk