Understanding Pain And Working Out: “Should I Continue To Exercise?”

One question that surely almost every person who is active has asked themselves is, “why is that hurting?” or “is that supposed to feel that way?”

As humans, we are inevitably going to feel things that are outside of our normal. We are going to have pains that come seemingly with and without reason and we are going to have concerns about these perceptions, sometimes due to lack of information, fear, assumptions, or misinformation. We are here today to attempt to shed some light on one of the most common questions that we at The Movement Dr get asked; “Should I keep training with XYZ?”

The Association Of Pain With Tissue Damage

There is a common pitfall that athletes and the general population fall into when considering pain while training, and this is the issue of thinking of tissue damage and its relationship with pain. The classic thinking is that each pain or symptom that is experienced must have a root cause or something that it is physically related to. This is easy enough to reason through as our experiences in the past have led us to believe that there is a direct relationship ie. hot stove with a painful burn.

As we have written about in the past, there is not a great connection between tissue status and symptom presentation, which is the main rebuttal that we have to the concern that exercising through pain will cause further tissue damage. The thinking is that the pain is coming from tissue status change, and while we can’t say that there has been no change in tissue status unless there is trauma (dropped a 45lb plate on your toe) or something hanging off of you (your toe), then we can lean on the extremely low injury prevalence that strength sports boast (as low as 2.4 injuries per 1000 hours and 1.0 injuries per 1000 hours in weightlifting and powerlifting respectively)¹ to err on the side of confidence that what you are experiencing is likely not a tissue status disruption.  

Understandably, this assumption is then applied to pain or symptoms while working out. It gets assumed that because we are training at a moderate to high intensity we are at a higher risk of injury. Luckily, the very activity of training, more so resistance training than aerobic, is exerting a protective/ risk reduction mechanism onto us, meaning that the act of training is helping us to decrease our risk of injury. 

A 2018 study by Lauersen et al looked at a body of evidence regarding resistance training and its protective effects during sport. With over 7700 subjects, the study concluded that resistance training “demonstrated a dose-response relationship between strength training and sports injury prevention. In addition to being very safe, these interventions have—through more than one mechanism—proven prevention results seldom achieved by other exercise interventions or fields of medicine.” This is great news as it speaks to the safety of resistance training itself as well as the overall protective effect it has on other modes of training and sport!

Assumptions About Form

The idea that a perfect form exists, for any of the exercises that we perform on a daily basis, is one that is deeply ingrained in the fabric of our culture. Constantly there is input from multiple data points about “lifting with your legs” or “sit up straight” or “keep your abs tight when you lift overhead”, which all play into our ability to think about and judge movement while in the gym. These thoughts translate into concern when movement from ourselves or others “doesn’t look right” because it does not match our expectations and can get even muddier when these movements coincide with pain, whether they be actual coincidence or not.

If you will, think about the origin of exercise. The way that those people long ago, before Gold’s Gym and LA fitness, developed gym equipment, and thought about working out is the creation point and direction that training went from thereon. If barbells were shaped like the letter S and med balls were filled with water, training might look much different than it does now. A good example of a seemingly double-edged sword in regard to low back position in certain movements is the comparison between the deadlift and the atlas stone lift. One is coached with a flat back, conventionally thought to stabilize the spine to make sure that all that weight wasn’t being pulled with the spine itself, and the other is coached with a very flexed spine, so as to be able to grip the stone from almost underneath it prior to getting it up onto the thighs. Both are done at the extremes of intensity and by amateur and elite athletes, and both are accepted within those cultures. There isn’t a warning from the CDC however that no one should be doing atlas stone lifts due to spinal explosion. 

A better way to think about form is that it is goal-oriented and can be done to meet a certain goal in more efficient ways than others, as well as can be tailored to individual body types and shapes, relating back to efficiency. With appropriate load management, humans can adapt to a wide array of stimuli.

Expectations Influence Outcomes

Without going down the rabbit hole of our reality being shaped by predictions and expectations as well as learned responses and prior experiences, let’s relate the former two sections back to training and pain. 

Fear of tissue damage and paying too much attention to form fall into categories of kinesiophobia and hyper-attention/perfectionism, both of which are things that can bring on less than ideal situations while exercising. 

Kinesiophobia is the fear of movement, and a 2018 study found that “a greater degree of kinesiophobia is associated with greater levels of pain intensity, pain severity, and disability as well as lower quality of life.”² How this relates tissue damage and expectations come from considering the fear of completing a movement or participating in an activity due to fear of tissue damage. Confidence and feelings of self-efficacy are important when considering pain and sport. When there is a chink in the armor, like fear of completing a movement, it can become problematic and should be addressed with a coach or provider. 

Perfectionism is defined as “a personality disposition characterized by striving for flawlessness and setting exceedingly high standards of performance accompanied by tendencies for overly critical evaluations of one’s behavior”³. Perfectionism falls along similar lines in that there is a concern that something about a movement or a performance is less than perfect. This can open a trainee up to chronic stress as well as decreased confidence in said movements due to not meeting their unrealistic expectations. 

In our practice, a large part of our therapy and rehabilitation is helping our clients have realistic expectations and develop their confidence and independence so they are not afraid. 

When Not To Train

There are very few reasons to completely rest or stop exercise. For the most part, there is always a level of activity that can be sustained while nature does its thing and shuffles you back towards your baseline. This baseline can be as low as doing activities in bed, going for a walk, performing bodyweight exercises, or modifying activities slightly away from what you were going to do. 

One time that it is ok not to train is if you personally do not feel comfortable or safe doing whatever it is you were intending on doing. Confidence in your ability to complete a task not only decreases the kinesiophobia associated with that task, but it also helps with keeping the consistency of working out higher so that you can continue to work out over time. If you are fearful that things aren’t going to go as you plan or that you are going to injure yourself, it might be a good idea to reach out to a professional or a coach to help give guidance, as it’s difficult to see the issues in our own planning and thinking. 

If you are not sure how to continue working out or any activity, contact us and we can help you.

At The Movement Dr., we can help you if you are struggling with your expectations, fear while exercising, understanding the integrity of your form, or even knowing how to train or whether you should be working out. We believe in educating our patients and helping them to be independent. Our methodology allows us to address and set realistic expectations, become (or realize you are) self-efficient, and help you navigate training and continued activity. 

References

1. Aasa U, Svartholm I, Andersson F, et al. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med 2017;51:211–220.
2. Luque-Suarez A, Martinez-Calderon J, Falla D.Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med Epub. . doi:10.1136/ bjsports-2017-098673 
3. Daniel J. Madigan, Joachim Stoeber, Dale Forsdyke. Perfectionism predicts injury in junior athletes: Preliminary evidence from a prospective study. JOURNAL OF SPORTS SCIENCES, 2018 VOL. 36, NO. 5, 545–550 https://doi.org/10.1080/02640414.2017.1322709