On Fitness: How to Train With Pain

11.06.2010 | by:

SmackOne aspect of fitness which has always intrigued me is the idea of mind over matter. More specifically, this refers to the way physical improvement drives changes to out look and perspective.

In my line of work, I have watched formerly timid individuals take on super human personas through simple acts such as reaching the floor in a push up. But while this sometimes leads to unfortunate side effects (such as crunching the abs in mirrors surrounding the gym), I have become absolutely convinced of the effects of exercise on every aspect of life.

Unfortunately when dealing with injury, this seems to be a two way street. Much like a vampire acting on the mind, I have watched the confidence drained away from even the most resilient exercise seekers by a bum knee, shoulder or back.

Though most injuries only involve one area of the body, the conventional wisdom is to cease all activity in order to “recover”. But while this strategy may work for the area in question, the effect of inactivity on the rest of the body– from a general weakening of muscles to the development of chronic stiffness and pain– could not be more opposite.

From a physiological perspective, a quick resumption of exercise is absolutely essential to improved blood circulation and maintaining strength of injured tissues– the question is where to begin?

In this article, we will explain the key steps to managing acute injury and strategies for training around various issues.

R.I.C.E.(Healthy food for thought)

In the presence of injury, the first response by the body is to initiate swelling and restriction of the injured limb or area to reduce further potential damage. Generally this process takes around 24 to 72 hours and is necessary to initiate the healing process.

With that said, too much or chronic inflammation can also complicate healing and a big part of managing acute injury is limiting this process while immobilizing the injured area. This generally involves a four step process:

• Rest: If you are injured, stop playing, get medical attention if necessary and rest. Resting an injury is important immediately after injury for two reasons. First, rest is vital to protect the injured muscle, tendon, ligament or other tissue from further injury. Second, your body needs to rest so it has the energy it needs to heal most effectively.

• Ice: Use ice bags, cold packs or even a bag of frozen peas wrapped in a thin towel to provide cold to the injured area. The best rule is to apply cold compresses for 15 minutes and then leave them off for at least 20 minutes.

• Compression: Compression helps limit and reduce swelling, which slows down healing. Some people also experience pain relief from compression. An easy way to compress the area of the injury is to wrap an ACE bandage around the swollen part. If you feel throbbing, or if the wrap just feels too tight, remove the bandage and re-wrap the area so the bandage is a little looser.

• Elevation: Elevating an injury reduces swelling. It’s most effective when the injured area is raised above the level of the heart. For example, if you injure an ankle, try lying on your bed with your foot propped on one or two pillows.

After a day or two of R.I.C.E., many sprains, strains or other injuries will begin to heal ( if your pain or swelling does not decrease after 48 hours, make an appointment to see your primary care physician).

Once swelling has subsided, the next step to returning to exercise with the injured area is understanding the movements which may provoke pain and alternative strategies for strengthening.

While by no means a comprehensive review, included below are a few tips and substitutions for returning to fitness in a safe and effective manner.

1. Back pain

In looking at acute and chronic back problems, the most important issue to understand is the direction of movement which provokes pain. Flexion based movements– such as full squats, crunches, bending over and prolonged forward flexing over computer screens and steering wheels– are often the culprit.

Extension based movements– such as running, dead lifting, planks and activities which cause the back to remain arched (think walking in heels and sitting upright at a computer) can also be at fault. In either situation, a simple test to determine the cause of pain can be performed by reaching down to touch the toes. If you feel pain reaching down, pain is cause by flexion. If you feel pain on the return to standing, pain is caused by extension.

In either situation, the key to getting around the injured area often lies in single leg training. Exercises such as step ups, split squats and lunges involve less spinal loading and are often an excellent way to strengthen stabilizer muscles around the injured area.

In our first video, we demonstrate a simple test to determine painful movement and few alternative choices for each issue.


2. Knee pain:

While knee pain results from a number of different causes, the ultimate result is often limited flexion of the knee. In terms of exercise, this means avoiding movements such as lunges, step ups, conventional running and squatting to parallel– at least initially.

One symptom we often find in individuals with chronic knee pain is the tendency to bend from the knees versus the hip. To understand this concept, squat down as far as possible and watch the position of you’re knees while descending. Do they remain over the toes or flare out if front?

If you can no longer see the toes upon reaching the bottom, this means the knees are bearing the brunt of stress during most daily activities and exercises. The solution to this problem lies in learning to bend from the hip and focusing on exercises which utilize the hip as a hinge.

In our second video, we explain some key posture fixes for knee pain and how to modify virtually any lower body exercise with this strategy.


3. Shoulder pain:

As the most moveable joint in the body, the shoulder is also susceptible to a wide variety of injuries. One of the primary causes of pain with exercise are shoulder separations– which involves a separation of the two bones connecting the shoulder–with movements which reach across the body.

The other major culprit in shoulder pain issues are shoulder impingement syndromes in which the space between the shoulder joint and tendon is reduced. This condition leads to a fraying of the tendon and the inability to perform exercises overhead.

Though both present serious risk for exercise, each issue can be safely managed by focusing on exercises such as push ups, band rows and presses which are performed in a front to back motion.

For our final video, we demonstrate two simple tests to pinpoint the problem and along with exercise alternatives for each condition.


Creative Commons License photo credit: ::hap

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