Understanding Pain: An Essential Part of Life - Part 2

Welcome back!  We’ll cover the last 3 influences of pain today and give you the tools to turn what most people think as a negative feeling to a positive change!  If you haven't yet, don't forget to check out Part 1!

3. Your Nerves (Peripheral Sensitivity)

This is very similar to what happens in the brain, but instead of the central computer being the culprit, the nerves are the culprit.  Just like how the brain can become too sensitive to stimulus, so can the nerves.  This is why shaking your hand after jamming your finger can help with pain by changing the input.  However, as you know, the relief in pain you get from this is often temporary.  And that is is okay.  

The main intent of getting some manual therapy or doing a self-mobilization is to generate a temporary relief in order to provide a window of opportunity to instill real change.  

How does this real change occur?  

Movement! (See Part 1.)  

Starting to get the hang of this?  If we can decrease the perception of pain through a healthy stimulus, like foam rolling, to decrease the sensitivity of the nerves, then we can capitalize on this with specific exercise and education to make this effect more permanent.  

4. Your Feelings (Emotion & Memory)

Both body and mind can have a really hard time forgetting pain.  We tend to make more permanent memories to events that invoke a strong emotion.  This is why it’s hard to remember what you ate breakfast yesterday, unless your yogurt and granola really moved you, but you can still remember your first break up, even if you are not personally invested in that event anymore.  Furthermore, negative emotions and memories tend to stick around longer (we learn better from our failures, as long we can let go of them at some point).  

So what does this have to do with pain?

Let’s say at some point, you reached below your sink and threw your back out, and were in terrible pain for 2 weeks.  You took some Advil, rested in bed and it went away (or did it?).  Now every time you bend down to reach low, you slowly get down on one knee and place your hand on your back to make sure it doesn’t move, effectively changing your movement patterns.  Anytime you lose this “perfect” position, you a get a little twinge in your low back as a friendly reminder, keeping you stuck in your pain cycle.  The initial event of reaching below your sink was just the straw that broke the camel’s back, exposing a possible dysfunction in your movement.  

Without addressing the cause of the dysfunction and simply avoiding the related movements of bending (due to the strong emotional tie you have to the memory) you end up feeding the issue even more.  

Again, this is why it’s so important to be properly educated on healthy movement and how to gradually reintegrate it through exercise and manual therapy.  Are you starting to see how all of these things tie together?

5. Your Stress (Mental & Physical)

Last but not least, everyone’s favorite... STRESS.

We need stress to change us for the better, but in controlled, healthy amounts.  When stress exceeds your limits, it can have a significant influence on many aspects of your life.  Stress does not cause pain but boy can it increase it.  Good inputs will always equal good outputs.  

So if you’re overtired, overworked, dehydrated, eating poorly, and under emotional distress, will you be able to:

Move well?

Stay focused on a goal?

Understand good from bad sensations in your body?

Use your past memories to inform your current experiences?

Limit inflammation in your body?

Recover after workouts?

Probably not.  

Stress can be one of the most difficult aspects of life to manage and control, and it’s individual from person to person.  What is important is to recognize when you need help controlling stress and whom to seek for assistance.  

If you train with us here at AMP Fitness, a good place to start is with one of the coaches.  We’re dedicated to you living your best life and even if we can’t specifically help with your issue, we can usually point you in the right direction.

Bottom Line

As you can see, pain is not that straight forward.  This is why the “pain industry” can range from mattress stores to pharmaceutical companies to sensory deprivation tanks to physical therapy.

I’m biased, of course, but I would say that the best place to start is physical therapy.  A skilled physical therapist can address all the issues above and all at the same time.  And not only will you have a good chance of feeling better, you will have the tools to continue progressing well after you are done with your PT visits.   

That said, I don’t see myself in the “pain industry” but rather in the “human movement and performance industry” based on its far reaching effects into improving people’s lives, function, and well being.  It just so happens that optimizing human movement, performance and mindset.... you will also do a good number on pain.

Understanding Pain: An Essential Part of Life - Part 1

"Why Am I in Pain?"

A simple question with a not so simple answer.  As a physical therapist, I hear many questions from patients, clients, friends, family, etc. about the nature and cause of their pain.  They equate pain to tissue damage (think the scary words: strain, sprain, tear, arthritis, cartilage damage, degeneration, bulging, etc), but I’m here to tell you it’s much more than that....and not always that scary.

Pain is simply a signal from the brain that tells you there is a problem.  It often doesn’t tell you the source or cause of the problem, just that there is a problem and something needs to change.  This is why there can be discrepancy in MRI findings for people who are in pain.  For every person that has knee pain with a meniscus tear,, there is also a person with knee pain that has a normal MRI and a person who has no pain but has what looks like shredded cheese for a knee on an MRI.  Many studies demonstrate this, especially in the low back.  In a study of individuals that had no back pain, 80% of 50 year olds had disc degeneration (whoa).  

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So what’s the deal? What causes pain if tissue damage and imaging findings are unreliable? It’s not so much what causes pain, but what influences pain.  More often or not, we can not change our anatomy, so we need to focus on the factors that we can control to help influence pain.  Below are the top 5 influences on pain that you can take control of today.

Note: Many of these influences play off each other, since nothing lives in isolation.  This is good news, because you can hit a lot of them together.

1. Your Movement Patterns (Mobility & Stability)

Every time you walk into AMP, you’re addressing this!  Proper training and exercise should target good, healthy, quality movement.  This is why we spend so much time on warming up, positioning, proper mechanics, breathing, mobility, stability, etc.  Your body craves movement and variability, allowing it to disperse physical stress evenly across your joints and muscles, making everything feel happy and healthy.  

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Pain will typically creep in when movement patterns become faulty because of mobility (I feel stiff!) and stability (I feel weak!) problems.  Stress will accumulate too much or too quickly at a specific area of the body causing pain and/or tissue damage (yes, this can still be the source of pain, but may not be the cause).  Luckily, if you catch these movement issues early, they can be a quick fix.  Some issues can be corrected through simple cueing and exercise modification by a strength coach, while others may require more hands on work from a clinician.

2. Your Brain (Central Sensitivity)

Here’s where we get into the fun stuff.  Pain is a perception generated in the brain.  It’s not tangible or measurable in a true objective way.  This doesn’t disqualify it as real but rather speaks to the power of perception and the role of our brain.  When our brain sends a pain signal, it’s often for a valid reason, but sometimes it’ll send a pain signal without a good reason.  I’ll use the home security analogy to explain this:  

Your body is the house and your nervous system is the home security system.  When an intruder breaks in the window or door (nerves) will trigger the computer (your brain) to set off the alarm.  Normally, you would reset the alarm once the ordeal is over, and normal entry to the house will not set off the alarm.  With chronic pain (pain lasting > 3 months), imagine that multiple break-ins happen over the course of a few days/weeks and the central computer is never reset.  Not only will the alarm go off every time an intruder enters, but even friends, family and your own self will start to set the alarm off.  The brain becomes too sensitive to input, regardless if it’s bad or good, and the pain sensation becomes more and more heightened.  It becomes harder for you to differentiate what makes the pain worse or better and you get caught in a pain-cycle.

How do we address this?

Well, we start through proper education of how this occurs and reintegration of healthy movement (see #1) with your physical therapist and then coach/trainer.  If you know why you’re doing what you’re doing and understand it’s role in establishing improved patterns, you will not only change your movement but your brain.  It’s a lot easier and more effective to exercise and stretch when you know why you’re doing it and what the goal is.  The brain will begin to desensitize to healthy stimulus, tissues will heal, and you’ll regain control of your pain.

To Be Continued...

Whoa, okay let’s take a break.  That’s a lot for just two points.  We’ll cover the last 3 in Part II next week, but between now and then I want you to think about how you use your movement and thoughts to your advantage in controlling your pain.  Pain is an essential part of life.  It can be a positive if we learn to accept the negative and use it to change.

Like it? Check out Part 2!

Negative Mental Habits...and How to Flip the Switch (Part 1)

Mindset is hands down one of the most overlooked and under appreciated components of any health and fitness program.  It can also the one factor that is totally cock-blocking you from getting optimal results from your training program.  The good news is you can totally change your mental habits! Building strength and fitness gains is the easy part.  You just have to show up, be consistent for a period of time and then, well, continuing to show up and do work.  Changing your mindset, on the other hand, is a challenge. It takes time, forces you to look inward, and really think.  For most, those things are painful and difficult since it requires work and changing deep seated beliefs.

By focusing on your mindset and facing your negative mental habits you will not only turbo-charge your fitness results, you will find it spirals out into your motivation, confidence, happiness and success in all areas of your life.  And that shit is f*&king cool!

Here are some big rocks to help you get started on flipping the switch on some possible negative mental habits.

1. Neglecting Process-Based Goals

 

Generally, when most people begin a new fitness or training program the big focus is on an 'outcome' based goal.  Things like:

"I want to lose 20lbs."

"I want to be able to squat double my bodyweight."

"I want to become the next American Ninja Warrior."

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Outcome-based goals describe how we want things to be at the end of the process and to be clear, there is nothing wrong with that.  But we can't stop there because what they are missing is everything that happens in the middle.  They are good enough to get you started but in most cases won't keep you motivated to continue on that journey.  The problem is most outcome based goals can change frequently and tend to be vague which can quickly derail motivation.

Have you ever started with one of these type goals in mind and found your motivation waning after about a week or two?

The truth is that we can't always control outcomes because there are way too many factors that can (and will) affect the outcome.  It can be external things like you get too busy busy at work, start dating someone new, have a baby, or decide to join the cast of Hamilton.  It can also come from internal factors like lack of sleep, getting sick, or your hormones changing with age.

Flip the switch

Instead, get into the habit of setting 'process-based' goals to focus on what you can control.  These are the things you can do daily to move toward an outcome goal AND that you have more power over.  They are infinitely more effective to maintaining motivation since it's easy to build momentum and have small wins daily.  Focusing here WILL get you where you want to go if you have patience.  You'll be much happier along the way, too!

These small daily things like scheduling your time to train, work on your (insert exercise here) to get better, or eating fruit for dessert instead of sweets 3 times per week.  There are literally billions of these tiny habits or process-based goals you can set to help you build up your ninja skills daily to become a better version of your already sexy self.

2. Having a Chronic Case of the 'Shoulds'

"Comparison is the thief of joy." - Benjamin Franklin

This is something that affects all of us at one point or another and is a mental habit that prevents you from enjoying where you are now.  Feeling like you 'should' (insert quality here) is an externally imposed expectation that can easily cause a mixed bag of feelings such as frustration, anxiety, anger and depression to emerge.  Here are a few examples:

"I should be more jacked-er than I already am."

"I should be able to deadlift as much as Drake."

"I should workout more."

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These statements are ultimately causing you to compare yourself to someone else or some cultural ideal of what is "good" behavior.  The problem is that it doesn't take into account whether or not it is exactly what is "right" for you, right now.  This can be especially harmful to your ego and how you feel about yourself.  (And, yes, you ARE awesome, by the way!)

Flip the switch

Instead, get into the habit of focusing on where you are now and just working to get a little better every day.  Ultimately, this will unlock your true potential and help you become the best version of yourself.

This has been a big one for me, personally.  What I have found that helps when I get a bad case of the 'shoulds' I like to remind myself of these 3 things:

  1. All the hard work that has got me where I am.
  2. I am doing everything I can to get a little better each day.
  3. Is what I think I 'should' have really what I want.

To Be Continued...

Those are 2 BIG mental habits to get started working to start nailing your health and fitness goals and generally being happy AF with the process.  Stay tuned for Part 2!

Know Pain, Get Gainz: Deadlifts and The Low Back

Welcome to the 2nd installment of Know Pain, Get Gainz!  In this series, I'll be covering different topics that will help you bulletproof your body and keep you injury free.  First up is the low back since it is a frequent topic for those who spend their day doing epic things...from a desk. Since this can be a broad topic, I want to start by answering a question I get frequently as a therapist:

“My low back feels stiff and sore after deadlifts, is that okay?”

Like anything...it depends.Deadlifts

Stiffness or soreness in your lower back muscles may occur from training hip hinge patterns (think deadlifts, kettlebell swings, Romanian Deadlifts, etc.).  This can seem like a normal response to exercise, as the muscles are responding to overload and adapting to get grow stronger.  If the same thing happens to my biceps after curls, than this should be good, right?  Not quite; when it comes to the low back, this is generally not a desired sensation from training.

If we apply one of the concepts I outlined in Part 1, we can answer this question logically:

Location of Pain + Exercise Selection

When we select exercises at AMP Fitness, we are typically targeting a specific movement.  This movement is produced by a muscle or muscle group called the “prime movers”, and supported by other muscles called “stabilizers”.  We can expect the “prime movers” to get sore after exercise because they are doing most of the work.  The “stabilizers” will typically feel fine because they were just simply not as taxed.  In most cases, the low back muscles are stabilizing during strength movements and should not experience soreness after exercise.  We will use the deadlift as an example:

To deadlift a kettlebell or barbell, you must stabilize your trunk and use your hips to produce an opposing force through the ground to lift the weight up.  The gluteus maximus (aka your butt), the strongest hip extensor in the body, is producing most of the force and acquiring most of the stimulus during this exercise to extend your hips (eg stand straight up).   Therefore, the glutes in this case are the “prime mover”.

Because deadlifts are typically trained in low repetitions, and there are many stabilizing muscles assisting during the movement, your glutes may never feel sore after deadlifts.*  This does not mean your low back should get sore though.  During the movement, your spinal extensor muscles are working hard to prevent your low back from rounding, providing a stabilization force through the spine.  This is great, because a rounded spine during deadlifting can get us into trouble over time.

*Trainer Note: Soreness in a muscle group is not always a reliable indicator that you had an effective training session.  Muscle adaptation can occur at many levels, and change over time depending on your training experience.

Using the Wrong Prime Mover....

However, when we change the role of the spinal extensors from a “stabilizer” to a “prime mover”, we can start experiencing stiffness or soreness in the low back.  The spinal extensors will never be as efficient as the glutes at producing an extension force, purely based on muscle shape/size and joint mechanics.screen-shot-2016-09-12-at-3-43-32-pm

This role reversal can occur during deadlifting due to decreased abdominal contraction that is needed to offset the extension forces occurring at the low back (why we use the cue: “ribs down”, “squeeze your abs”) and/or pulling from the back and not pushing with your legs (why we use the cue: “squeeze your butt”, “push through the floor with your feet”).  When these imbalances are corrected, you’ll be working your butt off instead of your back.  Pun intended.

 

Exceptions!

There are some scenarios where low back soreness can be unavoidable from deadlifting, but it’s typically short term.

Beginners

Beginners may experience a stiff low back the first time after performing a deadlift session, based on the fact that the stabilization force produced by the spinal extensors was enough to cause an overload effect on the muscle.  However, as the glutes gets stronger, and the low back adapts, this should go away after a few sessions.

Occasional #BeastMode

Typical training occurs at sub-max effort, allowing for good technique, skill acquisition and healthy adaptation, a.k.a. getting strong.  However, every once in a while we might push ourselves beyond our limits, either on purpose to test our maxes, or from feeling a little to adventurous with weight and reps.

When we’re working towards a true heavy maximum, technique can get a little shaky and the shear amount of load can provide a brand new stimulus.  The same holds true if you start to push the amount of weight and/or reps of an exercise without proper progression, causing fatigue and poor technique to set in.  The good news is that we can control most of this through good programming, but every once in a while (read: about 1-2x/year) it’s okay to test our maxes and allow some rest to recover.

Bottom Line

The role of your low back muscles are to stabilize your low back from rounding during a hip hinge movement.  Stabilizers typically do not get sore, unless they are relatively new to training, have been pushed beyond their limit, or are being used as movers.  Don’t fret though, we’re here to help you with this!  Movement can be optimized through hard work, consistency, and a little coaching.

Knowledge is power, so don’t hesitate to ask any questions!  Keep getting after it, and keeping living your best life!