1. What is pain?  Our understanding of pain is rapidly evolving.  What you MUST first understand is that we as a modern society in 2018 DO NOT FULLY UNDERSTAND PAIN. What we do KNOW, is that the old model of “pain = tissue damage” is outdated and is only part of the picture. For the most part Pain can be categories into 3 main categories  Nociceptive pain- pain arising from tissue damage, Neuropathic pain- pain arising from damage to the nervous system itself, Other- includes many other types of pain which are not well understood (fibromyalgia, chronic low back pain, psychosomatic causes of pain, etc)
2. 1. Nociceptors are nerves that detect  potentially harmful stimuli in various tissues throughout the body and transmit the message to the brain
   2. The brain receives this message and creates a subjective experience that we call pain.
   3. “Pain is predictably unpredictable, thanks to brains. Regardless of type, all pain is weird in some typical ways, because it’s all under the total control of our brains,7 and brains have complicated and conflicting priorities for us that we are oblivious to.8 The result is that pain is often weird, a somewhat paranoid guess about how much danger we’re in, and that’s when everything’s working correctly.”

Understanding these basic principles of pain science can help you to interpret your pain with curiosity and contemplation instead of fear.  Remember the common saying “correlation does not imply causation”. If you are dealing with pain during movement or exercise it’s a safe bet that your pain is CORRELATED to something going on the tissues (damage, wear and tear, poor movement pattern) but not necessarily directly caused by.  As tacfit master instructor Gwint Fisher says “pain is a sign you are doing something wrong”  If we can embody this attitude we can then move on on to step 2.

2. Challenge Perception and Build Confidence

One of the simplest and easiest things you can do if you are experiencing pain during a movement is to SLOW DOWN, breathe and not panic.  The human body is resilient and strong, it has stood the test of time. A little twinge of pain during a squat doesn’t mean you’re broken, that twinge is information that can be used to prevent further pain, NOT BY IGNORING IT, BUT ALSO NOT BY RUNNING AWAY FROM IT, but instead by breathing, modifying, and regressing.  

Often pain can arise during a movement we perceive as dangerous.  Maybe it caused us pain in the past, maybe we have been told its injurious and, maybe it looks scary and induces fear.  As super common example I keep coming back to is knee pain during squatting. I had a client once who reported high levels of pain during a bodyweight squat.  Even with reassurance that we would progress slowly, she panicked and reported pain on the first rep of a bodyweight squat. That day I decided to shift gears and do a more primarily upper body training session.  2 days later she came back and I had her play a game which involves carefully positioning a dowel rod upright, then reacting quickly to catch it just before it hits the ground. 10 minutes into this game, I observed this client, not only squatting, but also lunging, twisting, and hinging with vigor and speed.  I brought this to my clients attention and asked her if she was feeling any knee pain, there was ZERO PAIN.

So how is it that this client who couldn’t perform a bodyweight squat INTENTIONALLY, was able to not only  squat but also twist, lunge, hinge, all with half hazard form without realizing it. It all boils down to perception and fixation.  She had a deeply held belief, either conscious or subconscious that squatting would hurt her knees, but as soon as she was fixated on the objective of the game she felt no pain at all.  This realization helped her move past her fear of movement and to build confidence which in turn leads to better movement.

3. Breathe (exhale the pain away)

One of the simplest and easiest things you can do if you are experiencing pain during a movement is to SLOW DOWN, breathe and not panic.  The human body is resilient and strong, it has stood the test of time. A little twinge of pain during a squat doesn’t mean you’re broken, that twinge is information that can be used to prevent further pain, NOT BY IGNORING IT, BUT ALSO NOT BY RUNNING AWAY FROM IT, but instead by breathing, modifying, and regressing.  

In conjunction with this, we also used a specific breathing technique to stimulate a parasympathetic response (rest and digest mode) and mitigate the sympathetic response (fight or flight) which in turn dampened her pain response.  

This breathing technique applied to the squat was as follows.

1. Make several slow breaths with emphasis on slow and complete exhale
2. Time the slow exhale with the descent of the squat
3. Time the deepest point of exhalation with the deepest most provocative knee angle of the squat.  HOLD at the bottom of the exhale for 3-5 seconds if possible
4. Gentle belly inhale while pausing position
5. Deep slow exhale while rising out of squat, ending with complete exhalation, and pause with empty lungs at the top
6. Repeat for 5-10 rounds
7. Assess the level of pain you are experiencing.  If pain has completely disappeared continue the workout as planned.  If pain has decreased but not dissipated completely then regress to a simpler, easier version.  If pain has not decreased at all or has increased, then cease doing that movement for the day and look into other options.

4. Check your Mobility

Mobility is an umbrella term that describes one’s ability to articulate a joint through a range of motion. Different than flexibility which just implies passive range of motion, mobility requires that you actually have strength through the full range of motion of a joint.  An example to illustrate the difference between the two would be comparing an active straight leg raise to a passive hamstring stretch. For the active straight leg raise you will lie on your back and see how high you can raise one leg while keeping knee straight and the opposite leg flat to the floor.  Take note of how high you you are able to lift your leg, THEN compare to how far you are able to take your leg when you actually grab your leg with your arms and pull it towards your chest. A good rule of thumb is to try to narrow the gap between your active mobility and your passive flexibility.

Certain joints are designed to be more mobile and other joints are designed to be more stable.  However, due to stress, modern lifestyle, and chronic wear and tear we often lose mobility in the joints designed to be mobile and compensate with excess movement in joints that are designed to be more stable.  If we look at the model above, we can see that the hips and ankles are both mobile joints sandwiching the knee which is a stable joint. Many knee injuries and instances of knee pain can be attributed to poor mobility in the ankle or hip thus leading to torque and improver tracking of the knee joint.   

What do you do about, improve your mobility, particularly in the joints labeled as mobile in the model above.  If you want to get even more quick and dirty just improve the mobility of your hips, and thoracic spine and you’ll be well on your way to better movement and less pain.

5.  Strength Train

The benefits of strength training are numerous ranging  better joint stability, increased bone density, reduced chance of injury, better running economy (efficiency)  and more. There are many tools and many styles of strength training, some more effective than other, but make sure you doing something.  Whether it’s with a barbell, kettlebells, TRX, machines, or just your own bodyweight. Challenging your musculature with resistance training not only strengthens your muscles but also your ligaments, tendons, and even your bones. This makes it less likely that you’ll injure yourself, and also leads to better quality movement.

References:

https://www.painscience.com/articles/pain-types.php

https://www.youtube.com/watch?v=E0uDOjze010

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1151654/