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When Is Pain a Problem

By Alexander VanHouten, Master Trainer & Life Time Education Specialist

“No pain, no gain!”

Or so it’s often said in the gym….

But how true are those words—really?

When is pain an indication of progress and growth, and when is it an indication of injury or maladaptive movement?

With the holiday season winding to a close and the populace gearing up to descend on gyms everywhere, many people will seek to ramp up their existing (or nonexistent) efforts to get in shape. Unfortunately, a lot of them will be “feeling the burn” in a very bad way….

Let’s just say it seems like a good time to set the record straight about what is “normal” and adaptive to feel during and after exercise and what is not.

The Problem of Pain

In the most general sense, pain is an adaptive neurological response to a stimulus that communicates the important message to STOP doing something or to AVOID it in the future.[i]

Touch a hot stove, and you’ll pull your hand back in a flash. OUCH! You get to keep your hand intact with lesson learned: don’t do that again….

Yet, there are actions that can be painful in the moment but turn out to be rewarding in the long run. On that list among many other things are putting alcohol on a wound and engaging in a vigorous, challenging workout.

Exercise is stressful…but in a good way. Sure, it’s often uncomfortable and sometimes even painful, but it does amazing things.

But when is pushing through the pain a good thing, and when is it likely to cause injury? What about the aftermath? What level, type, intensity and duration of soreness is a good thing?

Unfortunately, there’s no easy answer.

When it comes to describing pain (or any feeling for that matter), research and anecdotal instruction both run into the same obstacle: pain is a subjective and transitory experience.

No measure can tell you exactly what you’re feeling. You have to be aware of it yourself. This means it’s difficult to measure with any objective, repeatable certainty. Not only do different people experience pain differently, but the experience of pain can differ in the same person from moment to moment. In fact, just hearing “I’m sorry, this is going to hurt a lot.” versus hearing “This might hurt just a little.” can have a profound effect on whether you even feel pain at all![ii]

Additionally, the degree of pain you experience differs based on your pain tolerance, which incidentally can be increased by exercise![iii] The higher your tolerance, the easier it is to ignore pain.

And lastly, exercise releases endorphins that mask pain perception in the body and brain in much the same way as morphine. This further complicates the problem of pain.[iv]

So, how can we then say anything meaningful about pain during or after exercise?

Let’s start by differentiating “Strain” and “Pain.”

The Difference Between PAIN and STRAIN

For our purposes, let’s differentiate good and bad versions of exericise-related discomfort.

Let’s call the good version“Strain” and the bad version “Pain,” keeping in mind the following definition: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”[v]

Pain comes from overdoing it with volume, intensity, frequency, muscle imbalances, improper form, injury (new or ongoing), underlying neurological issues, or lack of rest.

Pain is bad stress. You shouldn’t experience pain during or after your workout regimen.

Strain, on the other hand, is the uncomfortable but necessary feeling of adaptive stress related to pushing the body’s present strength, power, endurance, cardiovascular fitness, flexibility, and metabolic limits to stimulate growth, healing, and overall better conditioning. (Unfortunately, there’s no literature on that definition of strain, so let’s call it an Alex original. You’re welcome.)

Strain comes from lactic acid production and build-up, fast-healing microtrauna in muscle tissue, lack of oxygenation in the blood stream, rapid heartbeat, and depletion of ATP at the cellular level. Strain is good stress. Unless your goal is simply “to maintain” (good stress article again), strain is a necessary part of every effective workout program.

How to Distinguish Pain from Strain

Now that we have a functioning definition of good and bad stress, how can we tell the difference?

Here are some hard and fast tips.

Is the discomfort in the right place?

When you’re performing an exercise, know where you should be “feeling” it.

These are what we call primary and secondary movers. Burning, pulling, fatigue in this area during the movement or even afterward is “Strain” and occurs when you’re performing the exercise with proper form.

If, however, you’re feeling this discomfort in a different area than you should, then it’s likely “Pain,” and you should change something about your form, focus or the exercise itself. For example, during a single leg TRX squat, you should feel Strain in the quad and glute. If your lower back or hips hurt, then that’s Pain, and something isn’t right.

Is the discomfort in your muscle or joints?

Acute adaptive strain occurs in soft tissue like muscles. Strain to this kind of tissue causes fast adaptations (over days and weeks). On the other hand, ankles, knees, hips, spine, shoulders, elbows and wrists do adapt to exercise, but the process is very slow (over a period of months and years).

If your exercise discomfort is largely in these areas, then what you’re doing isn’t good for you. For example, did your running workout cause your knees to hurt? This is evidence of joint damage (Pain) rather than muscle development (Strain). Your program should be modified accordingly.

How long does your soreness last?

Delayed Onset Muscle Soreness (DOMS) is a real and adaptive phenomenon. For many, this is how one classifies a really good workout—a workout that you still feel days later.

There are a number of theoretical causes, but one thing is certain: soreness is a usual part of the package when it comes to a good-stress exercise program. How much is too much though?

Well, intensity and duration differentiate true DOMS from bad muscle pain. Up to 4 days of muscle soreness that makes normal movements (e.g. walking up stairs, sitting in a chair, rolling over in bed) uncomfortable is still classified as “Strain.”[vi]

However, anything that lasts longer than that or actually HINDERS normal movements (the difference between “It hurts to walk up stairs” and “I cannot walk up stairs) is “Pain.” If you’re in the >4 days range and cannot perform your normal functions, either reduce the intensity (weight, difficulty, tempo) of your workout or volume (sets or total time) to match your current conditioning.

Is the discomfort accompanied by swelling?

Inflammation is a natural process in the body that recruits necessary raw materials to injured tissue. However, not all inflammation causes significant swelling. It’s normal for muscles to be “pumped” during and directly following your workout in response to “Strain” due to muscle repair processes being initiated.

However, if this increased size persists after the first 24 hours, you likely have a high-inflammatory response to a greater amount of trauma than is adaptable for your body. This crosses into the “Pain” threshold.

Does the discomfort get worse with each workout?

Exercise should progressively condition your body. Movements, loads, variations and tempos will all get easier over time, allowing you to do more work or progress to different exercises. If you do the same movements and loads but notice no improvement in your threshold for “Strain,” then you’re likely causing yourself pain.

For example, pull-ups might cause a bit of tenderness near one’s elbow as the biceps tendon adapts to the load and movement of the exercise. But if the elbow never feels better while doing pull-ups or the tenderness gets progressively worse, then you’re likely developing tendinosis or worse, tendonitis (a fancy way of saying you are actually weakening the tendon over time, not strengthening it—likely due to progressing resistance or number of sets too quickly).

Fun fact: Tendons take much longer than muscle to adapt due to the much smaller cross-sectional density of living cells. In other words, if you’re getting back to exercise, just because you’re physically capable of going up in weight or number of sets doesn’t necessarily mean that your body is truly ready for it! This doesn’t mean stop. Movement is necessary for tendon repair.[vii] Instead, scale the movement to what your body is ready for!

Seek the Burn

In a recent seminar as I was applying the 7 stages of change (pre-contemplation, contemplation, preparation, etc…)[viii] to starting an exercise program, a woman in the back of the room raised her hand.

“There doesn’t seem to be a ‘I’m really looking for a way someone else can just exercise for me’ stage. Where would you put that sentiment, and how do you fix it?”

Amidst the room chuckling, the hard truth of a good exercise program is clear. Physical progress is an inherently difficult endeavor (and currently it cannot be achieved vicariously).

So, when you gear up to begin a new fitness program, be ready to endure the discomfort of good stress for the future payoff of health and vitality among other benefits.

Just work on replacing the old adage with a SMARTER philosophy for your program: “No Strain, No Gain.”

Are you interested in guidance for where strain meets pain in your workout experience? Talk with a fitness professional, who can offer his/her expertise and can help you optimize your gains while avoiding unnecessary pain or injury.

If you want to learn more about how we design our programs to support fitness and performance using our Core 3 Training™ methodologies,

Download the Core 3 Training Manual.

Thanks for reading. If you learned something new, please share the post on your favorite social media channel.

[i] “International Association for the Study of Pain: Pain Definitions”. Retrieved 12 January 2015. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage Derived from Bonica JJ. The need of a taxonomy. Pain. 1979;6(3):247–8. doi:10.1016/0304-3959(79)90046-0. PMID 460931.

[ii] Koyama, Tetsuo et al. “The Subjective Experience of Pain: Where Expectations Become Reality.” Proceedings of the National Academy of Sciences of the United States of America 102.36 (2005): 12950–12955. PMC. Web. 15 Dec. 2015.

[iii] Jones MD1, Booth J, Taylor JL, Barry BK. Med Sci Sports Exerc. Aerobic training increases pain tolerance in healthy individuals. 2014 Aug;46(8):1640-7.

[iv] http://www.webmd.com/depression/guide/exercise-depression

[v] “International Association for the Study of Pain: Pain Definitions”. Retrieved 12 January 2015. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage Derived from Bonica JJ. The need of a taxonomy. Pain. 1979;6(3):247–8. doi:10.1016/0304-3959(79)90046-0. PMID 460931.

[vi] Nosaka, Ken (2008). “Muscle Soreness and Damage and the Repeated-Bout Effect”. In Tiidus, Peter M. Skeletal muscle damage and repair. Human Kinetics. pp. 59–76. ISBN 978-0-7360-5867-4.

[vii] “Biology of tendon injury: healing, modeling and remodeling”. Journal of Musculoskeletal and Neuronal Interactions 6 (2): 181–190. PMID 16849830.

[viii] http://www.prevention.com/mind-body/emotional-health/seven-stages-change

The posts on this blog are not intended to suggest or recommend the diagnosis, treatment, cure, or prevention of any disease, nor to substitute for medical treatment, nor to be an alternative to medical advice. The use of the suggestions and recommendations on this blog post is at the choice and risk of the reader.
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