no brain - no gain (III)

Part one introduced this series and the limited value of complete rest for "treating" pain. Part two focused on some specifics of back and neck pain. This final entry offers a few thoughts on pain as related to high level sports performance.

One of the things that separates good from the great athletes is the ability to endure both "good" pains and "bad" pains. Pain? Yes, please. It hurts to be awesome, and we should make no apologies there.

I don't care what sport you're talking about, from cheer leading to golf (okay, maybe not golf)...to mountain climbing, neither of which I know much about. In just about everything that a 67 year old man can't easily destroy you (like golf), there comes a point where you have to decide if you want to have fun or work to get better. Even snowboarding becomes tedious, I'm sure.

The best athletes are driven. They enjoy the sport/activity so much that it's worth it for them to sacrifice a significant portion of their lives in order to be the best they possibly can be. They have consistently delivered the goods for a decade or more, and nobody was calling them "lucky" or commenting on their "freak genetics" when they were stuck at practices for three hours a day and up early for individual conditioning and skill work.

While I don't have "beef" with the pain and suffering required to achieve new heights of performance, I do have a problem with the typical training methods. If you're going to dive in and suffer in order to build a better machine, so be it. But oh, what a shame, to sacrifice and be miserable in order to stay the same or go backwards?

A recent issue of the official publication of the National Strength and Conditioning Association is a perfect illustration of the typical overkill. One article details an off-season training program for football players. The speed conditioning workout includes 4 80-yard sprints, 6 60-yard sprints, 8 40's, and 10 20's, all separated by twenty seconds of rest. And this was after 20 to 30 minutes of dynamic warm-ups and form running drills. Oh, and the training week is to include another conditioning day similiar to this as well as two to three days of heavy lower body weight training.

Are you kidding me? Are they training some kind of half human machines? This speed program definitely sounds like the work of a coach or trainer who hasn't actually done a hard sprint in a very long while.

I'm sure your typical 340-pound lineman can do 28 sprints of any distance and set new personal records in squats and power cleans the next day. I question if it's possible for even the leanest, meanest defensive backs to make it through this workout going full bore, without pacing the "sprints." Athletes who are deconditioned and in need of some leaning out may become faster. But the far majority of football players are going to be run into the ground, made literally slower and less powerful in no time flat.

As mentioned in this piece about over training, the body responds not by how much training an athlete performs, but by how much training an athlete can recover from. Every athlete is different. You don't need a PhD in kinesiology to know that these two athletes couldn't possibly both benefit from the same training program.

Probably could use some speed/conditioning focus for the demands of basketball.

Could use strength/power focus for the demands of baseball.
I believe you can and should focus on strength/power while maintaining "conditioning" or focus on "conditioning" while maintaining strength and power. But you simply cannot make optimal improvement in both. Yet is seems that we try to accomplish both, year round, training young athletes as if they're otherwise sedentary middle aged men who need to lose 30 pounds in order to compete as middle distance runners.

Pain and gain, yes, but what kind?
The typical wiry 15 or 22 year-old will never gain much size or explosive strength on an off season running protocol like the one above. They should sprint, for sure. They should train brutally hard in the weight room, and rest and recover. It's the off season, for crying out loud. Pick a goal and stick with it.

Running bleachers three days per week and being timed in the mile can be painful. Quite painful indeed. But that's far from the best way to increase vertical jump and sprint speed. There's little reason why higher level athletes should have to bench press or perform any other pressing type movement more than twice per week.

 What do I know - I'm not a coach at the high school or collegiate level. But I've been run into the ground by a few. I regularly see the consequences of the "more is better" mentality all the time. Why do young athletes and their parents jump through all these hoops with unproven overkill training methods? Am I missing something?

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no brain - no gain (II)

The previous entry made the claim that "no pain - no gain" is a half-truth. Yes, it's cool that the words pain and gain rhyme, but there's a lot of other words that end in -ain that maybe we should give more attention. Besides, you don't see wheat farmers walking around in T-shirts that proclaim in bold script "no rain - no grain!!!"

It's easy, you see?

"Well, no pain - no gain" is never an acceptable answer or motivational statement. Pain informs! Knowing a few details is tremendously beneficial to the pursuit of health and fitness.

Of course there are gainful pains associated with discomfort as well as bad pains associated with injury and regression. While the "just work it out" philosophy is rarely beneficial, it also holds potential for damage. On the other hand, more than a few days of rest is a less-than-proactive way of dealing with pain. Two weeks of rest does little to get a person moving toward their goals.

Since about 9 out of 10 people will experience varying degrees of spine pain at some point in their life, it may be good to know:

Case in point 2 - Centralization is less pain here, more pain there 

While pain in and immediately around the spine can certainly be miserable, the prognosis for short-term recovery is usually quite good. On the other hand, pain that starts to migrate away from the neck and back is bad news. Call it sciatica or radiculopathy or radiating; the tingly and numb feeling down an arm or leg, the stabbing shoulder blade or buttock pain, and a rapid onset of weakness are all symptoms of nerve root compression associated with significant spine issues. That ain't no muscle spasm.

When it comes to activities and movement that increase symptoms peripherally, no pain - no gain is just about the last philosophy you want to live by. On the other hand, positions and movements that decrease peripheral symptoms should be encouraged, even though that often comes with an increase in pain near the spine.

Lets say you do one of the simplest tests for the lumbar spine, standing and bending forward toward your toes. If ten or twenty movements in that direction cause an increase in peripheral pain or makes the back or buttock pain feel like it's migrating down to the knee or foot, avoid that direction of movement, at least for now. But if repeated bending forward or backward happens to cause centralization of symptoms (a reduction in peripheral pain or numbness), we explore that direction of movement further even if it causes an increase in central back pain.

Generally speaking, anything that causes peripheral pain gets a red light. Activities that cause peripheral pain to "move" to a more central region get a yellow light (proceed with caution). Systematically applying basic, gentle movements allows you to gradually hone in on appropriate loading strategies.

There's an art to "tweaking" the basic movements, and that's where qualified orthopedic care -ahem- comes in. The process allows us rehab people to perform manipulations and other hands-on procedures without fear of making the problem worse, as random cranking often does.

Systematic force progression sounds a lot less impressive than dramatic cracks and pops and requires quite a bit more time, but there's much less risk of harm than trying to jam that baby "back in." An added benefit is that many times patients suffering back pain can learn how to treat themselves, independently, without needing to be "adjusted" 3 times per week for 3 or 30 weeks. In the very least, clients learn how to reinforce the hands-on work of their rehab provider, which often goes a long way toward that independence.

The ability or inability to get peripheral pain to centralize is important. Researchers examine a wide range of factors involved with back and neck pain, from the patients flexibility and strength to their body weight to their work environment to their tendencies toward depression, and it turns out that centralization is one of the only things that is predictive of good long-term recovery. That's why I sometimes tell clients that I'd be happy to give them MORE back pain, especially when that goes along with less peripheral pain.

A specific type of pain = a specific type of gain. This is not cheesy 80's sentiment or the opinion of one wack-o PT. It's evidence-based medicine that actually helps someone beyond the rehab provider trying to justify endless "adjustments".

[The final installment of this series will talk about pain and sports performance.]



no brain no gain

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I hear “no pain, no gain” almost daily. The mantra comes from the lips of the frail elderly and hulking construction workers, scholars and adolescents. I nod my head with mild approval to show that I appreciate the willing spirit.

But of course there are different types of pain. I stubbed my toe yesterday and gain eluded me, other than remembering not to try walking through my garage in the dark. At least it wasn't this painful:

Beyond accidental bumps and painful mistakes, sometimes the best intention and discipline of the will may actually work against the "gain" wanted in the first place. Pain is an extremely intricate, life-saving message. No pain, no gain - insane.

Beginning an exercise regimen when you’ve neglected your body for a while is a painful decision. Then comes sweat and breathlessness, not to mention the pain of walking away from the second doughnut and taking time to plan and prepare balanced meals. But "no pain, no gain" should be put on the shelf beside "listen to your heart" and other half-truths of the 1980's.

Case in point 1 - Just need to work it out

People say this as they place one hand on the painful area while rolling the involved joint in some kind of circular motion. Has that ever worked? For very long? When is it okay to take a few Advil and just get moving? Is a few weeks off all you need?

Advil and a few weeks off will get you better until you try doing some physical activity again, which usually translates into doing a lot of nothing. It's true that a few weeks off may do the trick when an injury or issue was caused by accidental trauma. But a few weeks off does nothing to address the biomechanical issues and other factors that cause most instances of tissue overload and injury.

If running has been hurting your knees, the best treatment may be a few weeks off and then some. That allows time to strengthen the core and hips and improve mobility of the ankles, hips, and spine. It's often necessary to address soft tissue restrictions and the subtleties of running mechanics. Finally, don't go back at it without a structured plan of resuming the desired distance and frequency of running.

And then see what happens! Just stay away from the bulls, won't ya?

The next installment will provide two more illustration of dealing with pain mindfully, through common occurrences in the areas of back pain and sports performance.