How to deal with pain during training

You’ve been training consistently for several months.  You’ve been adding weight to your squat but recently you’ve started to experience left knee pain during your squat. This can be worrisome. You might start thinking you are causing damage. Though this may be true that ,in some cases, pain is an indication of damage in many cases that is not the case.  

Pain is a warning system. It indicates that there is a potential for damage.  Back in the day we looked at athletic/fitness injuries/pain as a result of only biomechanical origins.  Your pain was based solely on the stresses placed on it.  Over the last ten to twenty years the understanding of pain has expanded. There is a “new” model of explaining pain called the biopsychosocial model.  This model indicates that pain is a multi-factorial process that is based on biological (bio-), psychological and environmental (psychosocial) factors.  

Biological factors consist of:

  1. Nociception 
  2. Inflammation
  3. Fatigue
  4. Training load
  5. Sleep
  6. Illness

Psychological factors consists of

  1. Fear/anxiety
  2. Depression
  3. Stress
  4. Mood state
  5. Expectations
  6. Past experiences 

Social factors consists of:

  1. Knowledge of other people’s experiences
  2. Reactions from others
  3. The environment
  4. Culture

If the stresses placed on the knee during a squat is significant enough and your psychosocial factors consider the stress a threat you will experience pain. 

So if you are experiencing knee pain (or pain anywhere else) in the gym what should you do?  

Don’t Rest 

Resting your knee completely until you are pain free is not recommended. Rest ultimately leads to loss of strength, muscle mass and takes you further away from your goals. If you are experiencing tendinopathies you may see no improvement once you return to activity. Also, if you’ve stopped training because you are experiencing lower back pain, rest may result in worse outcomes in the long run. It’s important to stay active.

Modify training variables

What you need to do is modify the stresses you place on your knee.  Make modifications to your workout that don’t aggravate your knee.  

How can you modify your workout to reduce the overall load on the tissue?

  1. Reduce the weight to reduce the intensity
  2. Reduce the repetitions to reduce overall volume
  3. Reduce the sets to reduce overall volume
  4. Reduce rating of perceived exertion to reduce overall load
  5. Increase the number of repetitions and slow the movement down (3 seconds up: 3 seconds down) this will force you to reduce the weight you can use.
  6. Reduce the range of motion you move the joints through.  For example some people experience knee pain at the bottom of a squat so switching to box squats may help. 
  7. You may need to  drop the exercise and try a different movement.  

Use a traffic light analogy to gauge your activity’s effect on your knees.  If you rate your pain 1 to 4 out of 10 this is a green light situation.  You should be able to perform the activity without further aggravation.  If your pain is between 5 and 7 then this is a yellow light situation.  In this case you might want to pay attention.  There is the possibility that an aggravation can occur. If you are 8 to 10 out 10 then this is a red light situation and you should stop or not perform the exercise, for now. 

Once you discover what modifications will not aggravate your knee then you can begin to slowly expose the area to greater stimulus.  What we are looking for is positive workout experiences that don’t aggravate your knees. Remember you don’t have to be pain free during this process. It’s alright to have some discomfort that doesn’t escalate during training or 24 to 48 hours after training.

Load the area and then monitor.  If there is no aggravation perform this workout a couple more times.  Again, if there is no aggravation, increase the weight.  Remember just like strength training, improvements are not linear.  There may be some days where you might have to take a step back and work at a lower load and then slowly progress forward again.  There is no benefit in being overly aggressive by continuing to increase weight even though you continue to aggravate your knee.   This only lengthens your recovery.  Lastly, understand that for some it may take several months depending on the problem you are experiencing.

Still struggling?

You may also ask yourself

  1. Are you recovering from your workouts adequately?
  2. Are you eating well enough?
  3. Are you sleeping well enough?
  4. Are there other stresses in your life?
  5. Are your fears justified?
  6. Is your training program appropriate for you?
  7. Is there enough variety in your exercise selection?

There may be other factors at play.  Seek out a chiropractor, athletic therapist or physiotherapist who can help you pinpoint training errors in your workouts or discover biomedical reasons for your pain.

Disc herniation versus Disc Bulge

What is the difference between a disc herniation and disc bulge

You just received your MRI results and it says that you have a disc herniation or disc bulge. I’m sure this might be worrisome to you. So what does this mean? 

First of all, these terms are often used interchangeably but, in reality, there is a difference between the two.

Anatomy of the disc

The discs are spacers found between two vertebrae.  They are responsible for movement between the vertebrae; flexion, extension, rotations and lateral bending. 

They are made up of the following parts

  1. Annulus fibrosus – It consists of strong fibrous layers of criss-crossing fibers that firmly attach to the vertebrae above and below.  It is responsible for holding the two vertebrae together and pressurizing the inside of the disc.
  2. Nucleus pulposus.  This is found in the inner core of the disc. It is of jelly-like consistency.  The nucleus really likes water.  It absorbs water when we lay down. This is why we are taller in the morning. That excess water is squished out when we stand up and move around. 

Disc herniation

As you bend forward the pressure on the front of the disc causes the jelly like nucleus pulposus to creep backwards.  With repetitive flexion or flexion and rotation activities fissures can form  and the layers of connective tissue can separate in the annulus fibrosus (known as delamination). The nucleus can then work it’s way down these fissures.  Over time these cracks and fissures can extend out to the periphery of the disc which causes the nucleus to herniate out into the space where the nerves/spinal cord are located.  This is a disc herniation.

Think of it like a jelly filled donut.  Take a bite on one side of the donut and the pressure squirts the jelly out the hold.  If the hole for the jelly wasn’t there the jelly would be contained and not squirt out. 

Interestingly though, when it comes to an intervertebral disc, vertical pressure down on the disc won’t cause the jelly to herniate out but bending forward can.

Disc bulge 

Disc bulges are typically age related.  As we age, the discs have less ability to hold onto water. Less water causes the disc to decrease in height and bulge outwards. 

Think of this like a deflated tire. When a tire’s pressure is less than optimal the  car will sit lower and sides of the tire will bulge out.  If the bulge projects backwards towards the spinal cord. 

Both of these situations may cause back pain when there is nerve irritation (due to chemical irritation or physical compression).  But at the same time, there are numerous people walking around right now with disc herniations or bulges who experience no pain at all.  Their herniations or bulges may be of similar size and shape as yours. So what this means is your disc herniations or bulges may just be incidental findings. 

Be aware that most disc issues get better. Even the worst disc herniations resolve; as a matter of fact they are the most likely to resolve. 

So what can you do? 

Be assessed by a chiropractor, athletic therapist or other professional who can determine what factors aggravate or relieve you.  Seek someone who gets you active, guides you towards self care and makes lifestyle modifications  to manage pain and return you to an active healthy life.

Is it alright to exercise with pain?

“I shouldn’t be doing squats because my knees hurt? “

“I’ve not exercised for several months because I have back pain.”

“I’ve stopped all of my upper body training because my shoulder hurts”


It’s okay to experience pain when you exercise.  How your body responds to that pain dictates whether or not you should continue with the activity.

When helping people dealing with pain I use a traffic light analogy to guide activity. Movement is medicine. 

My treatments help compliment movement. What I do in the office is geared towards getting you back to moving.  Pain shouldn’t stop you from being active but it may require you to modify activity.

Green light activities

It’s okay to perform activities that result in mild degrees of pain.  These activities are typically rated less than 4 out of 10 (10 being blackout pain).  You may experience mild pain after the activity but it quickly subsides within 6 hours.  It’s alright to progress these exercises. Consider a 1 to 10% increase in activity the next time you do it.

Yellow light activities

A yellow light activity is an activity that results in moderate pain. Pain is typically rated a  5 to 7  out of 10.  That pain typically resolves within 24 to 72 hours after activity. 

Continue with active rest on off days. If managed correctly and there is no major loss of range of motion or strength you can attempt this activity again.  

If you experience pain that increases 3 points above your baseline of pain, this is a flare up. You should rest, ice, continue normal activities, avoid new activities, continue to think and speak positively, and avoid negative thoughts and words. You may need to back on this activity for a bit.

Red light activities 

Red light situations are activities where pain reaches 8 or more out of 10.  There is a significant loss of range of motion or strength.  Pain after activity persists for more than a couple of days; maybe weeks. It’s time to stop the activity or modify it. 

How do I cure a sore back?

I recently received a question from someone on Klout asking the question, “How do I “cure a sore back”. Here is my response:

“How do I cure a sore back?”

It’s a difficult question to answer since there are multiple reasons for someone to have a sore back. Factors that may influence your lower back soreness may be:

Postural Strain

Staying in a stationary position for extended periods of time. For example, sitting for long periods of time. This is called postural strain.  To help with this, taking mini breaks from that position may help. http://drnotley.com/protect-your-spine-mini-breaks/

Inappropriate movement habits

If you are an athlete or are active then looking at your technique may be needed. Simply having someone help with your technique may be all that you need to take the strain off your back and allow your soreness to improve. A wonderful exercise that may be great for conditioning, like the burpee, may be detrimental to your back if done improperly http://drnotley.com/burpees-and-back-pain-my-thoughts/

Deconditioning

If you are not very active then developing general conditioning may be what you need.  I often see those who have back pain and they are very deconditioned but once they start getting active their pains diminish.

TRX suspension trainer and back pain: challenging the spine

Back Strength: Four for the Core

Unaddressed old injuries

If you have other injuries or an old injury these should be addressed. For lower backs we often need to look at spine posture during the actively, as well, as how the looking at the mobility or stability of the hips, knees, ankles and feet. If there are problems in these areas they can put added stress on the spine and cause pain.   What you may need if these is the case is exercises that will aid in increasing mobility of joints or stability.

Suboptimal health habits

Smoking (http://drnotley.com/chronic-pain-and-cigarette-smoking/), stress, and nutrition (http://drnotley.com/understanding-essential-fatty-acids/) can also cause back pain among other health issues.

Help from a professional

 Above, I have discussed approaches that require an active approach on your part.  These are very important because you are taking control of your health/pain which is very effective but there are passive methods that can be beneficial in the process.  Here are some examples

Pain referring to the back

Back pain/soreness may be as a result of other internal problems. For example, women have sore backs as a result of their menstrual cycle. A number of internal organ problems can result in back soreness.  A rule of thumb is that if you can’t find a position  or treatment that gives you relief or that there are no movements that cause added soreness then seeking out a medical doctor is warranted.

Conclusion

This is a round about way of saying that there are numerous ways to help a sore back.

Dr Notley

P.S. This list may not be all inclusive. If this pain persists seek out a Chiropractor, Athletic therapist, Physiotherapist, acupuncturist, or medical doctor.

Review of a stand up desk converter

Movement is an important part of a healthy lifestyle.  Sadly, many of my low back pain patients are suffering with adisc injury because they sit for long periods of time. For these patients I often recommend they move more, get out of their seat more, going for walks, performing back bends, etc.  To keep them productive at work, I may suggest a stand up desk.

For most companies and patients, the cost of purchasing an adjustable desk is too costly.  An alternative to an adjustable desk is having a high desk and then using a stool to quickly go from sitting to standing. But again this can be costly too.  Another alternative is to use a regular desk and have a standing desk converter placed on the desk.

I was recently asked by AnthroDesk to review one of their products; the AnthroDesk: Sliding Standing Desk Converter (Black.

** Please note that this is not an affiliate link. The product was given to me so I could do a review.  I told them that despite receiving the product for free my comments on their product would not be biased. *

Anthrodesk Standing Desk Converter Review

I would like to note that I have only had the converter for approximately 3 weeks but here are my thoughts:

Pro:

  1. It was quick and easy to assemble the converter. An Allen key is provided and no added tools are necessary. It took me 10 minutes to assemble it.  The website said it could take up to 15 minutes.
  2. Once assembled, the converter feels sturdy.  In my video you can see the monitor shake but the converter felt solid.
  3. The latches have a safety mechanism to prevent accidental unlatching.  Though this might be difficult to unlatch when needed i’d rather have difficulty unlatching than having my monitor fall.
  4. With the monitor as far back as it can and the front end of the bottom shelf right at the edge of the desk the monitor is an arms length from the user.  A general rule of thumb for monitor distance is one arm’s length from the screen
  5. At the current price (February 3, 2019), the converter is $99.99 CAD.  This is a lot cheaper than an adjustable table.

Cons:

  1. It is loud when changing the heights of the shelves. In an open office setting this might not be desirable but in an home office room this might not bother you.  
  2. At the lowest position of the lower shelf it can be difficult to get the shelf up.
  3. When moving the shelves there are moments of sticking.
  4. The support post height is limited to the heights that it can support.  For shorter individuals this will be of no use.

Other Thoughts

At its lowest position the bottom shelf will stand 1.25 inches off the desk.  If your desk is currently at the right height for your keyboard this may alter your ergonomics.

It takes approximately 15 to 20 seconds, for me, to adjust the converter up or down. This may be considered long when comparing to a fixed height desk with a tall stool which takes seconds to adjust. I also don’t know how long it takes for an adjustable desk to change heights.  I would think that if it feels even remotely inconvenient you may end up not using it at all.

I’m curious to see if the noise from my converter is just a flaw in the converter given to me or if it is experienced on others. If this is what happens on all of the devices this might not be a product that would be desirable in an open office setting or a reception area.

Conclusion

 For the price, this product is a cheap alternative, and if you don’t mind the time it takes to change the heights of the shelves or the sound then this could be a good option for a stand up desk.

Effects of Long Standing

Remember movement is the most important part.  If you think that just switching to standing all day is going to fix all your problems, long standing can have its own negative effects.

  1. Lower back fatigue and discomfort.
  2. Carotid arteriosclerosis, leg edema, orthostatic symptoms (light headedness or dizziness), heart rate, blood pressure, and venous diseases (varicose veins, chronic venous disease and chronic venous insufficiency).
  3. A number of studies have shown that exposure to prolonged standing tasks can increase the physical fatigue and discomfort reported by workers.