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.

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. 

Winnipeg Chiropractor: What you need to know about a migraine

A migraine can take a lot out of you. Frequent migraines can negatively impact your quality of life. They affect the ability to maintain/develop fitness, the ability to work and the ability to enjoy relationships with family or friends.

So how do you know if you are experiencing a migraine?

The classic migraine is a migraine with aura. People who experience these migraines may experience warning signs hours or even days before the headache. These signs might be:

  • Food cravings
  • Feeling “hyper” or cranky
  • Experiencing fatigue and yawning more
  • Feeling stiff in your neck
  • Need to urinate more often
  • Get constipated or have diarrhea

If an aura occurs, not everyone experiences one, the aura tends to develop over time. The development of the aura is not quick. It typically takes more than 4 minutes to develop the aura. In addition, You may also experience more than one aura in succession.   Within 60 minutes after developing an aura the headache pain begins.

Examples of migraine aura include:

example of visual aura
  • Visual phenomena, such as seeing various shapes, bright spots or flashes of light
  • Vision loss
  • Pins and needles sensations in an arm or leg
  • Weakness or numbness in the face or one side of the body
  • Difficulty speaking
  • Hearing noises or music
  • Uncontrollable jerking or other movements

The Migraine headache

Migraine headaches tend to last between 4 and 72 hours.  Migraine sufferers may also experience nausea/vomiting, sensitivity to light and sound and they may experience at least two of the following: 

  • One sided headache pain
  • Headache is moderate to severe in intensity
  • The pain tends to be throbbing in nature
  • Symptoms may be aggravated with general physical activity

Migraine triggers

There are a number of different migraine triggers, including:

Drinks: alcohol, especially wine, and caffeine

Foods. Aged cheeses, salty and processed foods

Food additives. These include aspartame, monosodium glutamate (MSG), 

Skipping meals.

Stress.

Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.

Sleep changes. Missing sleep, getting too much sleep or jet lag can trigger migraines in some people.

Physical factors. Intense physical exertion

Medications. Oral contraceptives and vasodilators, such as nitroglycerin.

Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women. 

Weather changes. A change of weather or barometric pressure can prompt a migraine.

Chiropractic examination

When a patient comes to see me with a headache that is migraine in nature my examination is to rule out more serious problems.

In office, I’ll perform an examination, which includes checking blood pressure and a neurological exam which would include:

  • Romberg’s test
  • Tandem walking
  • Drift of outstretched hands
  • Finger-nose test
  • Assessing the eye  for pupillary response and horner’s syndrome, eye movement, and vision
  • Assessing hearing, 
  • Checking the skin’s sensation to touch or pain
  • Muscle strength
  • Facial expressions
  • Reflexes.  

 MRI or CT scans are only suggested if the patient comes in with the worst headache ever, if they have a headache that is made worse with exertion or /coughing, if there are signs of brain lesions, a known malignancy or if it is a new headache for an older patient.  ER or GP are referred to in these cases 

How you can help yourself

Here are a few ways you can help reduce the frequency of your migraines

  • Develop better sleep hygiene: keep a sleep diary
  • Eat wisely: Don’t skip meals, keep a food journal, and avoid foods that cause your migraines
  • Exercise regularly:
  • Reduce stress: Simplify your life, delegate, take breaks, meditate, do something you enjoy on a regular basis
  • Keep a a migraine journal to help discover what causes your migraines. In some cases avoiding triggers is helpful. In other cases avoiding triggers may actually increase sensitivity to those triggers.

How I can help you

There is evidence that chiropractic adjustments or joint manipulations and joint mobilizations reduce both the frequency and intensity of migraines. Most of the research papers on this subject use a treatment frequency of two times a week for 8 to 12 weeks

There is evidence that people with migraines have more active trigger points in their muscles. Part of my treatment includes treating these trigger points with various myofascial release methods including acupuncture. Recent research as shown that treating trigger points can reduce the frequency of migraines to similar amounts to that of a common migraine medication. Improvements were seen over 6 to 8 visits over the course of 17 weeks.

Lastly, it is very common to have poor endurance in the neck muscles in female migraine suffers. During your treatments you will be given the appropriate exercises for homework to aid in improving your neck endurance.

When you are ready to get out of pain and back to enjoying your life book an appointment.

Dr Chirstopher Notley – Winnipeg Chiropractor and Athletic Therapist

Anthrodesk wobble chair: product review

Currently, I have patients who are coming in to see me because they have lower back pain. This seems to be occurring more often due to Covid 19. They are sitting at their kitchen table working from home. They are sitting with a poor chair or poor desk setup and they are developing lower back pain.Their workouts are suffering. They are experiencing lower back pain performing deadlifts, squats and other activities. Something needs to be changed to help with this problem

Some people think maybe I need to change my chair, which does make some sense, since the major change is working from home rather than at work. I have patients ask me what kind of chair they should purchase? Maybe they should get a stability ball to sit on, maybe a kneeling chair or maybe a wobble chair.

I recently had an opportunity to review a wobble chair from Anthrodesk. Here is my review of that product.

** I was asked to review this product. They had me purchase the product and they reimbursed me the cost of the chair. No other money was given to write this review.**

Construction

When you buy this chair, it comes in four parts. There is the seat, a piston, a plastic collar that goes around the piston and the heavy base.

Underneath the seat with 2 of the 3 seat adjustment buttons visible

When we look at the seat, it’s not leather, it is a fabric of some sort. We can see cutouts for our thighs. We can see on the bottom three buttons. Those buttons control the piston. So when you are sitting, you don’t have to search for that button. Just put your hand under the seat and a button will be easy to find.

Base of the chair

This chair only goes down as far as 22 inches and as high as 33 inches. The weight capacity of the piston is unknown

When we look at the base, the base is a rubber grip and it’s fairly heavy. So when I push it over it’s not very easy to make it fall. You’re not going to bump into it and have it fall over very easily.

Pros

This chair is very easy to put together. It takes only a few minutes to put it together as long as you are following the instructions.

The wobble chair appears to be made with good quality material. I’ve only had the chair for a month so I don’t know how long the material on the seat will last. But other than that, it looks really well put together.

This is chair a Weeble wobble. It is not going to fall over. You can walk by it, bump it, and it isn’t going to fall over. Check out the video to see how hard it is to fall over. The only way this chair will fall over is if you take your feet off the ground and continue to wobble to the extreme ranges of the chair.

Lastly, this this chair definitely promotes movement variety of the spine and hips. These joints deserve to move. Movement is the only way we keep our joints healthy.

Cons

When I started to still in the chair for a longer period of time the convex curve of the seat started to be uncomfortable to sit on. My wife experienced the same thing. Interestingly, there is research that finds that sitting on a stability ball can become uncomfortable for some people. Since the wobble chair’s seat is convex it will be similar to a stability ball. Therefore for some people this seat may be uncomfortable.

What is the weight capacity of the piston? I’ve not been able to find what it is. If you are heavier, this is something for you need to consider because you don’t want to buy this chair and then have to have it break because the piston is not designed for your weight.

Another con, again, is with regards to the seat. Whatever the material of the seat is made of it can be slick with dress pants. So slick that if you are using this as a high stool you might easily slip your backside off the chair when you try and sit down. I did that a few times

Lastly, in my case, this seat doesn’t go down far enough. I like to be able to sit in a chair that allows my hips to be in line with my knees. When sitting on this chair, my hips are a lot higher than my knees. I’m five foot four, so somebody shorter is going to have some difficulty. Because, I can’t have the seat lower this means my laptop ends up lower relative to my eyes. This causes me to slouch forward to get my eyes inline with the monitor. This isn’t the best position to be in for hours a day

Conclusion

I think this is a good quality chair if you are looking for a wobble chair. It will look better than an instability ball in your office and you will have more freedom of movement for your hips and spine. This could be a good a good chair for you, but it may not be a perfect fit for everyone.

Dr Notley

Self myofascial release of the biceps and brachialis

The front of the arm has two muscles, the biceps brachii and the brachialis. Both muscles cross the elbow and are involved in flexing the elbow bringing the hand to the shoulder.  Whereas the brachialis only crosses the elbow, the biceps also crosses the front of the shoulder and proximal radio-ulnar joint (this joint is involved in turning the forearm. Because of this the biceps is involved in flexing the shoulder forward as well as turning the palm upwards (supinating) the forearm.  

The brachialis if found underneath the biceps covering the lower two thirds of the upper arm.  You can make some contact on the muscle if you come to the outside of the arm close to the lateral head of the triceps 

Pain in the biceps can refer to the shoulder or to the elbow. Pain in the brachialis refers to the same areas as the biceps as well as near the thumb

How to release the biceps and brachialis

1️⃣ Ideally grab a ball attached to a stick (for leverage)

2️⃣ To release the lower two thirds place the ball over the biceps to work the biceps or just between the biceps and triceps to work the brachialis. Starting with your elbow bent.   To release the upper third (biceps only) start with the shoulder extended

3️⃣ Pin the other part of the stick to your leg or something firm

4️⃣ Straighten your arm, like a triceps kick back

5️⃣ Draw the ball in the opposite direction of the arm movement to maintain tension