This video shows me doing some homework from Chris, my Osteopath, to help me solve the pain in my shoulder that started on Saturday. To put things in context, the pain I was experiencing meant that I couldn't sleep on Sunday night and was unable to shift gears in the car with my left arm. So it was pretty bad, I don't seek professional help for minor aches and pains.
Pain ≠ Tissue Damage
First things first, pain does not equal tissue damage. Most people believe that pain and tissue damage are directly related. The narrative goes like this; the worse pain they are feeling, the more tissue damage that must be causing it, the more serious the injury must be and the longer the recovery is going to take. This is simply not always true. "Pain is not equal to tissue damage" Todd Hargrove. Todd explains this idea in depth and presents the supporting evidence in his book, A Guide to Better Movement. I'll explain further with an anecdote comparing two injuries:
- In 2014 on the Tuesday prior to The Athlete Games I suffered what I assume was a massive back spasm while pulling a 220kg deadlift. It was one of the most painful experiences of my life, I couldn't walk, I couldn't do anything. I assumed I had herniated a disc or something serious. That Saturday I competed in the Athlete Games, admittedly I couldn't go full bore but I completed the events including a Barbel Total consisting of the heaviest singles on Deadlift, Back Squat, and Strict Press. I think I did 170, 150 and 80kg respectively. Although these were no where near my PB's the fact that I did them and about 5 other brutal events tells a story. In less than 3 days I went from thinking I might never walk properly again and being in crippling pain to lifting heavy again and completing a competition designed to push athletes to their limit. I suffered no further injury during the competition.
- In 2014 at Tribal Clash my friend Kamil tore the long head of his biceps tendon. He said it didn't really hurt when he did it, he said wasn't trying to be a tough guy, it just simply didn't cause pain.
Five Steps to Getting out of Pain and Bulletproofing Your Body
My recent injury and visit to Chris got me thinking about the process I go through when I sustain an injury or feel pain. Here goes.
Step 1. Relax
Relax and take a few minutes to remember all the other times that you have thought you have seriously injured yourself and then after a few days you are completely healed....IT'S PROBABLY NOT AS BAD AS IT SEEMS. Let it be noted that I am very bad at this step, just ask my girlfriend. But usually after about a day of sulking I remember Step 1.
Step 2. Get Help if Necessary
Get an experienced professional who understands your training to rule out a serious injury that may need a more in depth investigation. Being able to spot the difference between a good practitioner who is focused on getting you out of pain and back to training and someone who maybe isn't a great healer is an important skill. If they use big words and detailed anatomy terms you've never heard of or tell you with certainty that they know exactly what is causing your pain, or assure you they can solve the issue over the next 12 visits then you might want to get a second opinion. On the other hand, if they propose a potential solution and want to act as your guide to help you take ownership of and solve the pain then you might have found a great healer. They might say something like what Chris said to me on Monday: "it doesn't really matter if it's your tricep tendon or your supraspinatus but try playing with this drill. The goal is to find pain-free loading in as many positions and vectors as possible". Having someone you trust to work through injuries with is invaluable.
Step 3. Homework
Be patient and do your homework diligently. A practitioner (which is the mind set I am suggesting you adopt) devotes lots of time to the process of trial and error. In this scenario it's about finding as many pain-free vectors of loading as possible. If a vector causes pain (error) then change something about your body position (trial) to load a similar vector, keep adjusting until you find something pain free. Continually trial different vectors and positions, flirting with, but avoiding, the ones that cause pain. A theoretical approach (aka an academic approach) can often be quick to pin-point an exact diagnosis, say a level 2.7 strain of the sternocleidomastoid. With such an exact diagnosis often comes the claim of an exact solution in the form of a single exercise or protocol to solve the injury. This approach fails to recognise that every human body is different. Our bodies are the manifestation of every force we have undergone and movement we have made over the course of our lives. In most cases offering a jockey of 20 years and a 15 year old gymnast identical solutions to their shoulder pain doesn't make sense. Offering a scenario, like the one Chris has given me here, serves as a starting point for the process of trial and error in which the load can be progressively increased (in this case by lowering the height of the box) allows each person to find a tailored solution based on the feedback he receives from his body. The fruits of this exploration will be useful information that can feed into step five. Now, remember you'd never enjoy these fruits or step five without being injured I the first place, or could you....
Step 4. Keep Training
Be smart, if you’re in pain you’ll probably need to stay away from chaotic environments like riding rodeo bulls. But if you’ve injured your shoulder, for example, you might still be able work on pistol squats, the splits, hollow body holds, etc. This keeps you moving and in the mindset of self-improvement and progression. By focusing on the solution rather than the problem you'll avoid getting bogged down in a destructive mindset where your mind an body are not going to be optimised for healing. Now, again, I am not going to pretend I don’t have a history of letting injuries get me down, but in hindsight, the injuries I have experienced have taught me a lot more about movement, training, my body, and my mind than the times of smooth sailing. Even if at first glance injuries seems all bad and only to set us back, working through them forces us to be creative and the ideas that result are often transferrable to many other areas of training. Being forced to work on developing skills that you otherwise wouldn't have prioritised can be a positive thing; as humans we tend to think we always know best but sometimes we need fortune to show us the way.
Step 5. Antifragilise (the opposite of fragile is antifragile)
Once you’re out of pain, use the information you’ve gained from the process of trial and error to build a more robust body. For example my exploration in the video revealed that the most pain and lease accessible range of motion is in shoulder extension (when my hands are behind me). So once my pain is solved I will begin to include a variety of drills that will develop range and strength in shoulder extension.
Learning and practicing this process makes you antifragile. Each minor injury (obviously a catastrophic injury might not be repairable) will result in information being gained and used to make the body more robust. Something fragile, say a glass vase, doesn’t like shocks of any kind. There is no upside, only downside risk that it might shatter into a thousand pieces. The human body on the other hand can benefit from these minor shocks and injuries by becoming more robust in the process. The more practiced in implementing this process you are, the more Antifragile you are. Take an athlete who has suffered from some sprains and strains over the course of his career and understands this process. Might he not be better prepared than someone who has not had these experiences to bounce back from a more serious injury.
Finally, it is now Thursday, meaning 4 days have elapsed since I was in so much pain I couldn't sleep or open doors with my left arm. I am happy to report that the pain is nearly gone and my pre-injury pain free range of motion / loading is close to being restored. My recovery is further evidence to support the idea that pain ≠ tissue damage. After all, it is impossible that any significant tissue damage could be repaired in just four days.
The lesson I've learned from this injury and writing this post is that the technique I used to get out of pain (as shown in the video) contains an idea that can be transferred to every scenario/ apparatus in which I am trying to progress my abilities. This type of partial loading and exploring as many vectors as possible within a scenario is not just useful for getting out of pain but also as a pre-hab tool, and to stimulate blood flow to aid recovery. In my next post I'll take you through how to apply this idea to other scenarios.
Speaking of other scenarios where this idea has been applied, my good friend Erik Lau Kelner, founder of Weightlifting 101,
uses a similar type of exploration with his athletes in something he calls "Barbell Yoga". Most of the positions his athletes get into with the empty
bar are never seen in a heavy Clean & Jerk or Snatch but it's just about exploring, allowing the body to relax with a barbell in your hands in
order to open up range of motion, and also stimulating connective tissue to keep it healthy and resilient.
The concept of Antifragility is taken from the book Antifragile by Nassim Nicholas Taleb.
Chris Branch is the Principal Osteopath at Forte Physical Health in Chelmsford, Essex.