Navigating Pain with training.

Pain is a consequence of training. Anyone that tells you otherwise is selling something, a supplement, a rehab approach, a training program, something. Statements like this are profoundly ignorant, intentionally misleading, or a woeful oversimplification of the process of training. In some cases, they are a combination of all three. The truth is, pushing yourself comes with risk and that risk is pain and injury. What makes the issue of pain with training so challenging is that, while training with pain is unavoidable, not all pain should be considered equal, and each warrants a different response: pushing through, modification, avoidance, even medical care/consultation. In some cases, ignoring pain will result in a potentially career-ending injury; in others, it will result in failure to achieve your goals.

By the end of this article, I hope that you will be able to more skillfully answer this critical question so common in training. To navigate this question more easily, I find it helpful to divide symptoms into categories: location, intensity, symmetry, timing, focality, and character. Understanding the difference between these will hopefully enable you to push when you need to push and pull back when you need to pull back so you are able to achieve those performance goals you seek without getting injured.

Location:

The location of the symptoms are remarkably useful information when considering whether one should push through or pull back. Symptoms in the muscle are usual and customary with training, no matter whether you are undergoing strength or metabolic training. Yes, there are times when symptoms in the muscle should be avoided, but in general, muscle pain is acceptable in training.

Pain in the muscle is usually nothing more than the “sound” your muscles make when they cannot meet the energy demand of the effort, be it in the middle of a max set of 10 squats or at the end of an all-out effort on the track—a subtle cry for help. Your muscles are holding at peak exertion (energy output) and, due to the high energy demand, the [H+] builds to painful levels. This lowers the PH in your muscle, making them more acidic, likely the cause of the burning sensation you have radiating from the muscles you’re working.

While muscle pain is something one can/should regularly push through, pain in the joint or tendon however, is more concerning. This type of pain indicates improper movement in the joint, placing excessive stress on a particular tissue…tissues, I might add, that don’t heal so great. To avoid injury, pain in the joint or tendon should be continuously analyzed, stride-by-stride, stroke-by-stroke, rep-by-rep. If you cannot micro-modify the movement the reduce or abolish the symptoms, than you need to consider whether or not continuing along your current path is a good idea.

Another location of pain many of you fellow meatheads may not have experienced is what I will call “lung pain”. Lung pain is the sensation you feel in your chest when your need for oxygen is so high it hurts. It experienced is a tightening/burning type of pain you get during a nasty anaerobic workout, where your heart rate pushes to its absolute limit. Unlike the pure pain experienced with heavy weight training, this type of pain produces something more akin to a subtle panic, like you are gonna pass out…because might. In the absence of an an underlying cardiovascular condition, despite the incredible discomfort one experiences in such a workout, this type of pain one can push though and needs to push through if you hope to achieve that fitness level you crave. If you’ve never experienced it before, it is very alarming. None-the-less, with time and repetition, you become accustomed to it and can push right through.

Intensity:

In the medical field we typically qualify pain on a 0-10 scale with 0 being no symptoms at all and 10 being the most intense pain you’ve ever experienced, the kinda pain that gets you a trip to the hospital. Obviously the lower on this scale, the less concerning the symptoms. 0-4 is expected in training and exercise. Depending on the other factors of the symptoms (character, location, timing, symmetry, etc.), 5-7 is something experienced athletes seek on the regular. This level of pain intensity is a soft indication that you are pushing yourself adequately hard to get the results you seek. Pain intensity of 8+ however, is quite a bit more challenging to interpret. Truthfully, this level of pain should be reserved for only the most experienced athletes and should be avoided by everyone else. Remember, intensity is something that must be urned. The longer you train, measured in years not weeks, the more safely you can navigate training pain intensities greater than 7/10.

Symmetry:

Symmetry of pain is something your may not have considered. Pain, no matter how severe, that is symmetrical is much less sinister than asymmetrical pain, especially if the symptoms are transient. An example of such pain would be “my quads are killing me”, said during or after training, or even the next day. Symmetrical pain, no matter how severe, is likely nothing more than an indication that you are pushing hard. Asymmetrical pain, on the other hand, especially if it persists beyond the session, is much more concerning. This would be something like “my right quad is killing me” after a nasty squat set. Even at lower intensities, asymmetrical pain should be taken more seriously than more severe symmetrical pain. This is because asymmetrical pain indicates overloading of a specific tissue, be it from asymmetry of your anatomy or how you move. Regardless of the cause, asymmetrical pain should be taken more seriously in every situation.

Timing:

Timing of the symptoms is another good, more clear-cut indicator of the severity of what you are feeling as you train. Are you experiencing pain during your exercise efforts? How quickly does it subside? Does it last for seconds, minutes, hours, or even days after? The more transient the symptoms, the less concerning. The more long-lasting the symptoms, the more concerning. This is irrespective of intensity. If, for example, you experience intense pain in the middle of a nasty kettlebell swing set but it subsides before the next set begins, keep pushing. If, however, your pain increases during the set and continues into the next set, perhaps through the entire workout and even into the next day, then this demands analysis and potentially modification to one’s training. We have all had pain that lasts into the following morning and even beyond. For the training sadists, we seek such pain. However, the longer a pain persists, the more concerning it is.

If you are consistently experiencing pain during training that lasts for days, you need to consider if your training load and even the exercise you are performing is appropriate for your current fitness/strength levels. While many think that persistent pain following training “comes with the job”, it does not. Such pain indicates that you are pushing too hard, doing the wrong exercise, or perhaps doing the right exercise incorrectly. At best, if you are dosing your program appropriately and performing the movements properly, you should experience nothing more than mild pain the following day. Anything more severe or longer lasting warrants analysis and potentially modification. Pain experienced during training that subsides soon thereafter, on the other hand, regardless of the intensity, is something you can push through.

“Focality”:

“Focality” is a word I made-up that indicates the total area of the symptoms. Diffuse indicates a larger, more spread out area. Focal indicates a smaller, more localized area.

In general, diffuse pain is less concerning than focal pain. Diffuse pain would be “my quads are killing me”. Focal pain would be “it hurts right here” as you point to a specific area in the quad. Diffuse pain is likely nothing more than an indication that you are working hard and should be addressed as a green light, meaning keep pushing. Focal pain, however, indicates that you are over-working a specific tissue; continuing to do so comes at the risk of injury. In such cases, you want to pull back and analyze before you continue at your current path.

Character/Quality:

Last, but not least is the character of your symptoms. “Character” is the description of the sensation of the symptoms you are feeling such as sharp, dull, aching, or burning. As a subject, pain is a rather deep, complex, nuanced, and confusing. For the sake of time, I’m gonna stay in the shallow of the pool. The deep end of this pool is quite deep and will only pull us off course.

Broadly speaking, when it comes to pain, henceforth referred to as symptoms, experienced with training (during and after), can be divided into two categories: mechanical and neurological.

Mechanical Symptoms are experienced due to excessive stress on a given tissue (be it a muscle, tendon, meniscus, capsule, ligament, whatever) resulting from poor and/or repetitive movement. Typical characteristics of Mechanical Pain would be tightness, dull, aching, and sharp/stabbing.

Neurological Symptoms are those experienced due to excessive tress on, you guessed it, neurological structures such as the spinal cord, nerve roots, or peripheral nerves. Typical characteristics would be tightness (yes, tightness), shooting, dull, aching, numbness, tingling, weakness, burning, throbbing/pounding. As you can see, there’s a little overlap between mechanical and neurological pain, making differentiating between these two rather challenging.

Technically speaking, Neurological Symptoms is a sub-classification of Mechanical Symptoms in that it typically results form mechanical dysfunction that produces pathological stress on a neurological tissue. Because of the serious nature of damage to such tissue, we give it its own classification.   

As you may have already guessed, when it comes to training, Mechanical Symptoms are far more common (even expected) than it’s Neurological sibling. Because of the tissues involved, Mechanical Symptoms are also much less concerning than Neurological ones. They do, however, deserve some respect and consideration. The fact is, training involves repetitive movement, often performed at high speeds and under heavy loads. Such activity comes with the risk of pain and injury. Since training is the process of increasing your physical capability through pushing your physical limits, Mechanical Symptoms, such as pain, and injury are a necessary risk. The idea that one should “never train with pain” is frankly just silly.

Factoring only the character of your symptoms, navigating the question: is this pain I should push through or is this pain I should pull back from requires dividing it these symptoms into three categories: Overt Neurological Symptoms, Covert Neurological Symptoms, and Overt Mechanical Symptoms.

Overt Neurological Symptoms include weakness without pain, burning, tingling, numbness, radiating, and throbbing. The vast majority of the time, these symptoms indicate aggravation/damage to a neurological structure and should be taken seriously, particularly weakness without pain. In the event that you experience one of these symptoms, I advise that you modify or change the exercise immediately, enough that you no longer experience one of these, and get in to see your favorite chiropractor or physical therapist so you can rule out neurological etiology before your ramp up that exercise again.  While both tingling and numbness can be caused by trigger points, which often result from mechanical dysfunction, when it comes to neurological damage, you wanna play it safe and should seek medial consultation. The one I gotta call out again is weakness without pain. You might notice that when you run or when you drive out of the hole in a squat, one of your legs feels weak. While this symptom is neither uncomfortable nor painful, it strongly indicates damage to a nerve and is quite serious.

Overt Mechanical Symptoms would include burning with activity (aka muscle burning), sharp, and pinching. Muscle burning with activity is common in training and should be pushed through, especially if the pain does not linger beyond training. Regardless of the intensity of the burning, the more quickly it subsides, the less severe it is. Sharp and pinching indicate a more serious mechanical condition, but can be pushed through. To decide whether or not this is the case, you need other factors such as intensity, symmetry, location, and locality. Consider these two symptoms a proceed-with-caution, a yellow light if you will. You can continue to train, but if the symptoms intensify or linger longer and longer, you should modify or change the exercise to avoid a lasting injury.

Covert Neurological Symptoms include tightness, dull, aching, shooting, and weakness with pain. These are symptoms experienced with both neurological and mechanical pathology. The reason they are classified as Covert Neurological is because of the potential for damage to a neurological structure. In such cases, you want to play it safe and assume it is a neurological condition until proven otherwise. The least concerning and most common of the Covert Neurological Symptoms are tightness, dull, and aching. If you are pushing yourself hard enough, as one does when they train, these are experienced on the regular. With each and every rep, set, training session, and day, you need to assess these, consider the other factors, and make the call on whether you should push, pull back, or even seek medical consultation. If the intensity remains low and constant, you can continue to push. If the intensity build and even starts to linger beyond training longer and longer, you likely have an injury brewing and want to put that fire out before it comes a problem. Shooting and weakness with pain, on the other hand, are on the more severe side of the scale and should be considered with with elevated concern. Regardless of the other factors, these both indicate that you are farther down the path towards injury that you likely want to be and should you modify you training accordingly.

While this is by no means a comprehensive, definitive handling of this difficult issue, I hope it will improve your ability to navigate the difficult question we all must answer on a daily basis: are these symptoms something I should push through or something from which I should pull back from. The better you are at answering this critical question, the more likely will achieve your performance goals without getting injury.

Keep pushing!

Richard Ulm, DC