Showing posts with label pain. Show all posts
Showing posts with label pain. Show all posts
Sunday, October 24, 2010
Unpacking a mystery: when shoulder pain may be all (or largely) in the wrist (a t-phase assessment story)
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Pavel tells the joke about asking people in a weight room "so those of you who have had a shoulder injury, raise your hands" - half the people raise their hands; the other half can't.
Various types of shoulder issues are super common, and the usual go-to place is that the cause must be a rotator cuff tendon issue. But at least in my case, turns out it may be something very different: a muscle imbalance. That is, some muscles getting overworked with others getting underworked, resulting in other muscles not doing their jobs, and other muscles and associated tendons getting a bit worn out from having to do another muscle's job to pick up the slack. What's remarkable is how much immediate relief there can be once this issue is identified and actively addressed. So this is a bit of a story of unpacking that mystery through a lens that says always remember the site of pain mayn't be the source of pain.
Personal Case Study
A while ago i did a few posts about the latest work on tendonopathies and healing them, and a festival of posts on the amazing shoulder as a system in the body ( shoulder girdle part 1, gleno-humeral joint part 2), and then there was one about stopping reps in a set before they stopped us. These posts were largely motviated by my ongoing ache in my arm/shoulder. And i must say i was getting just a wee bit frustrated that i wasn't getting anywhere. This is the story of finally getting somewhere.
In the beginning: Seeing the MD. back in may/june the doc i first saw when my pain was at peak suggested what i had was a supraspinatus (top rotator cuff muscle) tendinitis. Ok.
Now i'm studying anatomy, and from what i could tell, all that muscle does is assist lifting the arm up to the side (like making airplane wings with ones arms). The things that hurt however were putting my coat on, when the arm reaches back to stick the arm into the jacket, and then when going the entire other way - crossing arms over to pull off a sweater. Ok, so maybe that's from a puffy supraspinatus getting jammed into the acromium of the shoulder (shown right) when the arm extends or internally rotates when abducting (emptying a pitcher). That seems pretty classic. And a week's worth of nsaids DID let me put my coat on again. So there seems to have been something going on there. But that wasn't all. Cuz it still hurt.
The Post MD Analysis, July 2010
In July, i'd asked a very competent movement scholar and chiropractic student to take a look at me, and we were rather flumoxed. He got as far as suggesting, based on loads of assessments, that perhaps it was lower trap related as doing some lower trap work seemed to bring some relief - he suggested that i spend some time with some drills focusing on lower trap work from Secrets of the Shoulder, which i did.
Time Passes - things shift/get worse. Intriguingly, the pain changed, but did not go away; my strength progress was bottoming out. My press was not only totally buggered on the left, the pain was getting triggered when doing my right press. Not good for a gal who wants to press a 24kg kettlebell for reps.
The other thing? Where it really seemed to hurt was at the top-ish of the arm. And then the pain radiated down into the biceps. Maybe supraspinatus pain refers into the arm, i wondered.
But here's another thing: both the insertion of the supraspinatus (the attachment point furthest away from the middle of the body) and the origin of the long head biceps tendon (the attachment point of the muscle closest to the middle of the body) are very close to each other. The supraspinatus inserts at the superior facet of greater tubercle (or tuberosity) of the humerus (at the top of the upper arm bone). The long head of the biceps brachii passes over a notch in the humerus to attach to the supraglenoid tubercle - a part of the surface of the scapula that the humerus abuts in the shoulder.
In other words the two tendons are almost right on top of each other, and both connect with with the upper arm/scapula, so if one's sore, perhaps the other is going to bloody feel it, too? Or perhaps they'll just be hard to discern from each other.
Why is this identification of tendon proximity important? It's going to play a role shortly.
Indeed, reading about biceps tendinitis certainly seems similar to "overhead overuse" injuries for the supraspinatus rotator cuff. Reading about it also sounds pretty dam fatal: wear and tear; doom and gloom. And strengthening the the biceps doesn't seem to be the winner here.
So what we have here is pain in shoulder extension and external rotation and pain in shoulder flexion, adduction and internal rotation. Yuck. Easier to stay naked than put clothes on or off, but not functional, and not helpful athletically. Playing frisbee all summer was a great way mainly to keep my shoulder mobile-ish without load, but i more or less had to forget about my 24kg press work.
The Analysis Redux, Oct 2010
Now we come to the latest analysis this past week with a very experienced z-health movement performance specialist whom i'd been waiting to have an opportunity to see. 1st, we went over the issue, reviewing a detailed history (any stomach upset? any elbow issues? any neck pain? etc). Second, there was a look/test of some muscles between left and right sides.
What i had noticed only recently came to view here: my posterior delt was not firing fully - lots of squishy bits in it - compared to how well the right side was firing, the left lower posterior delt was like a deflated tire. That can't be good. Indeed see this post on muscle firing through the whole of the muscle for more. From here, we started to Assume the Postion(s) - the Positions of Pain and test these.
Assessment Process, close up. After setting some global baselines, we moved through many of the muscles of the shoulder, either offering them an assist or taking them out of the equation to see what helped or did not through those movements. By this careful process of elimination, we got down to a few interesting findings:
And ta da, muscles start to re-balance, pain be much more gone; i can press again.
How could this issue come to be?
It's often just a best guess with what causes anything, but one proferred explanation for my stuff especially with the wrist/finger extensors is that kettlebelling offers a lot of opportunities for loaded wrist/finger flexion, not so much for loaded wrist/finger extension work. As in anything, balance is important. So who knows? Perhaps when doing a ton of double kb work, i pushed my less strong side to follow with my stronger side and things went sufficiently out of whack to build up an inflamation and ongoing pain. This fits more of the facts than a supraspinatus diagnosis alone.
Rehab'ing
Beyond the above mentioned mobility and nerve drills, i'm doing some specific strength work. For the extensors i'm using two props: a mini jump stretch band with very light tension focusing on only enough load that i can get full to end range of motion wrist extension and wrist circles for the extension. I'm also using ironmind finger bands to practice finger extension reps. For mobility, i'm doing a lot of finger waves.
Master Class in Test/Re-assess.
This whole suit of components listed above stemming from this assessment was very much for me a master class in what we learn in z-health t-phase (about z-health): take a great history; test and retest EACH step of an analysis (i haven't detailed all the stuff that was tested that did not get a result); apply one's understanding of muscle interaction, muscle function and nerve interaction; check function to bring it back on line; when locked in, apply dynamic joint mobility and loaded dynamic joint mobility as appropriate.
Test, re-test continuosly. Analysis is a process. And as things change/improve, retesting and refining in rehab remains important.
Analysis is also a process that follows where the path leads: despite the fact that this kind of pain is supposed to be indicative of a SITS/rotator cuff injury, it may not be. I'm also intrigued to learn about how the extensors relate to balancing the shoulder in rotation. Not something that seems obvious taking a shoulder-only focus. Likewise that working the area of the biceps tendon can be so impacted by rotation when it itself is not a rotator - makes sense looking at how rotation may stretch it, but again that's following the path and testing - and also having some faith. I *knew* i felt pain through the biceps, but just never conencted this with the biceps tendon.
A note on pain and perfromance:
One of the effects of finding these muscle imbalances and nerve issues was an immediate and pretty signficiant improved range of motion. Like way - 15-20 degrees of extension in the shoulder that i didn't even know i had.
What this experience reiterates for me is that pain is a performance signal; that having pain reduces performance, and perhaps especially that optimizing what we need for performance not only reduces that pain signal but also, as a connected process, opens up performance. The two are intimitaley and it seems inextricably related.
As i've suggested before, pain it seems is just another performance inhibitor indicator like tight muscles that restrict range of motion can be. When we take time to work with a movement performance coach to walk through the process, work the problem, both relief and performance pour in. I know this all intellectually - it makes sense in terms of what we know neurologically - but from time to time a demonstration of same is a pretty vital reminder of these issues.
In my case, the focus was on identifying performance issues: squishy muscle bits in extensors; impingement of some kind around muscles/tendons; looking at strategies to help bring performance back on line, lots of active work. Et voila: pain significantly reduced.
Coda It's only been a week since i've had this assessment but the performance improvment (and consequent pain reduction) is legion in comparison to what it's been. I'm being very gentle with working back into arm and shoulder strength work, but that i can get into these ranges of motion sans pain/ROM issues is pretty fab after months of pain/limitation.
What seems to have happened is that there is a path of unpacking/unwinding a problem going on towards addressing it. What is exciting to me is that the movement principles i've been studying for the past two and a half years keep working - even for difficult cases. The nervous system is a remarkable thing.
It's rewarding to get to a place of really starting to see how the application of these principles continually opens up new opportunities to support healing without creating more pain first and with such immeidate effect.
Self-critique. I am also somewhat kicking myself for not working these patterns myself: nothing was really done in this assessment that i haven't been trained to do myself - that's the plus side. The down side is that i didn't take the time to work through this for myself. I remember moaning over the phone to one of the z-health master trainers how frustrated i'd been that i couldn't see a z-health solution to this problem, and his calm reply was "did you do all of the assessments"? i figured out that there were literally about 14 thousand possible combinations of assessments and that i guess i really hadn't. It's a good thing we're not our own healers, and i'll say again, everyone needs a coach.
And one more time: analysis is an iterative process. Sometimes it will take more than one hour to get to the heart of a gnarly problem. In my case, it took two. Gosh. I'll also say that the confidence i have that this approach will help find a path through even gnarly performance problems elegantly has gone way up. As said, i see it in clients reguarly, but there's nothing like personal and direct experience to reenforce a value proposition, eh?
mc
Related Posts
Various types of shoulder issues are super common, and the usual go-to place is that the cause must be a rotator cuff tendon issue. But at least in my case, turns out it may be something very different: a muscle imbalance. That is, some muscles getting overworked with others getting underworked, resulting in other muscles not doing their jobs, and other muscles and associated tendons getting a bit worn out from having to do another muscle's job to pick up the slack. What's remarkable is how much immediate relief there can be once this issue is identified and actively addressed. So this is a bit of a story of unpacking that mystery through a lens that says always remember the site of pain mayn't be the source of pain.
Personal Case Study
A while ago i did a few posts about the latest work on tendonopathies and healing them, and a festival of posts on the amazing shoulder as a system in the body ( shoulder girdle part 1, gleno-humeral joint part 2), and then there was one about stopping reps in a set before they stopped us. These posts were largely motviated by my ongoing ache in my arm/shoulder. And i must say i was getting just a wee bit frustrated that i wasn't getting anywhere. This is the story of finally getting somewhere.
In the beginning: Seeing the MD. back in may/june the doc i first saw when my pain was at peak suggested what i had was a supraspinatus (top rotator cuff muscle) tendinitis. Ok.
The Post MD Analysis, July 2010
In July, i'd asked a very competent movement scholar and chiropractic student to take a look at me, and we were rather flumoxed. He got as far as suggesting, based on loads of assessments, that perhaps it was lower trap related as doing some lower trap work seemed to bring some relief - he suggested that i spend some time with some drills focusing on lower trap work from Secrets of the Shoulder, which i did.
Time Passes - things shift/get worse. Intriguingly, the pain changed, but did not go away; my strength progress was bottoming out. My press was not only totally buggered on the left, the pain was getting triggered when doing my right press. Not good for a gal who wants to press a 24kg kettlebell for reps.
The other thing? Where it really seemed to hurt was at the top-ish of the arm. And then the pain radiated down into the biceps. Maybe supraspinatus pain refers into the arm, i wondered.
In other words the two tendons are almost right on top of each other, and both connect with with the upper arm/scapula, so if one's sore, perhaps the other is going to bloody feel it, too? Or perhaps they'll just be hard to discern from each other.
Why is this identification of tendon proximity important? It's going to play a role shortly.Indeed, reading about biceps tendinitis certainly seems similar to "overhead overuse" injuries for the supraspinatus rotator cuff. Reading about it also sounds pretty dam fatal: wear and tear; doom and gloom. And strengthening the the biceps doesn't seem to be the winner here.
The Analysis Redux, Oct 2010
Now we come to the latest analysis this past week with a very experienced z-health movement performance specialist whom i'd been waiting to have an opportunity to see. 1st, we went over the issue, reviewing a detailed history (any stomach upset? any elbow issues? any neck pain? etc). Second, there was a look/test of some muscles between left and right sides.
What i had noticed only recently came to view here: my posterior delt was not firing fully - lots of squishy bits in it - compared to how well the right side was firing, the left lower posterior delt was like a deflated tire. That can't be good. Indeed see this post on muscle firing through the whole of the muscle for more. From here, we started to Assume the Postion(s) - the Positions of Pain and test these.
Assessment Process, close up. After setting some global baselines, we moved through many of the muscles of the shoulder, either offering them an assist or taking them out of the equation to see what helped or did not through those movements. By this careful process of elimination, we got down to a few interesting findings:
1) pain in the biceps: there's that biceps tendon going into the shoulder - address that, and guess what - pain HUGELY reduced.
2) help out the brachioradialis/extensors (esp carpi radialis perhaps) overlapping tendon/musle area, there's more relief (nerve work for the radial nerve included).
3) muscle test some of those extensors and there's squishy bits - get that fixed so the whole extensor is firing, more relief.
4) pay attention to the axilary nerve that fires the deltoids, and the posterior delt starts to come back on line (have some more work to do there but heck it's work i know how to do).
5) do a wee bit of hybrid minimal t-phase style kinesio taping around the long head bicpes tendon area, matched up with active dynamic joint mobility drills for the shoulder, elbow and extensors, and things start to simmer down
6) work out some of the fascial stickiness around the extenors with v.light hybrid t-phase fascial work
7) get some exercises for working the extensors in particular,
And ta da, muscles start to re-balance, pain be much more gone; i can press again.
How could this issue come to be?
It's often just a best guess with what causes anything, but one proferred explanation for my stuff especially with the wrist/finger extensors is that kettlebelling offers a lot of opportunities for loaded wrist/finger flexion, not so much for loaded wrist/finger extension work. As in anything, balance is important. So who knows? Perhaps when doing a ton of double kb work, i pushed my less strong side to follow with my stronger side and things went sufficiently out of whack to build up an inflamation and ongoing pain. This fits more of the facts than a supraspinatus diagnosis alone.
Rehab'ing
Beyond the above mentioned mobility and nerve drills, i'm doing some specific strength work. For the extensors i'm using two props: a mini jump stretch band with very light tension focusing on only enough load that i can get full to end range of motion wrist extension and wrist circles for the extension. I'm also using ironmind finger bands to practice finger extension reps. For mobility, i'm doing a lot of finger waves.
Master Class in Test/Re-assess.
This whole suit of components listed above stemming from this assessment was very much for me a master class in what we learn in z-health t-phase (about z-health): take a great history; test and retest EACH step of an analysis (i haven't detailed all the stuff that was tested that did not get a result); apply one's understanding of muscle interaction, muscle function and nerve interaction; check function to bring it back on line; when locked in, apply dynamic joint mobility and loaded dynamic joint mobility as appropriate.
Test, re-test continuosly. Analysis is a process. And as things change/improve, retesting and refining in rehab remains important.
Analysis is also a process that follows where the path leads: despite the fact that this kind of pain is supposed to be indicative of a SITS/rotator cuff injury, it may not be. I'm also intrigued to learn about how the extensors relate to balancing the shoulder in rotation. Not something that seems obvious taking a shoulder-only focus. Likewise that working the area of the biceps tendon can be so impacted by rotation when it itself is not a rotator - makes sense looking at how rotation may stretch it, but again that's following the path and testing - and also having some faith. I *knew* i felt pain through the biceps, but just never conencted this with the biceps tendon.
A note on pain and perfromance:
One of the effects of finding these muscle imbalances and nerve issues was an immediate and pretty signficiant improved range of motion. Like way - 15-20 degrees of extension in the shoulder that i didn't even know i had.
What this experience reiterates for me is that pain is a performance signal; that having pain reduces performance, and perhaps especially that optimizing what we need for performance not only reduces that pain signal but also, as a connected process, opens up performance. The two are intimitaley and it seems inextricably related.
As i've suggested before, pain it seems is just another performance inhibitor indicator like tight muscles that restrict range of motion can be. When we take time to work with a movement performance coach to walk through the process, work the problem, both relief and performance pour in. I know this all intellectually - it makes sense in terms of what we know neurologically - but from time to time a demonstration of same is a pretty vital reminder of these issues.
In my case, the focus was on identifying performance issues: squishy muscle bits in extensors; impingement of some kind around muscles/tendons; looking at strategies to help bring performance back on line, lots of active work. Et voila: pain significantly reduced.
Coda It's only been a week since i've had this assessment but the performance improvment (and consequent pain reduction) is legion in comparison to what it's been. I'm being very gentle with working back into arm and shoulder strength work, but that i can get into these ranges of motion sans pain/ROM issues is pretty fab after months of pain/limitation.
What seems to have happened is that there is a path of unpacking/unwinding a problem going on towards addressing it. What is exciting to me is that the movement principles i've been studying for the past two and a half years keep working - even for difficult cases. The nervous system is a remarkable thing.
It's rewarding to get to a place of really starting to see how the application of these principles continually opens up new opportunities to support healing without creating more pain first and with such immeidate effect.
Self-critique. I am also somewhat kicking myself for not working these patterns myself: nothing was really done in this assessment that i haven't been trained to do myself - that's the plus side. The down side is that i didn't take the time to work through this for myself. I remember moaning over the phone to one of the z-health master trainers how frustrated i'd been that i couldn't see a z-health solution to this problem, and his calm reply was "did you do all of the assessments"? i figured out that there were literally about 14 thousand possible combinations of assessments and that i guess i really hadn't. It's a good thing we're not our own healers, and i'll say again, everyone needs a coach.
And one more time: analysis is an iterative process. Sometimes it will take more than one hour to get to the heart of a gnarly problem. In my case, it took two. Gosh. I'll also say that the confidence i have that this approach will help find a path through even gnarly performance problems elegantly has gone way up. As said, i see it in clients reguarly, but there's nothing like personal and direct experience to reenforce a value proposition, eh?
Personal Practice So suggestion? If you're having hinky performance/pain issues, check in with a movement performance specialist. Here's a trainer listing. If you'd like a referal, call the office, and let them know mc suggested you ask them.Best with your practice,
mc
Related Posts
- Tendinopathy, tendinitis and Eccentric Exercise for rehab
- Ensuring that the *whole* muscle fires in a movement for real strength
- Why not move through pain
- dealing with chronic back pain
- active vs passive care/therapy
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Friday, June 4, 2010
One less Rep - It's ok NOT to finish a set. Really. Less is hard but can be more
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Workouts are about work, about sufficient challenge for adapatation, about getting more perfect in each step of our practice. So why so many overuse injuries? Why so many of us getting jacked up? I wonder if it's at least in part from the reluctance to quit when we need to quit? So let me all fellow workout heads ask this quesiton:
when you workout, if you have 10 reps of a set to do, or 5 sets to do, you WILL DO those reps; you will DO those sets. Even if you don't feel perfectly happy with yourself, entirely, especially if there's only three more reps, you're gonna do those reps. Or one more set, you're gonna do that set. Well are you, punk? your inner voice inquires?
Fave example: you're doing viking warrior conditioning - you have your 8 reps per 15 secs to do - ok wait, that's me, let's just own it: i'm doing VWC, these are my reps and sets, the timer is ticking, i have 3 more sets to do, the blister is forming on my hand - i can feel it - but will i quit? NO, because i HAVE TO FINISH MY SETS.
What's the Value of Having to get That Last Rep? Um, question to self: Why? Is this a competition? does someone have a gun to my head? What do i get out of a big fat crap-technique-showing blister except nearly a week off snatch practice? All i get is wow, i finished my sets. great. So what? i'm now looking at a several day hit to my training?
You know, saying this i'm thinking, this is just so obvious, isn't it? Hand starting to blister: stop. Duh. But the Duh has not been there, at least for me in the set, while the set is happening.
At the RKC II cert in Feb, Pavel Tsatsouline, frech off the research for his Power to the People Professional, gave a related lecture on old time strong man training. A big part of that was strong men staying away from 1RM work; staying fresh. This theme is nothing new to Tsatousline's training approach. Stay fresh, gas in the tank, perfect form.
And yet...
Even when i believe i'm focusing on Pavel Tsatsouline's guidance to "stay fresh" - always end the set feeling fresh rather than ever going to failure, see i'm thinking i'm not - or haven't been. Why? Because i have been recovering from what has been called an "overuse injury" - tendinopathy in the shoulder. Painful arc syndrome. What ever.
There are lots of reasons for overuse injuries: lots of reps being one of them, but usually that's lots of use that is beyond the capacity of that tendon. And what wears into overuse? Form issues? And what happens to form on the weaker side when going with the stronger side? Fatigue? And with fatigue comes injury. We know this. This is basic.
Pain is the Last Warning for Change, not the First. The ugly side of overuse injuries is that they don't show up as pain until there's been some damage. Imagine pain being like an oil gage that only tells you when there's a teaspoon of oil left in the engine: there's no funky needle showing you the oil steadily leaking out of the system. And by the time that needle is in the red, well ya know something has likely been hurt in the engine, too.
Another analogy - this time with the human body, but same "if you feel it, it's gone too far" effect is like thirst. Waiting to hydrate till we're thirsty - especially on a hot day out in the sun - is too late. By the time we're thirsty symptoms of sun stroke/dehydration have hit our systems.
Pain is really our LAST warning. And as i've written about before, from the pain literature, pain is a warning (or signal) to change. Figuring out what to change can sometimes be an issue, but in working out with weight
And in working out, it seems we need to get better at developing our early warning system. What is that early warning system? Learning to trust ourselves. How might we do that? Let me offer an example.
Test It. The other day i had a write up to do 10 sets of X for my particular routine that day. By set five i was feeling a bit fatigued. So i thought wow this is too early to quit, surely, but let me test it. So i did a fatigue test (described here) - waited my normal recovery time - and retested. Nope. Not ready. Wait, retest. Good to go. Did the next three sets, and when going to do set 9, i had to own i felt not quite fresh. Like i'd be pushing it. So i didn't push.
What's the difference between 9 sets or 10? Let's see. That's 90% of the workout instead of 100%. 10% less volume. Let's put this in context: 10 fewer reps out of 100. Once in a week. What's the performance difference? My recovering shoulder was not saying the next day "don't do that again," so i was able to go ahead with my next day's plan. Great.
For folks not doing rehab/recovery for an injury, you may be wondering what does this have to do with me? I'm going to push hard. Bien sur. No one is saying don't work hard. We have to work hard for an adaptation. Work smart and hard.
After all, has my body lost anything by those 10 fewer reps in one workout session all week? In terms of absolute total volume, sure, but in terms of adaptation, i *don't* know. My guess is, not likely. Indeed, maybe for me i just optimised my load, doing the best for me at that moment by doing a few less today than what was an arbitrary number on a piece of paper. Ranges are better than absolutes, perhaps; intensional rather than extensional.
Pain is the Last Signal, not the ONLY signal. Every workout since then i've been trying to *listen* to my body to hear the signals that are there before pain happens. Rather than ignoring them as "nothing" i've been asking "what if?" - what if this tiny tiny bit of lost form, or this teeny weeny bit of fatigue may actual be more than i want to give it credit as being?
The cool thing is (and it took me a long time to put together this simple 2+2 is 4) i have a suite of self-assessments i can use to self-test whether or not this is an "ok, just pause the set here - not even quit; just pause, do some recovery and then continue" kind of issue or a "bag it" one.
Now personally i do not test every set, every exercise, and perhaps i'll learn that that is less than optimal. Right now, what i'm testing is simply that set of question marks i would simply have ignored before and carried on to GET MY NUMBERS complete my workout.
Practicing Less(ness) - towards overuse prevention. What's interesting for me at least is that part of this practice is practicing a different perspective: letting go of the last rep. I have been consciously trying even if i feel fine going for X planned reps, just once in a while - usually at the end of the workout - to do X-1. Or one set in the block (if this is a volume day) to do a set that's half or two-thirds the no. of reps for that set.
Why? because i'm thinking it's kinda stupid to be so obsessed with getting in numbers - i'm pretty sure my "overuse shoulder injury" is not practicing a true focus on perfect quality rather than arbitrary numbers.
I may have thought oh ya i'm still fresh my form is still dandy, but my shoulder has told me something else, like "you blew it." I don't want that to happen anywhere else. So gonna listen - and lessen.
Less is Hard. Right now, i have to say, doing a set of 5 rather than 10 (in ten sets), finishing a set of 100's instead as 99's still causes a twinge in my brain. I still kinda clench my teeth, like somehow that means what? my whole workout is toast? i'm not as great as if i'd done the full count? That somehow without that weary adherence to numbers i'm a loser? can't cut it? oh dear. What would i say to someone i was coaching who was expressing such concern?
I guess i just decided i don't want to be that person anymore - who "has to do it" when there's no good reason why to do so and a potential raft of better reasons not to do so, or at least be flexible.
I'm not there yet - i'm not at a place where that less than planned sits well, but i'm working on it.
Take Aways Pain from overuse injuries shows up after the injury has happened. It may help therefore to learn to listen for other signs in the body to help suggest when actions that may contribute to overuse are happening.
There are ways to help hone this awareness - self-tests that we can leanr and practice when wanting to reality check how we're doing - lots of them in the essentials of elite performance dvd. BUT in order to hear something at all to trigger a test, speaking at least for myself, comes a willingness to do LESS than was scheduled for a day. And like any other performance skill, less needs to be practiced.
On the plus side, i'm finding that actually practicing less, learning less, has let me do more and in this recovery phase where doing anything has been a bonus, my better self is pleased with that progress.
How you doing with less is hard, but less can be more?
Related Resources
when you workout, if you have 10 reps of a set to do, or 5 sets to do, you WILL DO those reps; you will DO those sets. Even if you don't feel perfectly happy with yourself, entirely, especially if there's only three more reps, you're gonna do those reps. Or one more set, you're gonna do that set. Well are you, punk? your inner voice inquires?Fave example: you're doing viking warrior conditioning - you have your 8 reps per 15 secs to do - ok wait, that's me, let's just own it: i'm doing VWC, these are my reps and sets, the timer is ticking, i have 3 more sets to do, the blister is forming on my hand - i can feel it - but will i quit? NO, because i HAVE TO FINISH MY SETS.
What's the Value of Having to get That Last Rep? Um, question to self: Why? Is this a competition? does someone have a gun to my head? What do i get out of a big fat crap-technique-showing blister except nearly a week off snatch practice? All i get is wow, i finished my sets. great. So what? i'm now looking at a several day hit to my training?
You know, saying this i'm thinking, this is just so obvious, isn't it? Hand starting to blister: stop. Duh. But the Duh has not been there, at least for me in the set, while the set is happening.
At the RKC II cert in Feb, Pavel Tsatsouline, frech off the research for his Power to the People Professional, gave a related lecture on old time strong man training. A big part of that was strong men staying away from 1RM work; staying fresh. This theme is nothing new to Tsatousline's training approach. Stay fresh, gas in the tank, perfect form.And yet...
Even when i believe i'm focusing on Pavel Tsatsouline's guidance to "stay fresh" - always end the set feeling fresh rather than ever going to failure, see i'm thinking i'm not - or haven't been. Why? Because i have been recovering from what has been called an "overuse injury" - tendinopathy in the shoulder. Painful arc syndrome. What ever.
There are lots of reasons for overuse injuries: lots of reps being one of them, but usually that's lots of use that is beyond the capacity of that tendon. And what wears into overuse? Form issues? And what happens to form on the weaker side when going with the stronger side? Fatigue? And with fatigue comes injury. We know this. This is basic.
Pain is the Last Warning for Change, not the First. The ugly side of overuse injuries is that they don't show up as pain until there's been some damage. Imagine pain being like an oil gage that only tells you when there's a teaspoon of oil left in the engine: there's no funky needle showing you the oil steadily leaking out of the system. And by the time that needle is in the red, well ya know something has likely been hurt in the engine, too.
Another analogy - this time with the human body, but same "if you feel it, it's gone too far" effect is like thirst. Waiting to hydrate till we're thirsty - especially on a hot day out in the sun - is too late. By the time we're thirsty symptoms of sun stroke/dehydration have hit our systems.
Pain is really our LAST warning. And as i've written about before, from the pain literature, pain is a warning (or signal) to change. Figuring out what to change can sometimes be an issue, but in working out with weight
And in working out, it seems we need to get better at developing our early warning system. What is that early warning system? Learning to trust ourselves. How might we do that? Let me offer an example.
Test It. The other day i had a write up to do 10 sets of X for my particular routine that day. By set five i was feeling a bit fatigued. So i thought wow this is too early to quit, surely, but let me test it. So i did a fatigue test (described here) - waited my normal recovery time - and retested. Nope. Not ready. Wait, retest. Good to go. Did the next three sets, and when going to do set 9, i had to own i felt not quite fresh. Like i'd be pushing it. So i didn't push.
What's the difference between 9 sets or 10? Let's see. That's 90% of the workout instead of 100%. 10% less volume. Let's put this in context: 10 fewer reps out of 100. Once in a week. What's the performance difference? My recovering shoulder was not saying the next day "don't do that again," so i was able to go ahead with my next day's plan. Great.
For folks not doing rehab/recovery for an injury, you may be wondering what does this have to do with me? I'm going to push hard. Bien sur. No one is saying don't work hard. We have to work hard for an adaptation. Work smart and hard.
After all, has my body lost anything by those 10 fewer reps in one workout session all week? In terms of absolute total volume, sure, but in terms of adaptation, i *don't* know. My guess is, not likely. Indeed, maybe for me i just optimised my load, doing the best for me at that moment by doing a few less today than what was an arbitrary number on a piece of paper. Ranges are better than absolutes, perhaps; intensional rather than extensional.
Pain is the Last Signal, not the ONLY signal. Every workout since then i've been trying to *listen* to my body to hear the signals that are there before pain happens. Rather than ignoring them as "nothing" i've been asking "what if?" - what if this tiny tiny bit of lost form, or this teeny weeny bit of fatigue may actual be more than i want to give it credit as being?
Now personally i do not test every set, every exercise, and perhaps i'll learn that that is less than optimal. Right now, what i'm testing is simply that set of question marks i would simply have ignored before and carried on to GET MY NUMBERS complete my workout.
Practicing Less(ness) - towards overuse prevention. What's interesting for me at least is that part of this practice is practicing a different perspective: letting go of the last rep. I have been consciously trying even if i feel fine going for X planned reps, just once in a while - usually at the end of the workout - to do X-1. Or one set in the block (if this is a volume day) to do a set that's half or two-thirds the no. of reps for that set.
Why? because i'm thinking it's kinda stupid to be so obsessed with getting in numbers - i'm pretty sure my "overuse shoulder injury" is not practicing a true focus on perfect quality rather than arbitrary numbers.
I may have thought oh ya i'm still fresh my form is still dandy, but my shoulder has told me something else, like "you blew it." I don't want that to happen anywhere else. So gonna listen - and lessen.
Less is Hard. Right now, i have to say, doing a set of 5 rather than 10 (in ten sets), finishing a set of 100's instead as 99's still causes a twinge in my brain. I still kinda clench my teeth, like somehow that means what? my whole workout is toast? i'm not as great as if i'd done the full count? That somehow without that weary adherence to numbers i'm a loser? can't cut it? oh dear. What would i say to someone i was coaching who was expressing such concern?
I guess i just decided i don't want to be that person anymore - who "has to do it" when there's no good reason why to do so and a potential raft of better reasons not to do so, or at least be flexible.
I'm not there yet - i'm not at a place where that less than planned sits well, but i'm working on it.
Take Aways Pain from overuse injuries shows up after the injury has happened. It may help therefore to learn to listen for other signs in the body to help suggest when actions that may contribute to overuse are happening.
There are ways to help hone this awareness - self-tests that we can leanr and practice when wanting to reality check how we're doing - lots of them in the essentials of elite performance dvd. BUT in order to hear something at all to trigger a test, speaking at least for myself, comes a willingness to do LESS than was scheduled for a day. And like any other performance skill, less needs to be practiced.
On the plus side, i'm finding that actually practicing less, learning less, has let me do more and in this recovery phase where doing anything has been a bonus, my better self is pleased with that progress.
How you doing with less is hard, but less can be more?
Related Resources
- The Perfect Rep: revisiting the kettlebell front squat
- The perfect rep quest series
- Why not move through pain?
- What's going on with chronic low back pain - and possible approaches.
- Rannoch's 100
- Should i do this next set?
Friday, February 12, 2010
(Why) Do we get Protective of our Pain?
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When i was at my worst with chronic back pain, i was, i think, pretty durn open to hearing about approaches that promised redress. Better than weeping if i picked up a sock and actually didn't hurt - the rarity induced the tears, knowing this would be fleeting; wishing it weren't.
So i've been surprised when i get chatting with folks, and as they hear
about what i do with respect to movement and health coaching, that they start to tell me about their various (often chronic) experiences with their own pain. After the usual "how's it going with your doctor" and "oh they're useless it's just drugs or surgery so i've seen [insert manual therapist here]."
If that's followed with "and how's that going for you?" the reply may vary. Sometimes it's - "oh i have this great therapist i see once a month or once a week and i feel great after those sessions"
And sometimes the follow up discussion is about, why do you think you need to keep going back? - just to explore what the beliefs are that have seemingly come to accept that this is their new fate: to be committed to perpetual treatment. Sometimes, they're open to other models.
An alternate reply is the constant seeker - i can relate - "oh well i try 'em all; i'm still looking for a better [insert therapist type here] i used to have a great one - i've heard [insert other therapy here] is good, so i'm thinking of trying that" Sometimes this leads to a discussion of what these therapies might have in common, such that the approach may be leaving the person wanting; that something might be getting overlooked in the focus on the site of pain rather than perhaps on interrelated movements. Maybe it's not the right model for the circumstances. I do wish someone had offered me that observation sooner than later.
I'm Happy with my Condition. But these two responses are as nothing to this other, rarer
response. The, well, i like the therapy i have now for X. I'm not better, and i don't get too much worse, but it's ok." A few times i have asked "but don't you want to get to a place where you don't need to see Y for X? where X is just better?"
Often the response to such a query is surprisingly protective. I can see the person pulling back almost physically towards that area of specialness, getting it as far away from me as they politely can. Their words in reply to my query are generally awkward and non-specific, indicating they'd just rather change the subject - at least with me, at that time and place.
I realize now, since learning more about motivational interviewing, that my attempt at engagement while feeling incredulous could be better framed as "that's great. sounds like that management of flareups, adapting your workspaces, is working for you. if you learned of an approach that would likely diminish X, rather than manage it, would you explore it?"
Other circumstances, though, are similar. Someone told me recently that they suffer from a particular condition. I'd just seen some research looking at this from an alternative cause perspective, and so asked this person recently if they were aware of it, and that the results seemed promising. The person couldn't have been more luke warm to learning more. And i'm thinking what's up? don't you WANT to get well?
The Value of The Condition. And then it finally hit me, well, maybe not. And then i thought, duh. Physical limitations can be convenient; they can help deal with fears. One person i know is in a constant state about getting back to the Fat Kid stage (he's now skeletal) and happens to have irritable bowel syndrome (IBS) - a recent development, and we're talking a fellow in his late 20's. The biggie that can't get handled with IBS? Fat. Another person i know has "bad knees" and travels a lot, overeating poor food, but is quite content with being overweight - reflecting that for "her age" she's in good shape, don't i think. And with the knees, well, can't really go to the gym now.
That's cheap psychologizing on my part, isn't it? And i don't mean it as a judgement of any of these folks; more a revelation for me (i'm a bit slow sometimes). We likely all have things we use as ways to legitimize choices or limits we put on ourselves that work for ourselves as an optimal strategy, based on the best of our understanding. And i mean that: we're busy people. We only have so many cycles on a day to focus on learning new stuff.
So let's say my cheap psychologizing is right and that IBS person has the best tool they can imagine for maintaining the thin physique they wish. Health is not their priority; not ever getting fat again is. IBS is working. They have the protection of a Condition to justify their very restricted and to me frighteningly low cal way of eating.
Likewise, when my back was killing me, i admit to using it not to go to Event X as i couldn't stay on my feet that long (so true) but did i want to explore alternatives? Hmm.
How Might Our Approach Change? What this dim insight into our attraction some of us have to our own pain may mean is a question mark in terms of better designing delivery of proactive health care/support for well being.
It's a sort of the site of the pain isn't the source of the pain necessarily. To trainers, i might ask, how often do we when taking a history ask about how things are at home? How stressed at work? About general happiness? Generally for me, my focus is on past injuries, surgeries, current training, supplements/medication. I'm a coach, after all, not a doctor, right? Other state checks have only come up if an athlete tells me they've been having a hard time sleeping. But what if i asked "are you happy, stressed, getting enough sleep" or related up front?
I don't have to have the answers if they tell me they're really depressed, actually. But at least that's a sign to say, maybe consider a coach that can help navigate that path, too?
These aren't answers that are complete; its just to highlight that perhaps the way we do health, well being, as only treating an illness is not so useful, especially when that illness may be valued and protected in a person's world.
Still a bit muzzy about the point of all this, but maybe there's a bit of an ah ha in here. let me know what you think. Tweet Follow @begin2dig
So i've been surprised when i get chatting with folks, and as they hear
about what i do with respect to movement and health coaching, that they start to tell me about their various (often chronic) experiences with their own pain. After the usual "how's it going with your doctor" and "oh they're useless it's just drugs or surgery so i've seen [insert manual therapist here]."If that's followed with "and how's that going for you?" the reply may vary. Sometimes it's - "oh i have this great therapist i see once a month or once a week and i feel great after those sessions"
And sometimes the follow up discussion is about, why do you think you need to keep going back? - just to explore what the beliefs are that have seemingly come to accept that this is their new fate: to be committed to perpetual treatment. Sometimes, they're open to other models.
An alternate reply is the constant seeker - i can relate - "oh well i try 'em all; i'm still looking for a better [insert therapist type here] i used to have a great one - i've heard [insert other therapy here] is good, so i'm thinking of trying that" Sometimes this leads to a discussion of what these therapies might have in common, such that the approach may be leaving the person wanting; that something might be getting overlooked in the focus on the site of pain rather than perhaps on interrelated movements. Maybe it's not the right model for the circumstances. I do wish someone had offered me that observation sooner than later.
I'm Happy with my Condition. But these two responses are as nothing to this other, rarer
response. The, well, i like the therapy i have now for X. I'm not better, and i don't get too much worse, but it's ok." A few times i have asked "but don't you want to get to a place where you don't need to see Y for X? where X is just better?"Often the response to such a query is surprisingly protective. I can see the person pulling back almost physically towards that area of specialness, getting it as far away from me as they politely can. Their words in reply to my query are generally awkward and non-specific, indicating they'd just rather change the subject - at least with me, at that time and place.
I realize now, since learning more about motivational interviewing, that my attempt at engagement while feeling incredulous could be better framed as "that's great. sounds like that management of flareups, adapting your workspaces, is working for you. if you learned of an approach that would likely diminish X, rather than manage it, would you explore it?"
Other circumstances, though, are similar. Someone told me recently that they suffer from a particular condition. I'd just seen some research looking at this from an alternative cause perspective, and so asked this person recently if they were aware of it, and that the results seemed promising. The person couldn't have been more luke warm to learning more. And i'm thinking what's up? don't you WANT to get well?
The Value of The Condition. And then it finally hit me, well, maybe not. And then i thought, duh. Physical limitations can be convenient; they can help deal with fears. One person i know is in a constant state about getting back to the Fat Kid stage (he's now skeletal) and happens to have irritable bowel syndrome (IBS) - a recent development, and we're talking a fellow in his late 20's. The biggie that can't get handled with IBS? Fat. Another person i know has "bad knees" and travels a lot, overeating poor food, but is quite content with being overweight - reflecting that for "her age" she's in good shape, don't i think. And with the knees, well, can't really go to the gym now.
That's cheap psychologizing on my part, isn't it? And i don't mean it as a judgement of any of these folks; more a revelation for me (i'm a bit slow sometimes). We likely all have things we use as ways to legitimize choices or limits we put on ourselves that work for ourselves as an optimal strategy, based on the best of our understanding. And i mean that: we're busy people. We only have so many cycles on a day to focus on learning new stuff.
So let's say my cheap psychologizing is right and that IBS person has the best tool they can imagine for maintaining the thin physique they wish. Health is not their priority; not ever getting fat again is. IBS is working. They have the protection of a Condition to justify their very restricted and to me frighteningly low cal way of eating.
Likewise, when my back was killing me, i admit to using it not to go to Event X as i couldn't stay on my feet that long (so true) but did i want to explore alternatives? Hmm.
How Might Our Approach Change? What this dim insight into our attraction some of us have to our own pain may mean is a question mark in terms of better designing delivery of proactive health care/support for well being.
It's a sort of the site of the pain isn't the source of the pain necessarily. To trainers, i might ask, how often do we when taking a history ask about how things are at home? How stressed at work? About general happiness? Generally for me, my focus is on past injuries, surgeries, current training, supplements/medication. I'm a coach, after all, not a doctor, right? Other state checks have only come up if an athlete tells me they've been having a hard time sleeping. But what if i asked "are you happy, stressed, getting enough sleep" or related up front?
I don't have to have the answers if they tell me they're really depressed, actually. But at least that's a sign to say, maybe consider a coach that can help navigate that path, too?
These aren't answers that are complete; its just to highlight that perhaps the way we do health, well being, as only treating an illness is not so useful, especially when that illness may be valued and protected in a person's world.
Still a bit muzzy about the point of all this, but maybe there's a bit of an ah ha in here. let me know what you think. Tweet Follow @begin2dig
Tuesday, December 15, 2009
Fitness Geek Gift Book Recommendations
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Time for thinking Presents Thoughts. If the shops are driving you crazy, you can always have a gift sent to your favorite Fitness Geek through the miracle of the internet. Here's a couple of book recommendations you may wish to consider:
Pain & Change. If your fitness geek suffers from chronic pain, besides putting a card under the tree to say you're giving them a session with a z-health trainer (here's a list), consider helping them get a model of what's going on with chronic pain. A fabulous book in this regard is David Butler's Explain Pain.
This is a great plain-language, illustrated text on what we know about the neurology of pain, what's going on when pain goes from acute to chronic, and most particularly, what are strategies for getting a real handle on one's chronic pain to reduce it.
No surprise, movement is discussed
as a great way to help actually rewire the nervous system which can get a bit screwed up (described further in this post on chronic back pain). But the main thing this book offers is a model of the pain process: how pain is perceived by the nervous system, translated by the brain as pain or not, and how we can work with that knowledge to turn down the volume on pain.
If you know your geek really enjoys this area of research, another book that's interesting is The Body has a Mind of Its Own
Again, this book is looking at our neurology in terms of how we are plastic people: we adapt constantly. By getting a handle on that plasticity, we can begin to work with that more directly for our well-being.
Another one in this space - that shows great examples of this plasticity in
action is the Brain the Changes Itself. This book got me totally jazzed about how we are always adapting. In particular it inspired me to look into the work going on at Posit Science that's helped kids and now the elderly to reclaim their brains. That's only one example of the work that's described that's been looking at everything from stroke rehab to dyslexia to autism to supposed senility.
Aside: Elder Brain Care And that reminds me, this is not a book, but if you do have elders whom you care about, and where they or you or both of you sense that mental acuity, hearing, related, seems to be deteriorating, please consider looking into Posit Science's products yourself.
There's a great online evaluation that's just listening to tones/patterns that you can sit down and do with your elder or ask them to do on their own to give them a baseline of what their perceptual age seems to be.
The brain tools that are part of the programs are like games that the participant plays that rebuild perceptual and conceptual accuity. It is amazing it's so effective. The design is not like the brain games stuff that we see on hand helds. This stuff has been evaluated a LOT to check real results. The packages are a couple hundred bucks, but when we think about the costs of assisted living/care, and just quality of life, they pay for themselves over and over.
FOOD & Change
Sometimes for some people, food is as painful to contemplate as an ongoing ache. If there's one thing you can do for these folks is give them an e-book that
de-stresses the cooking, food-making process. RD Georgie Fear's DIG IN really does this in spades. The recipes are simple, delictious, tasty, and totally lean-eating friendly so no worries on over-dosing calories for the food geek.
The book is overviewed here, with indicative recipes also provided, and a list of any utensils actually needed, and an interview with the author linked in. What's not to like.
Oh and the book is cheap, too, AND you can have it now via instant download, or you can have it sent to someone really easily for that on time delivery - either download or physical copy. The pics are fab.
Perhaps you yourself are a fitness geek, and someone you love is actually having a hard time with getting their eating to a place where they're getting the body comp results they want. Maybe because you're already pretty fit, you're not sure how to help them. No kidding. Diet change work can be frought. Now i'm a long time fan of Precision Nutrition, and there's a free e-book way you can offer your special person a way to check it out, just click here.
A related approach that it diet-free by Martha Beck, simply focuses on working through stages of change. As Beck argues, a lot of dieting goes crazy not cuz people lack discipline but because we don't have great strategies (a) to plan for what usually is CHANGE to the way we do something like the conditions under which we eat and (b) we don't therefore know how to plan for success.
Beck's 4 Day Win: the Way to Thinner Piece is a fab and engaging workthrough and work book for eating change that if practiced (and she makes the practice be whatever is absolutely doable for the person reading the book - so it's YOU driven and based) that it's guarenteed to help get that person to a Happy Place - whatever diet you choose. It's so not about the food, but about what we do, and this book helps support those processes of doing change.
Patterns & Change & Opportunity
And just for fun? I've written about it before in the context of the Perfect Rep Quest, but Michael
Gladwell's book Outliers brings together a whole whack of work well known within sociology but not so well known beyond that takes on the story of the Loan Great Individual. Gladwell does a pretty convincing job to demonstrate that no genius on the scene has emerged without - besides being smart/talented - having put in their 10 thousand hours of work in their field. That's a powerful fact. Even in music - the great and talented there - there is evidence of the ten thousand hours.
Gladwell unpacks how to get to these ten thousand hours before others sometimes means pretty special access to the resources and opportunities to enable this 10k of time, or by some standards, literally being born early enough in a season to have the right development in place by the time a selection is made for say a sports team.
Some have argued against these points saying pishaw there are too geniuses - not everyone who plugs in 10k hours at something is brilliant.
This may be true, but the corollorary is not. Indeed, the point remains that even with native talent, without putting in the time with attention and will but the time nonetheless, a person just doesn't get to carnegie hall.
Why is this a fitness geek book selection? Am i just showing a bias for a canadian author? As i wrote about last year, the role of the rep towards the perfect rep is no small thing. The PR lift may be as much about form as it is about strength, eh? If strength is a skill then a lot of practice with attention will be a good thing.
Real Fitness Books for Fitness Geeks.
If you're interested in more traditional lifting and muscle and related books (and other necessities) for your fitness geek, i proposed a whole bunch in last year's fitness geek giving guide. They can all be found in this post. I hope you enjoy, and can use these tips to shop faster and spend more real time with the fitness geeks you love.
All the best of the season to you!
mc Tweet Follow @begin2dig
Pain & Change. If your fitness geek suffers from chronic pain, besides putting a card under the tree to say you're giving them a session with a z-health trainer (here's a list), consider helping them get a model of what's going on with chronic pain. A fabulous book in this regard is David Butler's Explain Pain.
This is a great plain-language, illustrated text on what we know about the neurology of pain, what's going on when pain goes from acute to chronic, and most particularly, what are strategies for getting a real handle on one's chronic pain to reduce it.
No surprise, movement is discussed
as a great way to help actually rewire the nervous system which can get a bit screwed up (described further in this post on chronic back pain). But the main thing this book offers is a model of the pain process: how pain is perceived by the nervous system, translated by the brain as pain or not, and how we can work with that knowledge to turn down the volume on pain.If you know your geek really enjoys this area of research, another book that's interesting is The Body has a Mind of Its Own
Again, this book is looking at our neurology in terms of how we are plastic people: we adapt constantly. By getting a handle on that plasticity, we can begin to work with that more directly for our well-being.
Another one in this space - that shows great examples of this plasticity in
action is the Brain the Changes Itself. This book got me totally jazzed about how we are always adapting. In particular it inspired me to look into the work going on at Posit Science that's helped kids and now the elderly to reclaim their brains. That's only one example of the work that's described that's been looking at everything from stroke rehab to dyslexia to autism to supposed senility.Aside: Elder Brain Care And that reminds me, this is not a book, but if you do have elders whom you care about, and where they or you or both of you sense that mental acuity, hearing, related, seems to be deteriorating, please consider looking into Posit Science's products yourself.
There's a great online evaluation that's just listening to tones/patterns that you can sit down and do with your elder or ask them to do on their own to give them a baseline of what their perceptual age seems to be.
The brain tools that are part of the programs are like games that the participant plays that rebuild perceptual and conceptual accuity. It is amazing it's so effective. The design is not like the brain games stuff that we see on hand helds. This stuff has been evaluated a LOT to check real results. The packages are a couple hundred bucks, but when we think about the costs of assisted living/care, and just quality of life, they pay for themselves over and over.
FOOD & Change
Sometimes for some people, food is as painful to contemplate as an ongoing ache. If there's one thing you can do for these folks is give them an e-book that
de-stresses the cooking, food-making process. RD Georgie Fear's DIG IN really does this in spades. The recipes are simple, delictious, tasty, and totally lean-eating friendly so no worries on over-dosing calories for the food geek.The book is overviewed here, with indicative recipes also provided, and a list of any utensils actually needed, and an interview with the author linked in. What's not to like.
Oh and the book is cheap, too, AND you can have it now via instant download, or you can have it sent to someone really easily for that on time delivery - either download or physical copy. The pics are fab.
Perhaps you yourself are a fitness geek, and someone you love is actually having a hard time with getting their eating to a place where they're getting the body comp results they want. Maybe because you're already pretty fit, you're not sure how to help them. No kidding. Diet change work can be frought. Now i'm a long time fan of Precision Nutrition, and there's a free e-book way you can offer your special person a way to check it out, just click here.
A related approach that it diet-free by Martha Beck, simply focuses on working through stages of change. As Beck argues, a lot of dieting goes crazy not cuz people lack discipline but because we don't have great strategies (a) to plan for what usually is CHANGE to the way we do something like the conditions under which we eat and (b) we don't therefore know how to plan for success.Beck's 4 Day Win: the Way to Thinner Piece is a fab and engaging workthrough and work book for eating change that if practiced (and she makes the practice be whatever is absolutely doable for the person reading the book - so it's YOU driven and based) that it's guarenteed to help get that person to a Happy Place - whatever diet you choose. It's so not about the food, but about what we do, and this book helps support those processes of doing change.
Patterns & Change & Opportunity
And just for fun? I've written about it before in the context of the Perfect Rep Quest, but Michael
Gladwell's book Outliers brings together a whole whack of work well known within sociology but not so well known beyond that takes on the story of the Loan Great Individual. Gladwell does a pretty convincing job to demonstrate that no genius on the scene has emerged without - besides being smart/talented - having put in their 10 thousand hours of work in their field. That's a powerful fact. Even in music - the great and talented there - there is evidence of the ten thousand hours.Gladwell unpacks how to get to these ten thousand hours before others sometimes means pretty special access to the resources and opportunities to enable this 10k of time, or by some standards, literally being born early enough in a season to have the right development in place by the time a selection is made for say a sports team.
Some have argued against these points saying pishaw there are too geniuses - not everyone who plugs in 10k hours at something is brilliant.
This may be true, but the corollorary is not. Indeed, the point remains that even with native talent, without putting in the time with attention and will but the time nonetheless, a person just doesn't get to carnegie hall.
Why is this a fitness geek book selection? Am i just showing a bias for a canadian author? As i wrote about last year, the role of the rep towards the perfect rep is no small thing. The PR lift may be as much about form as it is about strength, eh? If strength is a skill then a lot of practice with attention will be a good thing.
Real Fitness Books for Fitness Geeks.
If you're interested in more traditional lifting and muscle and related books (and other necessities) for your fitness geek, i proposed a whole bunch in last year's fitness geek giving guide. They can all be found in this post. I hope you enjoy, and can use these tips to shop faster and spend more real time with the fitness geeks you love.All the best of the season to you!
mc Tweet Follow @begin2dig
Tuesday, December 8, 2009
Thoughts on Low Back Pain - When in Chronic Pain Hell
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THis post started life as a reply to someone having "horrible back pain". I'd seen three of these "what can i do about my low back pain" in one day. No kidding it's one of the biggest reasons that stop folks from working or working out. It is hell.
The point of this post is to offer what may be an alternative perspective about back pain that says it mayn't be about the back; it may be about pain processes in the brain, and if we work with a model of pain, and of movement, even chronic stuff like the seemingly unsurmountable of low standing back pain can unwind. Let me further preface this by saying, in no way am i saying the pain is "all in one's head" or not real. It's real, alright. The shape of that reality, however, may be richer that we initially may think.
Going Chronic This post is motivated by the fact that a lot of folks ask about low back pain issues after they've had them for awhile. They've gone from acute - a sudden sharp pain brought on by a specific movement pretty predictably - to something chronic that can be a constant presence, as well as flaring up from time to time, but without a specific acute area that's sharp. It's a nasty thing that can, when flaring, debilitate a person. It is the proverbial monkey on the back, and it can make ya cry. I could go on and on.
In such advice-seeking experiences, many folks recommend chiros, phyiscal therapists, massage, exercises for the low back muscles and so on. All these things can bring benefit. In my experience though, if that back pain has been going on for months/years we're talking chronic, manually therapy has a much harder time addressing this. In my own experience, muscle work like yoga and kettlebells has brought some relief - more so than manual therapies - but not eliminated the problem.
The following offers some other ideas for dealing with low back pain - both at an early and definitely at an ongoing stage. The focus is really on models of pain as opposed to particular back issues.
context
First of all some context: me: like most folks with low back stuff - compressed l4/l5, long history of chronic back stuff. Chiro, pt, acupuncture, orthotics, heel lifts. shots and surgery offered - na thanks.
On the more physical approaches, as said, Yoga therapy worked a bit better than anything else; kettlebell swinging really helped but still chronic flare ups. Both these approaches were based on the theory that the muscles in the back are potentially weak or out of balance and needed to be rebuilt. As said, helped a lot but the chronic flare ups were not addressed; ROM still limited by pain etc. So rebuilding alone is not (at least for me) a complete answer.
Like a few who've been dealing with low back pain for awhile, a lot of money has already been spent for treatments that would hold for only a short time getting off the table. likewise there are models of back pain that suggest it's related to promarily to an emotional state - like anger or job dissatisfaction. Treat the anger; get rid of the pain. I'd encourage folks who are interested in this to investigate further with work like John Sarno's Mind/Body connection, where back pain is seen as psychosomatic, and an example of "Tension myosititis syndrome"
aside. I'd note that the first key study, the Boeing Prospective Study, widely studied and critiqued, that first suggested that the only consistent correlation with back pain was job dissatisfaction was done with shop floor workers (people who spend a lot of time on their feet). When the study was re-run with people who work at desks and also have high incidence of back pain that specific correlation did not, alas hold (pdf). What did hold is that, as we know about pain now, context plays a not insignificant role in pain creation/management. Or as some put it, psychosocial AND biomechanical issues can promote causes.
Work in what pain is, and how it works in the brain, however, shows that pain is toujours deja multi-factorial, and highly context dependent. BUT work in pain also shows that as it does manifest itself in very real neural adaptations. More on this below around "central wind up."
Breakthrough with the Percpetual Systems
During the six days of the Z-health R-phase certification, i had a couple sessions with Eric Cobb. He looked at not only movement (what Z-health is perhaps best known for) but vision and balance stuff as well. The experience was huge and transformative.
Since then i and colleagues have worked with TONS of athletes with chronic low back issues and have been able to help them move through the chronic-icity. How does this approach succeed where so many have not?
getting to the nervous system
Z-health puts the nervous system first by focusing on proprioception, and visual and vestibular perceptions of the world. The approach of nervous system first (aka threat modulation) always seems to have immediate benefit. The main approach is to check a person's responses to movement, and also visual and vestibular cues. The approach is critically largely active on the part of the participant, likewise invoking motor learning in grooving pain free patterns.
To summarise some reasons for this integrated approach:
low back: location of pain receptors for ANY pain event?
Here's something else about low back stuff. Lots of folks have compressed disks or degenerated discs, or scoliosis and have NO pain - so, especially when the pain becomes chronic - is the site of pain the source of the pain? maybe not.
site of pain mayn't be source of pain
Here's why: The back is a hugely important and highly stressed area of the body. An anthropologist colleague of mine swears it's an example of terrible/incomplete evolution. In some models of the body, the back like a big X - things cross from the right side on the lower body up to the left side of the upper body. So the low back again is a HUGE junction for LOTS of information.
As pain goes up, ironically sometimes with repeated poking via movement during an acute stage (that wretched "train through pain" thing), the number of nociceptors (the nerves that detect noxious stimulus) go up; mechanorecpetors that signal movement/position go down or get shut down. Normally, when mechanoreceptive stimulation more or less outnumbers nociceptive stimulation, the pain signal is effectively drownd out. That effect, in other words, can get broken.
AND what's worse is that there seems to be evidence that MORE nociceptive nerves sprout with increased immobility: the more we might reflexively try to protect our back by not moving it, the more we may be contributing to signaling that will continue to amp up any pain signal.
rewiring the back over time to be THE pain receiver
What these changes amount to with chronic pain, or as pain goes chronic is sometimes refered to as neural chunking or central wind up (more here and here). In other words, at this point, any pain/stress signals from anywhere may just start to manifest in the low back - that's become our response zone. That doesn't mean the pain is not happening; just that the brain/nervous system is now routing pain signaling through that super sensitive place. and it has been super sensitized, and so it may well be amplifying what's happening, too.
It's because of all this neuro-chemical soup (to use david butler's analogies from the Senstive Nervous System) happening that sometimes looking for issues in a back joint is not going to "unwind" the pain issue.
So to all you folks who have tried everything and are frustrated and in low back hell? may i recommend considering an active/neurologically sensitive approach? In brief, this means in part, begin to move. But also check what else may be inhibiting good movement.
As to the first part of that suggestion, if you'd like to see the research, Mike Nelson did a nice piece a year ago looking at the literature on why lumbar motion is such a good tonic for the back.
This doesn't necessarily mean huge movements, but it does mean, it seems, working towards full range of motion work in the back - and of course muscular work can be hugely beneficial for a number of reasons here to support that mobility (controlled movement) - but without that specific attention to ROM - something back muscle work alone does not necessarily afford - the benefit mayn't be complete.
Additionally, it may be critical to connect that proprioceptive signaling (nociceptors and mechanoreceptors that modulate signals that get interpretted as pain or not) with the rest of the perceptual systems: vestibular and visual.
Speaking for myself, it was not until my mobility work got hooked up with what turned out to be visual rehab work that my back pain started unwinding. Not this is necessarily the case with everyone, but with me, once the visual work got going, the speed of the unwinding was profound. I mean super rapid, overnight kind of profound.
Release. For anyone who's had low back pain, or has it now, you know what a prison it can feel like: will i ever be able to put my socks on without pain? pick something up from the ground without pain? drive or get in or out of a car without pain? sit and work without pain? bathe without pain?
Speaking for myself, yes. Before working with this approach, i used to get pain-free moments when i'd bend over to pick something up, and there'd be no pain. Nothing. normal. It was like a miracle. The number of times this happened over a decade i could count on one hand. i remember once starting to cry because it felt so incredible and i knew it wasn't going to last, and i so wanted it to last. Perhaps some of you can relate to that?
Understanding Pain and the Role of Movement to Reclaim Life
So, what all the above is speaking to is two things: getting a handle on what's happening withpain, and getting an approach to movement/nervous system communication that can start to rewire the very neurological and brain-based experience of pain. In the book Explain Pain, this is largely David Butler's advice: learn how pain works; learn how to move.
To this i have only added what z-health refines a wee bit: movement is a great way to talk to the nervous system. Remember that visual and vestibular issues may also be contributors to pain, so find a way to check that and engage them in one's movement rehab practice.
Doing It for Herself/Himself
What is a movement rehab practice that will also check the visual and vestibular?
Best approach: see a movement specialist for a Movement Assessment (what that is). In this list, preferably look for someone with either S or T certifications (or both), or a master trainer.
Likewise, if someone's not close with the qualifications, i do video consults, too (use the email link on this post to request info).
Secondary & Complementary approach: get a joint mobility program into your life. Moving each joint through a range of motion is an amazingly good way to talk to the nervous system. here's more on why and if you scroll down to "dig in" there's some recommended places of guided packages for that, eg the "level 1" kit.
The best part is, really, when we have an better understanding of how pain works, and how the nervous system works in terms of proprioception, vision and the vestibular sysetms, there's a path to start unwinding that. AND YOU DO IT FOR YOURSELF so it sticks.
The big take away seems to be that especially chronic low back pain is frequently not about the joints - pain is way more interesting and intriguing it seems than that, but it does make sense that the low back is where so much chronic pain gets filtered.
Moving towards an active, neurologically centered approach, based on an understanding of pain, may well offer the breakthrough that you seek.
The best part is, you will know, more or less on the spot, if this practice offers you the relief you seek, and each practice session will only enhance that benefit. Really - that's just how fast the nervous system works. Tweet Follow @begin2dig
Going Chronic This post is motivated by the fact that a lot of folks ask about low back pain issues after they've had them for awhile. They've gone from acute - a sudden sharp pain brought on by a specific movement pretty predictably - to something chronic that can be a constant presence, as well as flaring up from time to time, but without a specific acute area that's sharp. It's a nasty thing that can, when flaring, debilitate a person. It is the proverbial monkey on the back, and it can make ya cry. I could go on and on.
In such advice-seeking experiences, many folks recommend chiros, phyiscal therapists, massage, exercises for the low back muscles and so on. All these things can bring benefit. In my experience though, if that back pain has been going on for months/years we're talking chronic, manually therapy has a much harder time addressing this. In my own experience, muscle work like yoga and kettlebells has brought some relief - more so than manual therapies - but not eliminated the problem.
The following offers some other ideas for dealing with low back pain - both at an early and definitely at an ongoing stage. The focus is really on models of pain as opposed to particular back issues.
context
First of all some context: me: like most folks with low back stuff - compressed l4/l5, long history of chronic back stuff. Chiro, pt, acupuncture, orthotics, heel lifts. shots and surgery offered - na thanks.
On the more physical approaches, as said, Yoga therapy worked a bit better than anything else; kettlebell swinging really helped but still chronic flare ups. Both these approaches were based on the theory that the muscles in the back are potentially weak or out of balance and needed to be rebuilt. As said, helped a lot but the chronic flare ups were not addressed; ROM still limited by pain etc. So rebuilding alone is not (at least for me) a complete answer.
Like a few who've been dealing with low back pain for awhile, a lot of money has already been spent for treatments that would hold for only a short time getting off the table. likewise there are models of back pain that suggest it's related to promarily to an emotional state - like anger or job dissatisfaction. Treat the anger; get rid of the pain. I'd encourage folks who are interested in this to investigate further with work like John Sarno's Mind/Body connection, where back pain is seen as psychosomatic, and an example of "Tension myosititis syndrome"
aside. I'd note that the first key study, the Boeing Prospective Study, widely studied and critiqued, that first suggested that the only consistent correlation with back pain was job dissatisfaction was done with shop floor workers (people who spend a lot of time on their feet). When the study was re-run with people who work at desks and also have high incidence of back pain that specific correlation did not, alas hold (pdf). What did hold is that, as we know about pain now, context plays a not insignificant role in pain creation/management. Or as some put it, psychosocial AND biomechanical issues can promote causes.
Work in what pain is, and how it works in the brain, however, shows that pain is toujours deja multi-factorial, and highly context dependent. BUT work in pain also shows that as it does manifest itself in very real neural adaptations. More on this below around "central wind up."
Breakthrough with the Percpetual Systems
During the six days of the Z-health R-phase certification, i had a couple sessions with Eric Cobb. He looked at not only movement (what Z-health is perhaps best known for) but vision and balance stuff as well. The experience was huge and transformative.
Since then i and colleagues have worked with TONS of athletes with chronic low back issues and have been able to help them move through the chronic-icity. How does this approach succeed where so many have not?
getting to the nervous system
Z-health puts the nervous system first by focusing on proprioception, and visual and vestibular perceptions of the world. The approach of nervous system first (aka threat modulation) always seems to have immediate benefit. The main approach is to check a person's responses to movement, and also visual and vestibular cues. The approach is critically largely active on the part of the participant, likewise invoking motor learning in grooving pain free patterns.
To summarise some reasons for this integrated approach:
- it works with the nervous system - the body's governing system (what runs joints and muscles)
- it is active rather than passive (about the differences between the two, with video): you are moving yourself rather than being manipulated, which fires of thousands more signals in the body to learn new patterns than manipulations so benefits stick.
- it works in large part on threat reduction: the latest work on pain says pain is an action signal. it means change something. finding the right thing to change is part of the assessment process. i've yet to work with anyone who hasn't had immediate and significant pain reduction (or elimination) and that only improves as they continue to do the work FOR THEMSELVES.
low back: location of pain receptors for ANY pain event?
Here's something else about low back stuff. Lots of folks have compressed disks or degenerated discs, or scoliosis and have NO pain - so, especially when the pain becomes chronic - is the site of pain the source of the pain? maybe not.
site of pain mayn't be source of pain
Here's why: The back is a hugely important and highly stressed area of the body. An anthropologist colleague of mine swears it's an example of terrible/incomplete evolution. In some models of the body, the back like a big X - things cross from the right side on the lower body up to the left side of the upper body. So the low back again is a HUGE junction for LOTS of information.
As pain goes up, ironically sometimes with repeated poking via movement during an acute stage (that wretched "train through pain" thing), the number of nociceptors (the nerves that detect noxious stimulus) go up; mechanorecpetors that signal movement/position go down or get shut down. Normally, when mechanoreceptive stimulation more or less outnumbers nociceptive stimulation, the pain signal is effectively drownd out. That effect, in other words, can get broken.
AND what's worse is that there seems to be evidence that MORE nociceptive nerves sprout with increased immobility: the more we might reflexively try to protect our back by not moving it, the more we may be contributing to signaling that will continue to amp up any pain signal.
rewiring the back over time to be THE pain receiver
What these changes amount to with chronic pain, or as pain goes chronic is sometimes refered to as neural chunking or central wind up (more here and here). In other words, at this point, any pain/stress signals from anywhere may just start to manifest in the low back - that's become our response zone. That doesn't mean the pain is not happening; just that the brain/nervous system is now routing pain signaling through that super sensitive place. and it has been super sensitized, and so it may well be amplifying what's happening, too.
It's because of all this neuro-chemical soup (to use david butler's analogies from the Senstive Nervous System) happening that sometimes looking for issues in a back joint is not going to "unwind" the pain issue.So to all you folks who have tried everything and are frustrated and in low back hell? may i recommend considering an active/neurologically sensitive approach? In brief, this means in part, begin to move. But also check what else may be inhibiting good movement.
As to the first part of that suggestion, if you'd like to see the research, Mike Nelson did a nice piece a year ago looking at the literature on why lumbar motion is such a good tonic for the back.
This doesn't necessarily mean huge movements, but it does mean, it seems, working towards full range of motion work in the back - and of course muscular work can be hugely beneficial for a number of reasons here to support that mobility (controlled movement) - but without that specific attention to ROM - something back muscle work alone does not necessarily afford - the benefit mayn't be complete.
Additionally, it may be critical to connect that proprioceptive signaling (nociceptors and mechanoreceptors that modulate signals that get interpretted as pain or not) with the rest of the perceptual systems: vestibular and visual.
Speaking for myself, it was not until my mobility work got hooked up with what turned out to be visual rehab work that my back pain started unwinding. Not this is necessarily the case with everyone, but with me, once the visual work got going, the speed of the unwinding was profound. I mean super rapid, overnight kind of profound.
i remember once starting to cry because for a moment - i was out of pain - i knew it because could put on my socks without my back killing me - it felt so incredible and i knew it wasn't going to last, and i so wanted it to last...
Release. For anyone who's had low back pain, or has it now, you know what a prison it can feel like: will i ever be able to put my socks on without pain? pick something up from the ground without pain? drive or get in or out of a car without pain? sit and work without pain? bathe without pain?
Speaking for myself, yes. Before working with this approach, i used to get pain-free moments when i'd bend over to pick something up, and there'd be no pain. Nothing. normal. It was like a miracle. The number of times this happened over a decade i could count on one hand. i remember once starting to cry because it felt so incredible and i knew it wasn't going to last, and i so wanted it to last. Perhaps some of you can relate to that?
Understanding Pain and the Role of Movement to Reclaim Life
So, what all the above is speaking to is two things: getting a handle on what's happening with
pain, and getting an approach to movement/nervous system communication that can start to rewire the very neurological and brain-based experience of pain. In the book Explain Pain, this is largely David Butler's advice: learn how pain works; learn how to move.To this i have only added what z-health refines a wee bit: movement is a great way to talk to the nervous system. Remember that visual and vestibular issues may also be contributors to pain, so find a way to check that and engage them in one's movement rehab practice.
Doing It for Herself/Himself
What is a movement rehab practice that will also check the visual and vestibular?
Best approach: see a movement specialist for a Movement Assessment (what that is). In this list, preferably look for someone with either S or T certifications (or both), or a master trainer.
Likewise, if someone's not close with the qualifications, i do video consults, too (use the email link on this post to request info).
Secondary & Complementary approach: get a joint mobility program into your life. Moving each joint through a range of motion is an amazingly good way to talk to the nervous system. here's more on why and if you scroll down to "dig in" there's some recommended places of guided packages for that, eg the "level 1" kit.
The best part is, really, when we have an better understanding of how pain works, and how the nervous system works in terms of proprioception, vision and the vestibular sysetms, there's a path to start unwinding that. AND YOU DO IT FOR YOURSELF so it sticks.
The big take away seems to be that especially chronic low back pain is frequently not about the joints - pain is way more interesting and intriguing it seems than that, but it does make sense that the low back is where so much chronic pain gets filtered.
Moving towards an active, neurologically centered approach, based on an understanding of pain, may well offer the breakthrough that you seek.
The best part is, you will know, more or less on the spot, if this practice offers you the relief you seek, and each practice session will only enhance that benefit. Really - that's just how fast the nervous system works. Tweet Follow @begin2dig
Tuesday, November 3, 2009
Why Not "Train Through Pain"?
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Lately i've had the opportunity to listen to a lot of athletes talk about various injuries, ongoing problems, and how many of them have tried to "train through the pain." Probably we've all done it (do it). The way our nervous systems are wired, however, that's a sub-optimal response to pain that can often lead to more problems. This post is meant to be a quick look at some strategies on how to respond to a pain cue to get back in the game.
Who needs to "work through the pain"?
In a life and death situation, a person may need to work through the pain. The price of staying alive might be worth the potential long term cost of whatever damage is sustained.
A workout in a gym is not the same (is it?) Getting in a few extra reps so as not to spoil a set and "working through the pain" may have untold consequences for no benefit. Seriously.
Apparently we just don't know what the consequences of even a seemingly trivial injury can be for cascading through our systems and causing other issues. Knowing that there may be significant consequences when we break ourselves, we may need to ask ourselves: when there's pain, why not just stop and figure it out? why put our bodies at risk just to finish a set? who cares really, ultimately, if we get in 10 reps rather than 8? or 2?
I think a lot of this just-work-through-it comes from most of us not knowing what pain really is or not having tools specifically to respond to it appropriately. So i'd like to offer a little bit about what pain is, and some simple but effective pain response strategies.
Background A lot of the work i'm summarizing stems from pain research. Books like David Butler's Explain Pain, and the Blakeslee's the Body has a Mind of It's Own are super general references in this space. I was introduced to the following models/work on pain by Eric Cobb at the first Z-Health certification. When we focus on the nervous system, as Z-Heath does, and get that Pain is an action signal from the brain manifesting through the nervous sytem, we have a whole lot more tools to deal with pain as events.
Pain is in the brain, first and foremost, and it means Threat is caused by what we're doing. So CHANGE.
Pain is not what happens at the site of pain - like the ache in the wrist or the sharp pain in the back coming up from a poor lift. It's a kind of summation of a lot of information. We've all had experiences where a paper cut means nothing we ignore it and get on with our day, and other days where the same paper cut really HURTS and demands attention. This is because pain is not about the thing itself (the injury); it's about the whole system context of how our entire system is doing at that moment, including perceived threat. Yup, we can feel pain in response to the anticipation of something occurring.
Pain is not isolated; Pain takes place in the brain. It is an action signal; it's an event that is telling the body that something, somewhere is wrong (ie under threat) and to deal with it. We ignore it at our peril, and working through the pain like an ache in a rep is actually being stupid in a non life threatening situation.
Here's part of why.
In a tissue injury, nociceptors (things that detect noxious stimulus in the body, and that live particularly around joints and in muscle) get fired up and a whole chemical soup gets going around the site of trauma to deal with it. Incredibly, that response in and of itself can be pretty varied and doesn't mean there's PAIN yet. Based on whatever else is going on in the body, signals go up to the brain, and based on that context, the brain decides whether to signal or even surpress a pain event.
If the brain says this is pain, however, it means, for whatever reason, we need to attend to it.
Pain is a Threat Response - real or perceived. The nervous system is always on; it only checks a single binary condition: threat or no threat. The response to threat to the body is to respond to the area where there is threat. Often that's a kind of shut down sequence.
Consider what happens dramatically if we have an inflamed finger. The range of motion is restricted, right? Or sore quads from DOMS - range of motion and also power can often be restricted. We are being held back from injuring ourselves further in the current circumstances.
Pain becomes a clear action signal not necessarily to stop what we're doing but to change what we're doing (which sometimes does mean "stop" - temporarily)
If we decide to go ahead with that lift anyway, when the body is pulling muscular firing power away from the site and sending up pain events to say this is not a happy thing, then we're stressing our bodies out further which cranks up stressor chemicals, cortisol can get going and well, we're well far away from an ideal environment for performance, right?
It's a feedback loop for more shutdown, more pain: by working against ourselves we start setting up the body to act more to defend itself, while we're taxing it further and potentially injuring ourselves more.
I've spoken with experts about what's going on with people who say they trained through the pain and after awhile it went away. The consensus seems to be that in those cases (a) the person is actually most likely developing new movement patterns away from the site of pain (b) doing so sub-optimally at a potential cost to overly sensitizing those sites to future pain/trauma events. Similar people who "work through" pain will often also talk about the same kind of pain showing up months/years later as a now more persistent ache, or have other physical issues.
The costs of risking "breaking" ourselves in some way by working through pain are potentially complex. We really have no idea what might be the one seemingly trivial thing that can set up a cascade of events in our nervous system that will have repercussions. So even though we're very robust, and will adapt to almost anything, to ensure the robustness of the system it's really easy just to learn some strategies to respond to a pain/threat event.
Here's an analogy with stress. Stress or anxiety like we might feel before having to get up in front of a group of people and give a talk is an example of a threat response. Chemicals start to get released from the brain to get us ready for fight or flight. Often people who are stressed are encouraged to go for a walk or move and they report feeling better: we effectively start to use those chemicals for the purpose they've been stirred up - to move. The same chemicals (catecholamines) pretty much get fired up every time we work out and get our heart rate up. So they're not bad, they're just physical, and there is a physical response available. If we become aware of "getting stressed" - note the breathing responses etc and respond, we can quickly get back to normal performance.
Pain is a similar kind of response to threat - perceived or actual - and is an action signal. Again, often (not 100% of the time, but often) movement can likewise help both diagnosis that there's an issue and check if there's a good response to the action signal.
The right mobility can be an optimal response to the pain action signal
So, with all the athletes i work with, i recommend that at a minimum they consider making mobility practice a regular part of their daily routine. If you're interested in more of the details of why, here's an article. Likewise, if you haven't and especially if you're concerned about your performance goals, consider getting your movement in general and your specific ahtletic form checked by a movement specialist to make sure you're repping in good patterns.
Scenario of Pain Event Listening
SO let's say you're doing something that fires up a pain signal in the elbow or forearm.
You check your shoulder range of motion.
You can only get your arm up to the start of your ear - usually you're behind it. Something's wrong.
You do some opposing joint drills and recheck - your arm mobility is back to normal. awesome.
You recheck your form for whatever was hurting, remember your form: tall spine, good breathing, focus on open form, pain is gone, life is good again.
Yes it can happen that fast. The nervous system mechanoreceptors fire at 300mph. And with the SAID principle, we respond exactly and immediately to what we're doing.
Now there may be instances where the ROM does not come back; where the pain is acute when doing ANY ROM of the given move. That may be time to bag it. Rule no. 1: never move through pain because of all the above: upping threat, further shut down, more threat response chemical events etc. Related strategies are, when and as possible: reduce the range of motion of a movement that causes pain so you work outside the pain zone; reduce the load that brings on pain in any ROM.
An intriguing benefit of regular mobility practice is that, by practicing regular and better movement, better information is getting to the nervous system about where we are and what our options are, so there is a decreased incidence of injury and in no small part increased performance as well. Why? Mobility work helps us achieve the Perfect Rep - or at least efficient movement (discussed mid article here), which is the least likely to result in problems, because it also enables the best ROM from which to respond to the unexpected.
An example of mobility and connecting up nervous system communication we've talked about at b2d before is with the arthrokinetic reflex - a powerful example of what happens (1) with a threat response in the nervous system - when it senses even the slightest impingement - and how to fix that with self-mobilization and (2) how performance improves when connecting the neuro-reflexes in the body: here connecting eye movement with hip movement.
So why shouldn't we train though Pain, in brief?
We really don't know the extent to which a pain event can screw ourselves up for right now, or for some event in the future. Like a stress fracture in metal, it may be fine for some time, but it becomes a progressive site of deterioration until suddenly there's a potentially catastrophic break. By not stopping to deal with the pain, we set up a cascade effect of progressive responses in the body to get us to attend to the ever amping up signal. These further events have further costs on our performance. A way the body may deal with unattended pain is to bring on a compensation that will lead to other/new pains. Likewise, ignoring pain can also set up various sensitizations to pain that can trip the pain from a single acute incident to something that gets would up into our nervous system and goes chronic, also potentially harder to address. All in all, it's not nice.
Bottom line?
Who needs to "work through the pain"?
In a life and death situation, a person may need to work through the pain. The price of staying alive might be worth the potential long term cost of whatever damage is sustained.
A workout in a gym is not the same (is it?) Getting in a few extra reps so as not to spoil a set and "working through the pain" may have untold consequences for no benefit. Seriously.Apparently we just don't know what the consequences of even a seemingly trivial injury can be for cascading through our systems and causing other issues. Knowing that there may be significant consequences when we break ourselves, we may need to ask ourselves: when there's pain, why not just stop and figure it out? why put our bodies at risk just to finish a set? who cares really, ultimately, if we get in 10 reps rather than 8? or 2?
I think a lot of this just-work-through-it comes from most of us not knowing what pain really is or not having tools specifically to respond to it appropriately. So i'd like to offer a little bit about what pain is, and some simple but effective pain response strategies.
Background A lot of the work i'm summarizing stems from pain research. Books like David Butler's Explain Pain, and the Blakeslee's the Body has a Mind of It's Own are super general references in this space. I was introduced to the following models/work on pain by Eric Cobb at the first Z-Health certification. When we focus on the nervous system, as Z-Heath does, and get that Pain is an action signal from the brain manifesting through the nervous sytem, we have a whole lot more tools to deal with pain as events.
Pain is in the brain, first and foremost, and it means Threat is caused by what we're doing. So CHANGE.
Pain is not what happens at the site of pain - like the ache in the wrist or the sharp pain in the back coming up from a poor lift. It's a kind of summation of a lot of information. We've all had experiences where a paper cut means nothing we ignore it and get on with our day, and other days where the same paper cut really HURTS and demands attention. This is because pain is not about the thing itself (the injury); it's about the whole system context of how our entire system is doing at that moment, including perceived threat. Yup, we can feel pain in response to the anticipation of something occurring.
Pain is not isolated; Pain takes place in the brain. It is an action signal; it's an event that is telling the body that something, somewhere is wrong (ie under threat) and to deal with it. We ignore it at our peril, and working through the pain like an ache in a rep is actually being stupid in a non life threatening situation.
Here's part of why.
In a tissue injury, nociceptors (things that detect noxious stimulus in the body, and that live particularly around joints and in muscle) get fired up and a whole chemical soup gets going around the site of trauma to deal with it. Incredibly, that response in and of itself can be pretty varied and doesn't mean there's PAIN yet. Based on whatever else is going on in the body, signals go up to the brain, and based on that context, the brain decides whether to signal or even surpress a pain event.If the brain says this is pain, however, it means, for whatever reason, we need to attend to it.
Pain is a Threat Response - real or perceived. The nervous system is always on; it only checks a single binary condition: threat or no threat. The response to threat to the body is to respond to the area where there is threat. Often that's a kind of shut down sequence.
Consider what happens dramatically if we have an inflamed finger. The range of motion is restricted, right? Or sore quads from DOMS - range of motion and also power can often be restricted. We are being held back from injuring ourselves further in the current circumstances.
Pain becomes a clear action signal not necessarily to stop what we're doing but to change what we're doing (which sometimes does mean "stop" - temporarily)
If we decide to go ahead with that lift anyway, when the body is pulling muscular firing power away from the site and sending up pain events to say this is not a happy thing, then we're stressing our bodies out further which cranks up stressor chemicals, cortisol can get going and well, we're well far away from an ideal environment for performance, right?
It's a feedback loop for more shutdown, more pain: by working against ourselves we start setting up the body to act more to defend itself, while we're taxing it further and potentially injuring ourselves more.I've spoken with experts about what's going on with people who say they trained through the pain and after awhile it went away. The consensus seems to be that in those cases (a) the person is actually most likely developing new movement patterns away from the site of pain (b) doing so sub-optimally at a potential cost to overly sensitizing those sites to future pain/trauma events. Similar people who "work through" pain will often also talk about the same kind of pain showing up months/years later as a now more persistent ache, or have other physical issues.
The costs of risking "breaking" ourselves in some way by working through pain are potentially complex. We really have no idea what might be the one seemingly trivial thing that can set up a cascade of events in our nervous system that will have repercussions. So even though we're very robust, and will adapt to almost anything, to ensure the robustness of the system it's really easy just to learn some strategies to respond to a pain/threat event.
Here's an analogy with stress. Stress or anxiety like we might feel before having to get up in front of a group of people and give a talk is an example of a threat response. Chemicals start to get released from the brain to get us ready for fight or flight. Often people who are stressed are encouraged to go for a walk or move and they report feeling better: we effectively start to use those chemicals for the purpose they've been stirred up - to move. The same chemicals (catecholamines) pretty much get fired up every time we work out and get our heart rate up. So they're not bad, they're just physical, and there is a physical response available. If we become aware of "getting stressed" - note the breathing responses etc and respond, we can quickly get back to normal performance.
Pain is a similar kind of response to threat - perceived or actual - and is an action signal. Again, often (not 100% of the time, but often) movement can likewise help both diagnosis that there's an issue and check if there's a good response to the action signal.
The right mobility can be an optimal response to the pain action signal
- So first things first: never move through pain. If pain happens, stop and check. That stopping is a movement response.
- Next, pending severity we can quickly check where the mobility around the joints where the pain occurs may be restricted. So sore elbow - how's the shoulder movement, wrist movement, elbow movement without load (it helps also to learn what the ROM of these joints is for yourself). If there's pain through everything, just frickin' stop.
- Knowing some mobility work for the related joints, going through them where there's no pain, and rechecking range of motion - better worse no change - is again a great fast way to see how things are going. If things are improved awesome, you may want to try - gently - to see if the original move is ok, and if the load has to be reduced to move through the ROM without pain
- Recheck regularly to see where the threat is
- Move a bit as soon as you can without ever moving into pain.
So, with all the athletes i work with, i recommend that at a minimum they consider making mobility practice a regular part of their daily routine. If you're interested in more of the details of why, here's an article. Likewise, if you haven't and especially if you're concerned about your performance goals, consider getting your movement in general and your specific ahtletic form checked by a movement specialist to make sure you're repping in good patterns.
Scenario of Pain Event Listening
SO let's say you're doing something that fires up a pain signal in the elbow or forearm.You check your shoulder range of motion.
You can only get your arm up to the start of your ear - usually you're behind it. Something's wrong.
You do some opposing joint drills and recheck - your arm mobility is back to normal. awesome.
You recheck your form for whatever was hurting, remember your form: tall spine, good breathing, focus on open form, pain is gone, life is good again.
Yes it can happen that fast. The nervous system mechanoreceptors fire at 300mph. And with the SAID principle, we respond exactly and immediately to what we're doing.
Now there may be instances where the ROM does not come back; where the pain is acute when doing ANY ROM of the given move. That may be time to bag it. Rule no. 1: never move through pain because of all the above: upping threat, further shut down, more threat response chemical events etc. Related strategies are, when and as possible: reduce the range of motion of a movement that causes pain so you work outside the pain zone; reduce the load that brings on pain in any ROM.
An intriguing benefit of regular mobility practice is that, by practicing regular and better movement, better information is getting to the nervous system about where we are and what our options are, so there is a decreased incidence of injury and in no small part increased performance as well. Why? Mobility work helps us achieve the Perfect Rep - or at least efficient movement (discussed mid article here), which is the least likely to result in problems, because it also enables the best ROM from which to respond to the unexpected.
An example of mobility and connecting up nervous system communication we've talked about at b2d before is with the arthrokinetic reflex - a powerful example of what happens (1) with a threat response in the nervous system - when it senses even the slightest impingement - and how to fix that with self-mobilization and (2) how performance improves when connecting the neuro-reflexes in the body: here connecting eye movement with hip movement.
So why shouldn't we train though Pain, in brief?
We really don't know the extent to which a pain event can screw ourselves up for right now, or for some event in the future. Like a stress fracture in metal, it may be fine for some time, but it becomes a progressive site of deterioration until suddenly there's a potentially catastrophic break. By not stopping to deal with the pain, we set up a cascade effect of progressive responses in the body to get us to attend to the ever amping up signal. These further events have further costs on our performance. A way the body may deal with unattended pain is to bring on a compensation that will lead to other/new pains. Likewise, ignoring pain can also set up various sensitizations to pain that can trip the pain from a single acute incident to something that gets would up into our nervous system and goes chronic, also potentially harder to address. All in all, it's not nice.
Bottom line?
- A pain event is non-trivial. It means something. So it's a good idea to listen to that signal.
- At a minimum, never move into pain: reduce range of motion/load/speed as necessary (for awhile this may mean non-movement, but getting to possible movement is a good idea)
- Mobility work like z-health rphase/iphase is a fabulous tool kit to be able to self-assess to respond to that pain event and get back to practice asap.
- lots of articles about the z-health approach to movement/mobility
- Mike T Nelson's great exercise approach to Tendonitis/Tendonosis
- mike t nelson presents a new study on pain/performance.
Sunday, September 20, 2009
DOMS Part 1: What is Delayed Onset Muscle Soreness (DOMS) and what doesn't work to reduce/eliminate it
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Ever get sore a day or two after a workout? Muscle pain, muscle soreness or muscle stiffness that is felt 12-48 hours after exercise is usually known as Delayed Onset Muscle Soreness or DOMS. The tell tale signs of DOMS are sore muscles, unable to move such muscles in normal range of motion, reduced strength in those limbs. It usually happens after trying out a new workout or doing new type of physical activity, or if the intensity of 
a familiar activity goes up up.
Exactly what's happening in DOMS that creates the soreness and related effects is still speculation, but regardless of cause what might reduce or eliminate its effects has been studied from multiple approaches. This article has two parts (1) what it is and what doesn't work to reduce doms (this article); (2) what actually does seem to work to reduce or eliminate doms.
In part 1, this one, there's a summary about what is known about it. We then looks at what seems not to work at all, what actually makes DOMS worse. In Part II we look at what seems to mitigate its effects on performance but not pain, or vice versa, and what may actually really eliminate it from occurring (that part is very hair of the dog). If you'd just like the program of what works, skip to Part II, Summary, right now because a lot of suggestions on the rest of the web (like cool down or stretch after exercise) are just wrong. Knowing what doesn't work - since all the proposals are so sensible, but so useless, is interesting too.
So next time you're in a shower room argument about be sure to cool down and stretch it out or have a hot shower or get a massage, take an aspirin or vitamin c, you'll be able to say bollocks, as you are able to move freely two days after that intense training session while your peers are hobbling.
DOMS Review of the Known
DOMS is brought on by
In normal circumstances, eccentric muscle work that is either at a new intensity level or is a new eccentric-loaded movement brings on DOMS. In some studies, for instance, DOMS has been successfully induced by backwards walking down an 13 degree inclined treadmill.
DOMS effects
The most obvious effects of DOMS are that they occur 12-48 hours after the activity; DOMS hurts with the consequent effect being a decreased range of motion, increased size from swelling, and less power to work in the effected muscles. The effected muscles are most often the big leg muscles and to lesser degree, calves, but DOMS is not restricted to the lower body.
Beneath the manifested physical effects are the physiological ones that are less clear: changes in creatine kinase for instance, amount of inflammation, degree of muscle fiber damage. Whether or not an intervention mitigates the effects of DOMS is usually measured by perceived soreness, but also less subjective range of motion and force production. In some cases the physiological markers like CK levels pre and post are also checked. In some cases we'll see that treatments can decrease the DOMS effect on ROM and power, but do nothing to eliminate the duration/intensity of the pain.
DOMS physiological causes
This section is based on a great overview by sports fitness advisor of research from the 70's up to about 2006, the authors show that by about the mid-80's any thoughts that lactic acid buildup in the muscles was the cause of DOMS was put to rest. Likewise in the 80's and early 90's the main theories that seem to be still active are DOMS is either muscle cell damage (ruptured cells spilling contents into muscle fibers), muscle fiber damage, where the repair process at sensitive nerve endings is the pain signal, or an inflammatory (Tidball JG. Inflammatory cell response to acute muscle injury. Med Sci Sports Exerc. 1995 Jul;27(7):1022-32) response. The latter suggests that the 48 hour period when DOMS hits is the peak time for cell death (Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc. 1984 Dec;16(6):529-38).
In other words no one knows the exact mechanism for DOMS - a review of the literature i've done to 2009 suggests this is still the case.
I cannot find the reference, alas, but my favorite hypothesis to date has been that the pain is actually the building up of the new muscle fiber material where other fibers are getting pushed out of the way as new tissue comes in. If anyone knows of the reference, please let me know.
DOMS - unpredictable degree of effect
What we do know at this point is that, as of March 2009, we don't have the appropriate scales to predict "Onset, intensity, and duration of DOMS" in 87% of a tested population. SO we can bring it on, but we don't know exactly how it's going to effect participants.
While we can't yet predict how long and how intense DOMS will be, we know alot more about where it actually acts in the muscluature: the bits further away from the center of the body - the distal ends of the muscles.
In 2003, nothing that had been tried really worked - and i've found a few studies recently that show we can make it worse. And while the review abstract says that NSAIDS (ibuprofen, etc) and antioxidants have potential, that hope has been fleeting. Antioxidants like Vit C have not been shown in clinical trials to work (Close GL, Ashton T, Cable T, Doran D, Holloway C, McArdle F, MacLaren DP. Ascorbic acid supplementation does not attenuate post-exercise muscle soreness following muscle-damaging exercise but may delay the recovery process. Br J Nutr. 2006 May;95(5):976-81). Likewise, NSAIDS have been shot down again:
Even while asking that question, the authors suggest there's no reason to think that what we know doesn't work in non-elite athletic populations will work in elite athletes. Really the questions these researchers want to know about are physiological effects: any way to say how much longer before elite athletes can get back to optimal work post DOMS?
Making DOMS worse? You betcha
Despite the warning above, researchers have indeed found a couple ways to indeed make the pain of DOMS worse: we can make it hurt more - in 2005 with hyperbaric chambers:
In the realm of what doesn't help, it's intriguing to see how frequently massage of various kinds has been investigated. Sufficiently so that one might be able to say that it doesn't help. In 2005, for instance, one article claimed success for massage by saying that range of motion and perceived tenderness, as well as CK levels were all better in the massage group. It's always nice to be less sore. But what did not occur was any impact on recovery of ROM or muscle strength.
Really? Let's try that again, and not to put too fine a point on the null effect:
In Part II we'll consider what does work. There is hope. There is technology, but especially, there is Heart (Rate).
Citations:
CRIBB, P., & HAYES, A. (2006). Effects of Supplement Timing and Resistance Exercise on Skeletal Muscle Hypertrophy Medicine & Science in Sports & Exercise, 38 (11), 1918-1925 DOI: 10.1249/01.mss.0000233790.08788.3e
CRIBB, P., & HAYES, A. (2006). Effects of Supplement Timing and Resistance Exercise on Skeletal Muscle Hypertrophy Medicine & Science in Sports & Exercise, 38 (11), 1918-1925 DOI: 10.1249/01.mss.0000233790.08788.3e
Hedayatpour, N., Falla, D., Arendt-Nielsen, L., & Farina, D. (2010). Effect of delayed-onset muscle soreness on muscle recovery after a fatiguing isometric contraction Scandinavian Journal of Medicine & Science in Sports, 20 (1), 145-153 DOI: 10.1111/j.1600-0838.2008.00866.x
Connolly DA, Sayers SP, & McHugh MP (2003). Treatment and prevention of delayed onset muscle soreness. Journal of strength and conditioning research / National Strength & Conditioning Association, 17 (1), 197-208 PMID: 12580677
McAnulty, S., McAnulty, L., Nieman, D., Morrow, J., Dumke, C., & Henson, D. (2007). Effect of NSAID on Muscle Injury and Oxidative Stress International Journal of Sports Medicine, 28 (11), 909-915 DOI: 10.1055/s-2007-964966
Cheung K, Hume P, & Maxwell L (2003). Delayed onset muscle soreness : treatment strategies and performance factors. Sports medicine (Auckland, N.Z.), 33 (2), 145-64 PMID: 12617692
Barnett A (2006). Using recovery modalities between training sessions in elite athletes: does it help? Sports medicine (Auckland, N.Z.), 36 (9), 781-96 PMID: 16937953
COUDREUSE, J. (2004). Douleurs musculaires posteffort Annales de R�adaptation et de M�decine Physique, 47 (6), 290-298 DOI: 10.1016/j.annrmp.2004.05.012
Bennett M, Best TM, Babul S, Taunton J, & Lepawsky M (2005). Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury. Cochrane database of systematic reviews (Online) (4) PMID: 16235376
Micklewright D (2009). The effect of soft tissue release on delayed onset muscle soreness: a pilot study. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 10 (1), 19-24 PMID: 19218075
Zainuddin Z, Newton M, Sacco P, & Nosaka K (2005). Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. Journal of athletic training, 40 (3), 174-80 PMID: 16284637
Herbert RD, & de Noronha M (2007). Stretching to prevent or reduce muscle soreness after exercise. Cochrane database of systematic reviews (Online) (4) PMID: 17943822
Barlas, P., Robinson, J., Allen, J., & Baxter, G. (2000). Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness Clinical Physiology, 20 (6), 449-456 DOI: 10.1046/j.1365-2281.2000.00280.x
Itoh, K., Ochi, H., & Kitakoji, H. (2008). Effects of tender point acupuncture on delayed onset muscle soreness (DOMS) – a pragmatic trial Chinese Medicine, 3 (1) DOI: 10.1186/1749-8546-3-14
Hübscher, M., Vogt, L., Bernhörster, M., Rosenhagen, A., & Banzer, W. (2008). Effects of Acupuncture on Symptoms and Muscle Function in Delayed-Onset Muscle Soreness The Journal of Alternative and Complementary Medicine, 14 (8), 1011-1016 DOI: 10.1089/acm.2008.0173 Tweet Follow @begin2dig
Ever get sore a day or two after a workout? Muscle pain, muscle soreness or muscle stiffness that is felt 12-48 hours after exercise is usually known as Delayed Onset Muscle Soreness or DOMS. The tell tale signs of DOMS are sore muscles, unable to move such muscles in normal range of motion, reduced strength in those limbs. It usually happens after trying out a new workout or doing new type of physical activity, or if the intensity of a familiar activity goes up up.Exactly what's happening in DOMS that creates the soreness and related effects is still speculation, but regardless of cause what might reduce or eliminate its effects has been studied from multiple approaches. This article has two parts (1) what it is and what doesn't work to reduce doms (this article); (2) what actually does seem to work to reduce or eliminate doms.
In part 1, this one, there's a summary about what is known about it. We then looks at what seems not to work at all, what actually makes DOMS worse. In Part II we look at what seems to mitigate its effects on performance but not pain, or vice versa, and what may actually really eliminate it from occurring (that part is very hair of the dog). If you'd just like the program of what works, skip to Part II, Summary, right now because a lot of suggestions on the rest of the web (like cool down or stretch after exercise) are just wrong. Knowing what doesn't work - since all the proposals are so sensible, but so useless, is interesting too.
So next time you're in a shower room argument about be sure to cool down and stretch it out or have a hot shower or get a massage, take an aspirin or vitamin c, you'll be able to say bollocks, as you are able to move freely two days after that intense training session while your peers are hobbling.
DOMS Review of the Known
DOMS is brought on by
In normal circumstances, eccentric muscle work that is either at a new intensity level or is a new eccentric-loaded movement brings on DOMS. In some studies, for instance, DOMS has been successfully induced by backwards walking down an 13 degree inclined treadmill.
DOMS effects
The most obvious effects of DOMS are that they occur 12-48 hours after the activity; DOMS hurts with the consequent effect being a decreased range of motion, increased size from swelling, and less power to work in the effected muscles. The effected muscles are most often the big leg muscles and to lesser degree, calves, but DOMS is not restricted to the lower body.
Beneath the manifested physical effects are the physiological ones that are less clear: changes in creatine kinase for instance, amount of inflammation, degree of muscle fiber damage. Whether or not an intervention mitigates the effects of DOMS is usually measured by perceived soreness, but also less subjective range of motion and force production. In some cases the physiological markers like CK levels pre and post are also checked. In some cases we'll see that treatments can decrease the DOMS effect on ROM and power, but do nothing to eliminate the duration/intensity of the pain.
DOMS physiological causes
This section is based on a great overview by sports fitness advisor of research from the 70's up to about 2006, the authors show that by about the mid-80's any thoughts that lactic acid buildup in the muscles was the cause of DOMS was put to rest. Likewise in the 80's and early 90's the main theories that seem to be still active are DOMS is either muscle cell damage (ruptured cells spilling contents into muscle fibers), muscle fiber damage, where the repair process at sensitive nerve endings is the pain signal, or an inflammatory (Tidball JG. Inflammatory cell response to acute muscle injury. Med Sci Sports Exerc. 1995 Jul;27(7):1022-32) response. The latter suggests that the 48 hour period when DOMS hits is the peak time for cell death (Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc. 1984 Dec;16(6):529-38).
In other words no one knows the exact mechanism for DOMS - a review of the literature i've done to 2009 suggests this is still the case.
I cannot find the reference, alas, but my favorite hypothesis to date has been that the pain is actually the building up of the new muscle fiber material where other fibers are getting pushed out of the way as new tissue comes in. If anyone knows of the reference, please let me know.
DOMS - unpredictable degree of effect
What we do know at this point is that, as of March 2009, we don't have the appropriate scales to predict "Onset, intensity, and duration of DOMS" in 87% of a tested population. SO we can bring it on, but we don't know exactly how it's going to effect participants.
Clin J Pain. 2009 Mar-Apr;25(3):239-43.Characteristics of DOMS
Can muscle soreness after intensive work-related activities be predicted?
Soer R, Geertzen JH, van der Schans CP, Groothoff JW, Reneman MF.
Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Haren, The Netherlands. r.soer@cvr.umcg.nl
OBJECTIVES: It is currently unknown whether specific determinants are predictive for developing delayed onset muscle soreness (DOMS) after heavy work-related activities. The aim of this study was to analyze whether personal characteristics and performance measures are predictive for onset, intensity, and duration of DOMS after performing work-related activities during a Functional Capacity Evaluation in healthy participants. METHODS: Included in this study were 197 healthy participants (102 men, 95 women), all working within a broad range of professions. Five groups of predictors were tested in a multiple regression analysis model: personal variables, self-reported activity, self-reported health, perceived effort during the test, and objective outcomes of the test. Twenty-three independent variables were selected and tested with a backward regression analysis. RESULTS: The onset of DOMS could be explained for 7% by the variables: sex and the work index of the Baecke questionnaire. Variance of intensity of DOMS could be explained for 13% by the variables: age, sex, and VO2max. Variance in duration of DOMS could be explained for 8% by the variables: sex and reported emotional role limitations. Onset, intensity, and duration of DOMS remain unpredictable for 87% or more. CONCLUSIONS: The results demonstrate that the intensity and duration of self-reported DOMS can only minimally be predicted from the candidate predictors used in this study.
While we can't yet predict how long and how intense DOMS will be, we know alot more about where it actually acts in the muscluature: the bits further away from the center of the body - the distal ends of the muscles.
Med Sci Sports Exerc. 2008 Feb;40(2):326-34.Click here to read LinksIn case one is curious, DOMS is different in effect than muscular fatigue when muscular activity is viewed using a similar EMG set up to the above study. The power generated in muscle repair goes up in a fatigued muscle; it's totally nuked in a DOMS - effected muscle.
Sensory and electromyographic mapping during delayed-onset muscle soreness.
Hedayatpour N, Falla D, Arendt-Nielsen L, Farina D.
Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D-3, Aalborg, Denmark.
PURPOSE: The aim of this human study was to apply novel topographical mapping techniques to investigate sensory and EMG manifestations of delayed-onset muscle soreness (DOMS) in multiple locations of the quadriceps. METHODS: Bipolar surface EMG signals were recorded from 11 healthy men with 15 pairs of electrodes located at 10, 20, 30, 40, and 50% of the distance from the medial, superior, and lateral border of the patella to the anterior superior iliac spine. Subjects performed sustained isometric knee extensions at 40% of the maximal force (MVC) until task failure before, 24 h, and 48 h after eccentric exercise. Pressure-pain thresholds (PPT) were assessed at the 15 locations where the EMG was recorded. RESULTS: Time to task failure was reduced after the eccentric exercise (mean +/- SD, 56.6 +/- 23 s before the eccentric exercise; 34.3 +/- 18.9 s at 24 h after exercise; and 34.3 +/- 14.4 s at 48 h after exercise). During the postexercise sustained contractions, EMG average rectified value (ARV) significantly decreased over time (P < style="color: rgb(102, 51, 0);">ONCLUSION: Novel topographical mapping of both surface EMG and PPT of the quadriceps showed site-dependent effects of eccentric exercise, probably attributable to variations in the morphological and architectural characteristics of the muscle fibers. Greater manifestations of DOMS in the distal region of the quadriceps may indicate a greater susceptibility of this region to further injury after eccentric exercise.
Scand J Med Sci Sports. 2008 Nov 3.Reducing DOMS - overview from 2003 - it's better; it's worse
Effect of delayed-onset muscle soreness on muscle recovery after a fatiguing isometric contraction.
Hedayatpour N, Falla D, Arendt-Nielsen L, Farina D.
Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark.
An increase to above-baseline levels of electromyography (EMG) mean power spectral frequency (MPF) has been observed previously during muscle recovery following fatiguing contractions and has been explained by membrane hyperpolarization due to increased activation of the Na(+)-K(+) pump. It is hypothesized that this membrane mechanism is impaired by muscle fiber damage following eccentric exercise. Thus, the aim of the study was to investigate surface EMG signal characteristics during recovery from fatigue after eccentric exercise. Ten healthy subjects performed sustained isometric knee extensions at 40% of the maximal torque (MVC) until task failure before, immediately after and 24 and 48 h after eccentric exercise. Bipolar surface EMG signals were recorded from six locations over the quadriceps during the sustained isometric contraction and during 3-s long contractions at 40% MVC separated by 1-min intervals for 15 min (recovery). Before the eccentric exercise, MPF of EMG signals increased to values above baseline during recovery from the fatiguing isometric contraction (P<0.001), style="color: rgb(102, 51, 0);">In conclusion, delayed-onset muscle soreness abolished the supranormal increase in EMG MPF following recovery from fatigue.
J Strength Cond Res. 2003 Feb;17(1):197-208.Linksmore from 2003:nothing works
Treatment and prevention of delayed onset muscle soreness.
Connolly DA, Sayers SP, McHugh MP.
Human Performance Laboratory, University of Vermont, Burlington, Vermont 05401, USA. dconnoll@zoo.uvm.ed
Eccentric exercise continues to receive attention as a productive means of exercise. Coupled with this has been the heightened study of the damage that occurs in early stages of exposure to eccentric exercise. This is commonly referred to as delayed onset muscle soreness (DOMS). To date, a sound and consistent treatment for DOMS has not been established. Although multiple practices exist for the treatment of DOMS, few have scientific support. Suggested treatments for DOMS are numerous and include pharmaceuticals, herbal remedies, stretching, massage, nutritional supplements, and many more. DOMS is particularly prevalent in resistance training; hence, this article may be of particular interest to the coach, trainer, or physical therapist to aid in selection of efficient treatments. First, we briefly review eccentric exercise and its characteristics and then proceed to a scientific and systematic overview and evaluation of treatments for DOMS. We have classified treatments into 3 sections, namely, pharmacological, conventional rehabilitation approaches, and a third section that collectively evaluates multiple additional practiced treatments. Literature that addresses most directly the question regarding the effectiveness of a particular treatment has been selected. The reader will note that selected treatments such as anti-inflammatory drugs and antioxidants appear to have a potential in the treatment of DOMS. Other conventional approaches, such as massage, ultrasound, and stretching appear less promising.
In 2003, nothing that had been tried really worked - and i've found a few studies recently that show we can make it worse. And while the review abstract says that NSAIDS (ibuprofen, etc) and antioxidants have potential, that hope has been fleeting. Antioxidants like Vit C have not been shown in clinical trials to work (Close GL, Ashton T, Cable T, Doran D, Holloway C, McArdle F, MacLaren DP. Ascorbic acid supplementation does not attenuate post-exercise muscle soreness following muscle-damaging exercise but may delay the recovery process. Br J Nutr. 2006 May;95(5):976-81). Likewise, NSAIDS have been shot down again:
Int J Sports Med. 2007 Nov;28(11):909-15. Epub 2007 May 31.Click here to read LinksInrtiguingly another review in 2003 of DOMS literature seems more accurate about interpretations of the existing research at that time:
Effect of NSAID on muscle injury and oxidative stress.
McAnulty S, McAnulty L, Nieman D, Morrow J, Dumke C, Henson D.
Health, Leisure, and Exercise Science, Appalachian State University, Boone, NC 28608, USA. mcanltysr@appstate.edu
Indirect markers of muscle damage and delayed onset muscle soreness were examined and correlated to changes in oxidative stress, plasma antioxidant potential, and use or nonuse of non-steroidal anti-inflammatory drugs in 60 ultra-marathoners following the Western States Endurance Run. Blood was collected prior to and immediately following the race and analyzed for muscle damage by creatine phosphokinase and oxidative stress by F (2)-isoprostanes, protein carbonyls, and lipid hydroperoxides and antioxidant potential by the ferric reducing ability of plasma. Subjects recorded delayed onset muscle soreness during the week following the race. Lipid hydroperoxide concentrations were unchanged, but F (2)-isoprostanes, protein carbonyls, ferric reducing ability of plasma, creatine phosphokinase, and delayed onset muscle soreness increased significantly postrace. Protein carbonyls were significantly higher postrace in nonsteroidal anti-inflammatory drug users versus nonusers.
Sports Med. 2003;33(2):145-64.In the above reference, a phase of adaptation is proposed to mitigate the effects of DOMS, while a few years on in 2006, some researchers suggest that what we know about DOMS behaviour may be biased by the population, and raises the question would the results be any different if studies were restricted to elite athlete populations?
Delayed onset muscle soreness : treatment strategies and performance factors.
Cheung K, Hume P, Maxwell L.
School of Community Health and Sports Studies, Auckland University of Technology, Auckland, New Zealand.
Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. However, an integration of two or more theories is likely to explain muscle soreness. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted.A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms. Exercise is the most effective means of alleviating pain during DOMS, however the analgesic effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1-2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover. Eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption. There are still many unanswered questions relating to DOMS, and many potential areas for future research.
Even while asking that question, the authors suggest there's no reason to think that what we know doesn't work in non-elite athletic populations will work in elite athletes. Really the questions these researchers want to know about are physiological effects: any way to say how much longer before elite athletes can get back to optimal work post DOMS?
Sports Med. 2006;36(9):781-96.LinksAnd in 2004 there's a lovely caveat to say that because we are so in the dark about the cause of DOMS we should be very careful about what we give a go as it might make things worse - especially as DOMS disappears 2-10 days (!) before "complete functional recovery"
Using recovery modalities between training sessions in elite athletes: does it help?
Barnett A.
Centre of Excellence for Applied Sport Science Research, Queensland Academy of Sport, Brisbane, Queensland, Australia. abarnett@hku.hk
Achieving an appropriate balance between training and competition stresses and recovery is important in maximising the performance of athletes. A wide range of recovery modalities are now used as integral parts of the training programmes of elite athletes to help attain this balance. This review examined the evidence available as to the efficacy of these recovery modalities in enhancing between-training session recovery in elite athletes. Recovery modalities have largely been investigated with regard to their ability to enhance the rate of blood lactate removal following high-intensity exercise or to reduce the severity and duration of exercise-induced muscle injury and delayed onset muscle soreness (DOMS). Neither of these reflects the circumstances of between-training session recovery in elite athletes. After high-intensity exercise, rest alone will return blood lactate to baseline levels well within the normal time period between the training sessions of athletes. The majority of studies examining exercise-induced muscle injury and DOMS have used untrained subjects undertaking large amounts of unfamiliar eccentric exercise. This model is unlikely to closely reflect the circumstances of elite athletes. Even without considering the above limitations, there is no substantial scientific evidence to support the use of the recovery modalities reviewed to enhance the between-training session recovery of elite athletes. Modalities reviewed were massage, active recovery, cryotherapy, contrast temperature water immersion therapy, hyperbaric oxygen therapy, nonsteroidal anti-inflammatory drugs, compression garments, stretching, electromyostimulation and combination modalities. Experimental models designed to reflect the circumstances of elite athletes are needed to further investigate the efficacy of various recovery modalities for elite athletes. Other potentially important factors associated with recovery, such as the rate of post-exercise glycogen synthesis and the role of inflammation in the recovery and adaptation process, also need to be considered in this future assessment.
Ann Readapt Med Phys. 2004 Aug;47(6):290-8.Things have certainly changed in that attenuation since 2004, but what we've also improved our knowledge around: how to make DOMS worse.
Coudreuse JM, Dupont P, Nicol C.
Service de medecine du sport, CHU Salvator, APHM, 249, boulevard Sainte-Marguerite, 13009 Marseille, France. jean-marie.coudreuse@mail.ap-hm.fr
Muscle intolerance to exercise may result from different processes. Diagnosis involves confirming first the source of pain, then potential pathological myalgia. Delayed-onset muscle soreness (DOMS), commonly referred as tiredness, occurs frequently in sport. DOMS usually develops 12-48 h after intensive and/or unusual eccentric muscle action. Symptoms usually involve the quadriceps muscle group but may also affect the hamstring and triceps surae groups. The muscles are sensitive to palpation, contraction and passive stretch. Acidosis, muscle spasm and microlesions in both connective and muscle tissues may explain the symptoms. However, inflammation appears to be the most common explanation. Interestingly, there is strong evidence that the progression of the exercise-induced muscle injury proceeds no further in the absence of inflammation. Even though unpleasant, DOMS should not be considered as an indicator of muscle damage but, rather, a sign of the regenerative process, which is well known to contribute to the increased muscle mass. DOMS can be associated with decreased proprioception and range of motion, as well as maximal force and activation. DOMS disappears 2-10 days before complete functional recovery. This painless period is ripe for additional joint injuries. Similarly, if some treatments are well known to attenuate DOMS, none has been demonstrated to accelerate either structural or functional recovery. In terms of the role of the inflammatory process, these treatments might even delay overall recovery
Making DOMS worse? You betcha
Despite the warning above, researchers have indeed found a couple ways to indeed make the pain of DOMS worse: we can make it hurt more - in 2005 with hyperbaric chambers:
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004713.Click here to read LinksWe can make it worse with soft tissue release, too (that was a surprise):
Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury.
Bennett M, Best TM, Babul S, Taunton J, Lepawsky M.
Prince of Wales Hospital, Department of Diving and Hyperbaric Medicine, Barker Street, Randwick, New South Wales 2031, Australia. m.bennett@unsw.edu.au
BACKGROUND: Soft tissue injuries (including muscle damage after unaccustomed exercise) are common and are often associated with athletic activity. Hyperbaric oxygen therapy (HBOT) is the therapeutic administration of 100% oxygen at environmental pressures greater than one atmosphere. OBJECTIVES: To assess the benefits and harms of HBOT for treating soft tissue injury, including delayed onset muscle soreness (DOMS). SEARCH STRATEGY: We searched the following in July 2004: CENTRAL, MEDLINE, EMBASE, CINAHL, DORCTIHM and reference lists from relevant articles. Relevant journals were handsearched and researchers in the field contacted. SELECTION CRITERIA: Randomised trials comparing the effect on closed soft tissue injury (including DOMS) of therapeutic regimens which include HBOT with those that exclude HBOT (with or without sham therapy). DATA COLLECTION AND ANALYSIS: Four reviewers independently evaluated study quality and extracted data. Most of the data presented in the review were extracted from graphs in the trial reports. MAIN RESULTS: Nine small trials involving 219 participants were included. Two trials compared HBOT versus sham therapy on acute closed soft tissue injuries (ankle sprain and medial collateral knee ligament injury respectively). The other seven trials examined the effect of HBOT on DOMS following eccentric exercise in unconditioned volunteers.All 32 participants of the ankle sprain trial returned to their normal activities. There were no significant differences between the two groups in time to recovery, functional outcomes, pain, or swelling. There was no difference between the two groups in knee function scores in the second acute injury trial; however, intention-to-treat analysis was not possible for this trial.Pooling of data from the seven DOMS trials showed significantly and consistently higher pain at 48 and 72 hours in the HBOT group (mean difference in pain score at 48 hours [0 to 10 worst pain] 0.88, 95% CI 0.09 to 1.67, P = 0.03) in trials where HBOT was started immediately. There were no differences between the two groups in longer-term pain scores or in any measures of swelling or muscle strength.No trial reported complications of HBOT but careful selection of participants was evident in most trials. AUTHORS' CONCLUSIONS: There was insufficient evidence from comparisons tested within randomised controlled trials to establish the effects of HBOT on ankle sprain or acute knee ligament injury, or on experimentally induced DOMS. There was some evidence that HBOT may increase interim pain in DOMS. Any future use of HBOT for these injuries would need to have been preceded by carefully conducted randomised controlled trials which have demonstrated effectiveness.
Phys Ther Sport. 2009 Feb;10(1):19-24. Epub 2008 Dec 16.LinksDOMS: what else doesn't help but doesn't make it worse.
The effect of soft tissue release on delayed onset muscle soreness: a pilot study.
Micklewright D.
Department of Biological Sciences, The University of Essex, Wivenhoe Park, Colchester, Essex CO43SQ, UK. dpmick@essex.ac.uk
OBJECTIVES: To examine soft tissue release (STR) as an intervention for delayed onset muscle soreness (DOMS). DESIGN: A mixed-subjects experimental design was used. Participants performed 4 x 20 eccentric elbow extensions at 80% of 1RM. Participants received either STR (50%) or no treatment (50%). DOMS measurements were taken before the elbow extensions and at 0, 24, and 48 h afterwards. SETTING: The study was conducted at the University of Essex exercise physiology laboratory. PARTICIPANTS: Twenty male participants, unaccustomed to strength conditioning, completed the study. MAIN OUTCOME MEASURES: DOMS was evaluated using relaxed joint angle (RJA), active range of motion (AROM), passive range of motion (PROM), and arm girth measurements. Soreness ratings were measured using a 100 mm visual analogue scale (VAS). RESULTS: In both conditions there were post-DOMS task increases in VAS ratings (p < style="color: rgb(102, 51, 0);">STR exacerbates the DOMS sensation yet does not seem to improve the rate of recovery during the first 48 h.
In the realm of what doesn't help, it's intriguing to see how frequently massage of various kinds has been investigated. Sufficiently so that one might be able to say that it doesn't help. In 2005, for instance, one article claimed success for massage by saying that range of motion and perceived tenderness, as well as CK levels were all better in the massage group. It's always nice to be less sore. But what did not occur was any impact on recovery of ROM or muscle strength.
J Athl Train. 2005 Jul-Sep;40(3):174-80.In 2007, in a survey of stretching/DOMS studies that looked at impact on soreness of massage, however, shows that the effects of stretching are very small (.5 on a 100 point scale)
Comment in:
J Athl Train. 2005 Jul-Sep;40(3):186-90.
Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function.
Zainuddin Z, Newton M, Sacco P, Nosaka K.
Edith Cowan University, Joondalup, Western Australia, Australia.
CONTEXT: Delayed-onset muscle soreness (DOMS) describes muscle pain and tenderness that typically develop several hours postexercise and consist of predominantly eccentric muscle actions, especially if the exercise is unfamiliar. Although DOMS is likely a symptom of eccentric-exercise-induced muscle damage, it does not necessarily reflect muscle damage. Some prophylactic or therapeutic modalities may be effective only for alleviating DOMS, whereas others may enhance recovery of muscle function without affecting DOMS. OBJECTIVE: To test the hypothesis that massage applied after eccentric exercise would effectively alleviate DOMS without affecting muscle function. DESIGN: We used an arm-to-arm comparison model with 2 independent variables (control and massage) and 6 dependent variables (maximal isometric and isokinetic voluntary strength, range of motion, upper arm circumference, plasma creatine kinase activity, and muscle soreness). A 2-way repeated-measures analysis of variance and paired t tests were used to examine differences in changes of the dependent variable over time (before, immediately and 30 minutes after exercise, and 1, 2, 3, 4, 7, 10, and 14 days postexercise) between control and massage conditions. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: Ten healthy subjects (5 men and 5 women) with no history of upper arm injury and no experience in resistance training. INTERVENTION(S): Subjects performed 10 sets of 6 maximal isokinetic (90 degrees x s(-1)) eccentric actions of the elbow flexors with each arm on a dynamometer, separated by 2 weeks. One arm received 10 minutes of massage 3 hours after eccentric exercise; the contralateral arm received no treatment. MAIN OUTCOME MEASURE(S): Maximal voluntary isometric and isokinetic elbow flexor strength, range of motion, upper arm circumference, plasma creatine kinase activity, and muscle soreness. RESULTS: Delayed-onset muscle soreness was significantly less for the massage condition for peak soreness in extending the elbow joint and palpating the brachioradialis muscle (P < .05). Soreness while flexing the elbow joint (P = .07) and palpating the brachialis muscle (P = .06) was also less with massage. Massage treatment had significant effects on plasma creatine kinase activity, with a significantly lower peak value at 4 days postexercise (P < .05), and upper arm circumference, with a significantly smaller increase than the control at 3 and 4 days postexercise (P < .05). However, no significant effects of massage on recovery of muscle strength and ROM were evident. CONCLUSIONS: Massage was effective in alleviating DOMS by approximately 30% and reducing swelling, but it had no effects on muscle function.
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD004577.THe findings of the survey seem to be confirmed in yet another massage oriented study that shows massage may somewhat mitigate perceived soreness, but not significantly, and there is no effect on the other key markers of ROM and swelling.
Stretching to prevent or reduce muscle soreness after exercise.
Herbert RD, de Noronha M.
University of Sydney, School of Physiotherapy, PO Box 170, Lidcombe, NSW, Australia, 1825. R.Herbert@fhs.usyd.edu.au
BACKGROUND: Many people stretch before or after (or both) engaging in athletic activity. Usually the purpose is to reduce risk of injury, reduce soreness after exercise, or enhance athletic performance. OBJECTIVES: The aim of this review was to determine effects of stretching before or after exercise on the development of post-exercise muscle soreness. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to April 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2), MEDLINE (1966 to May 2006), EMBASE (1988 to May 2006), CINAHL (1982 to May 2006), SPORTDiscus (1949 to May 2006), PEDro (to May 2006) and reference lists of articles. SELECTION CRITERIA: Eligible studies were randomised or quasi-randomised studies of any pre-or post-exercise stretching technique designed to prevent or treat delayed-onset muscle soreness (DOMS), provided the stretching was conducted soon before or soon after exercise. To be eligible studies must have assessed muscle soreness or tenderness. DATA COLLECTION AND ANALYSIS: Methodological quality of the studies was assessed using the Cochrane Bone, Joint and Muscle Trauma Group's methodological quality assessment tool. Estimates of effects of stretching were converted to a common 100-point scale. Outcomes were pooled in a fixed-effect meta-analysis. MAIN RESULTS: Of the 10 included studies, nine were carried out in laboratory settings using standardised exercise protocols and one involved post-exercise stretching in footballers. All participants were young healthy adults. Three studies examined the effects of stretching before exercise and seven studies investigated the effects of stretching after exercise. Two studies, both of stretching after exercise, involved repeated stretching sessions at intervals of greater than two hours. The duration of stretching applied in a single session ranged from 40 to 600 seconds.All studies were small (between 10 and 30 participants received the stretch condition) and of questionable quality.The effects of stretching reported in individual studies were very small and there was a high degree of consistency of results across studies. The pooled estimate showed that pre-exercise stretching reduced soreness one day after exercise by, on average, 0.5 points on a 100-point scale (95% CI -11.3 to 10.3; 3 studies). Post-exercise stretching reduced soreness one day after exercise by, on average, 1.0 points on a 100-point scale (95% CI -6.9 to 4.8; 4 studies). Similar effects were evident between half a day and three days after exercise. AUTHORS' CONCLUSIONS: The evidence derived from mainly laboratory-based studies of stretching indicate that muscle stretching does not reduce delayed-onset muscle soreness in young healthy adults.
Chir Narzadow Ruchu Ortop Pol. 2008 Jul-Aug;73(4):261-5.No change from any previous work on massage, not matter how frequently it's tested or from what angle it seems. And just to add some current studies to previous work, acupuncture doesn't help any factor:
[Effects of massage on delayed-onset muscle soreness]
[Article in Polish]
Bakowski P, Musielak B, Sip P, Biegański G.
Studenckie Koło Medycyny Sportowej, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu. pawelbakowski@o2.pl
INTRODUCTION: Delayed onset muscle soreness (DOMS) is the pain or discomfort often felt 12 to 24 hours after exercising and subsides generally within 4 to 6 days. Once thought to be caused by lactic acid buildup, a more recent theory is that it is caused by inflammatory process or tiny tears in the muscle fibers caused by eccentric contraction, or unaccustomed training levels. Exercises that involve many eccentric contractions will result in the most severe DOMS. MATERIAL AND METHODS: Fourteen healthy men with no history of upper arm injury and no experience in resistance training were recruited. The mean age, height, and mass of the subjects were 22.8 +/- 1.2 years, 178.3 +/- 10.3 cm, and 75.0 +/- 14.2 kg, respectively. Subjects performed 8 sets of concentric and eccentric actions of the elbow flexors with each arm according to Stay protocol. One arm received 10 minutes of massage 30 minutes after exercise, the contralateral arm received no treatment. Measurements were taken at 9 assessment times: pre-exercise and postexercise at 10 min, 6, 12, 24, 36, 48, 72 and 96 hours. Dependent variables were range of motion, perceived soreness and upper arm circumference. RESULTS: There was noticed difference in perceived soreness across time between groups. The analysis indicated that massage resulted in a 10% to 20% decrease in the severity of soreness, but the differences were not significant. Difference in range of motion and arm circumference was not observed. CONCLUSIONS: Massage administered 30 minutes after exercises could have a beneficial influence on DOMS but without influence on muscle swelling and range of motion.
Clin Physiol. 2000 Nov;20(6):449-56.While the 2000 study seems to come up with a big fat zero, in 2008, two groups showed some relieve from DOMS pain associated with acupuncture. The second group looked at other DOMS factors like muscle force and confirmed earlier work: no effect.
Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness.
Barlas P, Robinson J, Allen J, Baxter GD.
Physiotherapy Subject Group, School of Health and Social Sciences, Coventry University, UK.
The effect of acupuncture upon experimentally induced delayed onset muscle soreness (DOMS) was assessed in a placebo-controlled study under blinded conditions. Volunteers (n = 48; 24 M & 24 F) were randomly allocated to one of four groups: control (20 min rest), placebo (minimal needling at non-acupuncture points), treatment group 1 (acupuncture at classic acupuncture points) and treatment group 2 (acupuncture at 'tender' points). DOMS was induced in the elbow flexors of the non-dominant arm using a standardized eccentric exercise regime. Measurements of elbow range of movement (flexion, extension, relaxed angle), and pain as well as visual analogue scores (VAS), tenderness (using a pressure algometer) were employed as indices of treatment efficacy. Measurements of elbow range of movement and tenderness were made prior to DOMS induction on the first day, and repeated pre- and post-treatment on subsequent days; pain was assessed using visual analogue scales post-induction and post-treatment on the first day, and pre- and post-treatment thereafter. For all conditions, subjects rested supine for a period of 20 min, during which treatment was delivered according to group allocation. Repeated measures and one-way analysis of variance (ANOVA) demonstrated no significant interactive (AB) effects, except for visual analogue scores (P = 0.0483); one factor ANOVA on the second day of the experiment (pre-treatment) indicated significant differences between the control and all other groups. However, such differences were not found on any other day of the experiment. It is concluded that acupuncture has little effect upon the cardinal signs and symptoms of DOMS, at least under the conditions of the current experiment.
Chin Med. 2008 Nov 25;3:14.
Effects of tender point acupuncture on delayed onset muscle soreness (DOMS) - a pragmatic trial.
Itoh K, Ochi H, Kitakoji H.
Department of Clinical Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Hiyoshi-cho, Nantan, Kyoto 629-0392, Japan. k_itoh@meiji-u.ac.jp.
ABSTRACT: BACKGROUND: Acupuncture is used to reduce inflammation and decrease pain in delayed onset muscle soreness (DOMS). This study investigates the efficacy of acupuncture on the symptoms of DOMS. METHODS: Thirty subjects were assigned randomly to there groups, namely the control, non-tender point and tender point groups. Measurement of pain with full elbow flexion was used as indices of efficacy. Measurements were taken before and after exercise, immediately after treatment and seven days after treatment. RESULTS: Significant differences in visual analog scores for pain were found between the control group and tender point group immediately after treatment and three days after exercise
Really? Let's try that again, and not to put too fine a point on the null effect:
J Altern Complement Med. 2008 Oct;14(8):1011-6.SO That's what doesn't work: massage, stretching, acupuncture, cool downs, vitamin C or NSAIDS.
Effects of acupuncture on symptoms and muscle function in delayed-onset muscle soreness.
Hübscher M, Vogt L, Bernhörster M, Rosenhagen A, Banzer W.
Department of Sports Medicine, Goethe-University, Frankfurt/Main, Germany. m.huebscher@sport.uni-frankfurt.de
OBJECTIVE: This study was done to investigate the effects of a standardized acupuncture treatment on symptoms and muscle function in exercise-induced delayed-onset muscle soreness (DOMS). METHODS: A prospective, randomized, controlled, observer and subject-blinded trial was undertaken. Twenty-two (22) healthy subjects (22-30 years; 10 males and 12 females) were randomly assigned to three treatment groups: real acupuncture (deep needling at classic acupuncture points and tender points; n = 7), sham-acupuncture (superficial needling at nonacupuncture points; n = 8), and control (no needling; n = 7). DOMS of the nondominant elbow-flexors was experimentally induced through eccentric contractions until exhaustion. The outcome measures were pain perception (visual analogue scale; VAS; range: 0-10 cm), mechanical pain threshold (MPT; pressure algometer), and maximum isometric voluntary force (MIVF; force transducer). Treatment was applied immediately, 24 and 48 hours after DOMS induction. Measurements of MPT and MIVF were made prior to DOMS induction as well as before and after every treatment session. VAS data were acquired after DOMS induction as well as pre- and post-treatment. Final pain, MPT, and MIVF measurements were performed 72 hours after DOMS induction. RESULTS: Following nonparametric testing, there were no significant differences between groups in outcome measures at baseline. After 72 hours, pain perception (VAS) was significantly lower in the acupuncture group compared to the sham acupuncture and control subjects. However, the mean MPT and MIVF scores were not significantly different between groups. CONCLUSIONS: Although acupuncture seemed to have no effects on mechanical pain threshold and muscle function, it proved to reduce perceived pain arising from exercise-induced muscle soreness.
In Part II we'll consider what does work. There is hope. There is technology, but especially, there is Heart (Rate).
Related Posts
Citations:
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CRIBB, P., & HAYES, A. (2006). Effects of Supplement Timing and Resistance Exercise on Skeletal Muscle Hypertrophy Medicine & Science in Sports & Exercise, 38 (11), 1918-1925 DOI: 10.1249/01.mss.0000233790.08788.3e
Hedayatpour, N., Falla, D., Arendt-Nielsen, L., & Farina, D. (2010). Effect of delayed-onset muscle soreness on muscle recovery after a fatiguing isometric contraction Scandinavian Journal of Medicine & Science in Sports, 20 (1), 145-153 DOI: 10.1111/j.1600-0838.2008.00866.x
Connolly DA, Sayers SP, & McHugh MP (2003). Treatment and prevention of delayed onset muscle soreness. Journal of strength and conditioning research / National Strength & Conditioning Association, 17 (1), 197-208 PMID: 12580677
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Cheung K, Hume P, & Maxwell L (2003). Delayed onset muscle soreness : treatment strategies and performance factors. Sports medicine (Auckland, N.Z.), 33 (2), 145-64 PMID: 12617692
Barnett A (2006). Using recovery modalities between training sessions in elite athletes: does it help? Sports medicine (Auckland, N.Z.), 36 (9), 781-96 PMID: 16937953
COUDREUSE, J. (2004). Douleurs musculaires posteffort Annales de R�adaptation et de M�decine Physique, 47 (6), 290-298 DOI: 10.1016/j.annrmp.2004.05.012
Bennett M, Best TM, Babul S, Taunton J, & Lepawsky M (2005). Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury. Cochrane database of systematic reviews (Online) (4) PMID: 16235376
Micklewright D (2009). The effect of soft tissue release on delayed onset muscle soreness: a pilot study. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 10 (1), 19-24 PMID: 19218075
Zainuddin Z, Newton M, Sacco P, & Nosaka K (2005). Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. Journal of athletic training, 40 (3), 174-80 PMID: 16284637
Herbert RD, & de Noronha M (2007). Stretching to prevent or reduce muscle soreness after exercise. Cochrane database of systematic reviews (Online) (4) PMID: 17943822
Barlas, P., Robinson, J., Allen, J., & Baxter, G. (2000). Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness Clinical Physiology, 20 (6), 449-456 DOI: 10.1046/j.1365-2281.2000.00280.x
Itoh, K., Ochi, H., & Kitakoji, H. (2008). Effects of tender point acupuncture on delayed onset muscle soreness (DOMS) – a pragmatic trial Chinese Medicine, 3 (1) DOI: 10.1186/1749-8546-3-14
Hübscher, M., Vogt, L., Bernhörster, M., Rosenhagen, A., & Banzer, W. (2008). Effects of Acupuncture on Symptoms and Muscle Function in Delayed-Onset Muscle Soreness The Journal of Alternative and Complementary Medicine, 14 (8), 1011-1016 DOI: 10.1089/acm.2008.0173 Tweet Follow @begin2dig
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