Personal Training Series: Ignoring pain

The human body has a pain sensing system. This system is designed to preserve the body and prevent long term damage. In training the body responds to stimuli and training pain needs to be overcome. However, there is a limit, and it is important to understand for your own body what that limit is.

I saw a documentary on television where a young boy had no pain sensing system. He would go to school and ask his friends to punch him in the stomach; he pretended he was superman because he felt no pain. One day his parents noticed bruising and swelling around his legs and abdomen, and took him to hospital. The doctors discovered he had severe internal haemorrhaging from being punched too much. This young boy’s lack of a pain sensing system could have led to his death.

Another documentary showed scientists trying to reproduce the pain sensing system in the body because it is so important for preserving life. With all the technology and advances in science today they were unable to replicate the system. It is highly complex and adapts to its changing environment. We need it to learn what not to do, what we can do, and what is dangerous.

In training, if we ignore pain completely then injuries often occur. It is important to put in perspective what you are doing, the experience you’ve had in training, and what you think your body can do – you must have realistic limitations as to how much pain you will withstand.

Be sensible and listen to your body. Focus on gradual increase in loading in training, and be happy with steady progress in your training goals. Aim long term rather than short term. Keep in touch with your physiotherapist and trainer to guide you through this process and avoid injury.

It is not much fun being injured and in the long run ignoring pain from an injury will make your training time longer. Get your body assessed by a physiotherapist and work with a personal trainer to prevent injury and to enjoy your training.

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Personal training series: Risk of long term injuries

 

Injuries can occur in several degrees of severity. Some injuries can be niggles which ease with time; some of these niggles continue to plague a person throughout their life. Severe injuries may require hospitalisation or immobilisation and rehabilitation; other sever injuries will handicap a person for life. There is a spectrum of minor to severe injuries, and each person’s injury sits somewhere along this line.

Why can’t you get rid of these injuries? When you get assessed by a physiotherapist the physiotherapist will tell you what the injury is and what needs to be done to heal that injury. I see the best results when the client follows the physiotherapists instructions and does their homework. Failed treatment usually results when a client comes to physiotherapy under the illusion that treatment for 30 mins twice a week will take away their pain without their having to make lifestyle choices to stop aggravating their injury.

When injuries are neglected during daily life and in training they become more deeply set in within the body. Pain can be remembered by the body through the nervous system. The nervous system is said to be ‘sensitised’ and will hence react to normal movement in an abnormal way. A person can live their life in pain even though the actual initial injury is healed.

Some injuries do require surgical intervention or help from various medical professionals. More than this, however, change in mental attitude is required about a client’s injuries. Sometimes injuries which have been present for a long time will continue to cause pain and it is about managing that pain through a different mindset.

Injuries should not prevent training; what prevents training is what decisions a person makes about what they are committed to do in their training and at home. Failure in physiotherapy and training should not be blamed on the clinicians; clients should look within to see the degree to which they are contributing themselves to the pain that they suffer. Physiotherapy requires input from the client just as much as the physiotherapist has his own input on the client.

It is clear that those clients who are most successful in physiotherapy are those prepared to make changes in their life. It is not easy to assess what changes you need in your life and that is where a physiotherapist and trainer can help you with their vast experience with other clients and their training. A physiotherapist and trainer can also monitor a client’s progress; help with maintenance of his good health; and inspire him to achieve goals that he never thought were possible.

My advice is that if you want to start training to help long term injuries, you would benefit from the input of a physiotherapist and personal trainer working closely together with your interests at heart.

Personal Training series: The Shoulder injury in training

Shoulder pain is a common complaint when training in the gym. I have often seen shoulder pain occur when someone is doing a deep bench press or a very low shoulder press. This pain could be associated with a clicking noise or a sharp pain at the point of deepest position. Often the person tries to train harder to resolve the problem, because they believe that strengthening the shoulder will be the solution to the problem.

The other time shoulder problems can occur is when someone is given a new exercise which is very functional in many degrees of motion, using small weights quickly or pushing very heavy weights. Today exercises are often more functional which means that they do not function in single planes of motion. These movements can be very complex and require coordination and skill. When a person does this for the first time, and then they try to do this too fast with a heavy weight, they lose control of their shoulder joint and the shoulder joint is put under unnecessary stress. This stresses the shoulder over time and breaks down the tissues leading to injury.

When the total movement of an exercise is videoed it can be seen that the shoulder can also be put under stress because other parts of the body are not moving as well. When someone rotates their body and pulls weight up and out above their head, if their hips, pelvis or knee are not moving in a coordinated fashion the shoulder gets unnecessary stress and this can also lead to tissue breakdown and injury. An injury can occur from one explosive movement or from repetitive movements done badly over time. Sudden movements are often associated with a one off severe pain; however the repetitive movements done badly over time tend to creep up on a person. Pain develops insidiously and starts at a low level, gradually building to a point at which they must seek physiotherapy.

Rehabilitation protocol for shoulder pain can be very complex as the shoulder is the most mobile joint in the body. The shoulder can be prone to increased movement in some areas but stiffness in others. The spine, hips and knees – even the big toe – joints can all be causes leading to shoulder pain. The assessment protocol for assessing the shoulder will be a global one and treatment may involve working on areas other than the shoulder.

To prevent shoulder problems it is very important for a physiotherapist to work closely with a personal trainer. The trainer communicates clearly with the physiotherapist what they intend to do with their client, and then the physiotherapist can guide the trainer as to what potential risks there are. If this close relationship functions correctly between the physiotherapist and trainer than injuries can be prevented, goals can be achieved and long term damage to the body can be avoided.

Personal Training series: Running shoes and running biomechanics

There are many shoes on the market at the moment for running. Running biomechanics have taken a big shift in the last 5 years.  Running brands such as Asics, Brooks and  Saucony have created shoes which are designed to prevent collapsing of the foot, or increased cushioning for those people with high arches. The general understanding of biomechanics and these types of shoes, is one which involves a heel strike pattern. In this pattern the heel will hit the ground first, the heel of the shoe absorbs the shock; the heel then controls the foot as it passes through mid stance and toe off.

Conventional shoes have worked over time for some people; however for others they have not made any difference, and some people who wear these shoes are still prone to knee, hip and lower back pain. When running with a heel strike pattern it is thought that as the heel strikes in front of the body there is a vertical force passed back up through the leg, the hip, the groin, the knee, and the lower back and that this results in injury.

Over the last 5 years there has been a wealth of research and contentious debate over the benefits of forefoot running. Forefoot running is where a person runs landing more towards the mid and front of their foot, instead of the heel being the first point of contact when the foot hits the ground during running. The foot also lands underneath the body and the stress imposed on joints are reduced.

Support for forefoot running comes from practical demonstrations on treadmills. When someone walks on a treadmill they have a characteristic heel strike pattern; however as the speed of the treadmill is increased they naturally start to run more towards the mid and forefoot. It has been theorised that the body is not designed to run with a heel strike pattern. When videoed at a faster speed on the treadmill the foot can be seen to strike more towards the mid foot and spring off. When seen at its best – like in Olympic marathon runners – the foot will actually hit the ground under the body; it is then kicked up behind their back using the hamstring muscles, before quickly returning to land again directly under the body.

The theory that running on the forefoot reduces joint pressure has been researched. With forefoot running the force of the body passes directly up through the body vertically –thereby relying upon the natural cushioning effect of the quads and the hip muscles. If the body is stiff enough – and the biomechanics are correct – the knee and hip joints can absorb the repetitive loading of running and hence reduce injury to the joints.

There are now shoes which have been adapted for forefoot running. Vivo barefoot is one of these companies and has created a range of shoes designed for walking right through to cross country running. Forefoot running shoes are designed to have minimalistic cushioning in the foot. These shoes are designed for the foot to feel the ground and reaction forces of the ground as the foot hits the floor. When the foot can feel the landing onto the floor, it can stimulate muscles to fire and get immediate push off onto the opposite leg. The soles of these shoes are very thin and Vivo Barefoot have described the sole to being as close to skin depth as possible.

Clients have reported they enjoy using these shoes. They feel completely different to thick soled shoes. They also give a refreshing feel to the foot at contact with the ground. The key is that this ‘feel’ will stimulate better muscular activity, shock absorption and reduction injuries. There are many successful runners in Olympics and World Championships who do not have a forefoot running pattern. It is not advised that everyone run on their forefoot – and a physiotherapist and trainer will be able to tell whether your body is capable of withstanding the pressure required to learn how to forefoot run.

Recently a trainer started forefoot running; it has taken 4 months for him to be able to run on his forefoot for 10km continuous running. To change to a forefoot running pattern requires significant adaptation and change within the body. The runner must allow time for this adaptation to occur because if they push themselves too hard and too fast in training injuries will occur.

I believe forefoot running biomechanics seems to make sense; however I have also seen that not everyone is prepared to take the time to learn how to forefoot run and people who run heel strike can still become world champions.

If you want to learn how to forefoot run it is important that you see a forefoot running coach – such as a physiotherapist who has experience, or an independent specialised coach.

Personal Training series: Foot and Ankle injuries

The foot is often overlooked by medical professionals and trainers. The foot can be a common cause of problems in other areas of the body. Biomechanics of the foot can be complex; however if assessed with video analysis, looking at joint play within the foot and how the muscles are coordinated to control the foot, then often the problem can be identified.

I have treated a runner who developed groin pain because he developed a stiff first toe (big toe). He was a 100m sprinter which involved rapid bursts out of the blocks and ten seconds of very intense running. Over time the big toe created abnormal ankle movement which led to knee, hip, pelvic and lower back pain. The weakest link among all these joints was his groin. The groin pain affected him so badly he could no longer compete for that season.

Another illustration is someone who has had a previous ankle injury and the ankle joint is stiff. When comparing the right and left sides they can see that one side of their body has less ankle movement when they squat. The restriction in the ankle will create abnormal knee and hip motion and have consequences on the pelvis and lumbar spine. The ankle joint can be a difficult joint to increase mobility. To keep the improved range of motion often requires regular home stretching. Sometimes a Physiotherapist is required to help return normal joint play to the smaller joints within the foot.

The foot and ankle are made up of an array of small and long bones; these bones all have to work in a coordinated fashion to enable the ankle joint to move correctly. It is the job of the physiotherapist and trainer to identify where these smaller restrictions may be – where they affect or present as generalised pain in other parts of the body.

Clinically, if the ankle has been fractured or sprained there can be restrictions due to a poor healing process.  If the restriction has come on with no trauma then maybe the ankle has been restricted over time due to myofascial restrictions throughout the foot and ankle. The latter can be corrected much more quickly. When a client has on-going assessment by their personal trainer and Physiotherapist myofascial restrictions like this can be easily identified, especially in the foot but also throughout the rest of the body.

The foot and ankle are the first parts of the body to connect with the ground when walking, standing, running. Before training, it is important that the foot and ankle have normal range of motion to prevent injury.

Personal Training series: Heavy weight training and injury prevention

Many people like to look their best and this requires a toned shaped body. Some people want to lose weight and this will also involve weight training. It has been found that a combination of cardiovascular exercise and weight training can get faster results because increased muscle mass will burn more calories and hence improve reduction in weight, as well as a shaped body.

If someone starts weight training from scratch injuries are often common because the correct movement patterns are unknown. Most people know that they can hire a one-on-one trainer to assist them in this process.

Weight training has many forms; if the weight training is kept at a light to moderate weight, and the movement patterns are correct, injuries can be prevented. Problems start to occur when weight training becomes very heavy. In order for muscles to grow they require a stimulus harder than the time before; training can start gradually and increasing in weight is a simple process. When a person starts to reach the maximum weight that they can push then challenges will occur.

The challenges of pushing weights higher than a person’s current maximum lifting weight will be controlling the weight when putting it into a starting position; lowering the weight in a controlled fashion; avoiding excessive joint position; and finally pushing the weight back to the start position. Sometimes lifting heavy weights will require standing, a lunge position or a position other than on a stable bench. When a person has to control a heavy weight, as well as the position of their entire body, the movement becomes very complex.

Commonly the injuries I see when someone lifts heavy weights are at the very start of the movement and in the middle of the movement. The weight is very heavy and at the start of the movement the person has to lift from a standing still position. To generate extra power a person will compensate by swinging their body to help; it is at this point that an injury may occur to the lower back, the sacroiliac joint, the knee or any other joint that is the weakest joint in the link. The time pain occurs is in the middle of the movement because the middle of the movement is the most awkward; controlling the body puts the body in its weakest position, and tissues get injured.

A client was training and wanted to be pushed more, and therefore was told to start Olympic deadlifts. She was 5 foot, of petite build, and when she explosively lifted this weight her sacroiliac joint popped. Treatment for this joint has taken several months and she now requires pilates and controlled movement training to keep her pain at a satisfactory level.

At some point in a person’s training lifting heavy weights may become necessary. If a physiotherapist can identify weak areas within the body – and the trainer is aware of these areas – then when lifting  a heavy weight in a complex movement pattern, the trainer can help a client control and prevent injury.

My advice is always to have your entire body assessed before you start lifting weights to give the trainer the information they need to prevent an injury from heavy weight training.

Personal Training series: Predicting Injuries

No two people have the same body; and even if two people look the same their ability to withstand load can be vastly different. Commonly in the clinic my clients complain about holding good posture. They report how other colleagues in their places of work can sit with bad posture but never develop pain. Why is this?

There are some people who have a musculoskeletal system which is able to withstand the abnormal loads on their bodies in poor sitting postures: there are others who have a very low tolerance to the stress of sitting with poor posture. There may be many reasons for this but I think a major factor is simply genetics. Genetics cannot be changed. Therefore, two people should avoid comparing themselves when it comes to posture, movement and pain.

Another example of this is athletes – who play sport regularly – and get more injuries than others who may sit at home with an unhealthy lifestyle and watch TV. If you play sport you are generally going to be healthier on the inside but maybe more prone to injuries on the outside. Unfortunately this cannot be avoided as sport does put abnormal loads on the body. If the body cannot adapt to these loads then injuries will occur.Those people who sit on a sofa and eat unhealthy foods do not expose their body to the stresses of sport and in the long run may have fewer injuries and actually better joint condition.

When a physiotherapist assesses a person a bespoke testing protocol is followed; this protocol will take into consideration the movement patterns this person puts themselves through in normal daily life as well as in their sports or hobbies. This assessment is a very functionally based assessment whereby the client can see where their issues are in daily function or sport – and then has a goal to achieve in the rehabilitation process.

The physio will do a thorough examination of the musculoskeletal system and identify individual variances within each person. Physiotherapists can then report to the trainer what the potential consequences of training that person will be. This method will also identify what limitations this person may have when setting goals. When a physiotherapist and personal trainer work closely together you get a synergy like no other. The client gets fully assessed at the start and the constant feedback throughout the training process will provide a bespoke feedforward system for goal attainment and injury prevention.

When a physio and trainer work closely together injuries due to movement can be predicted. Sometimes a client can do an awkward movement once, twice, ten times but if they decided to run a marathon with the biomechanics that they have they will develop an injury. The training process must be adapted to provide help to prevent this injury increasing strengthen and flexibility in various parts of the body to enable that person still to run a marathon.

It is my intention that a client is able to train with very few major injuries; continue to train if they have minor injuries; and attain their goals on time. The client also has the benefit of knowing the physiotherapist, and of knowing that the trainer and physiotherapist are working together as a team.