Learning to Listen to Your Body
By: Jamie T. Raymond, D.C., C.C.S.P.
Many of us have a love-hate relationship with training. We love doing it. We love what it does for us physically and mentally. We become addicted (hopefully in a healthy way) to the endorphins. We love the time alone to think, or to not think. But we hate the pain that comes with it.
Part of training is about learning to understand pain and differentiating between appropriate pain levels and on the other hand warning signs. Too often I see athletes accepting pain as a normal part of their work-outs when they shouldn't. Ignoring persistent pain is a sure way of developing a more serious injury that will force you to stop training altogether. In terms of injury prevention, this is the number one mistake many athletes make.
Differentiating between the various types of pains during exercise can be an art form. In general though, most of it is pretty common sense. We'll start with a brief description of "acceptable" pains:
- Delayed Onset Muscle Soreness (DOMS) is the medical term used to describe the muscle soreness felt within 12-48 hours after a tough work-out. It used to be attributed to lactic-acid accumulation but now we understand that it has more to do with actual tissue trauma and the subsequent repair process. DOMS can happen after any type of intense workout or new activity relative to the athlete's conditioning level. It is typically generalized (as opposed to localized) and as long as it goes away within a few days is not a cause for concern.
- There is a certain level of discomfort inherent in acclimating to the ergonomics or technique of a new sport or one you haven't participated in for a while. This is especially true for sports that utilize equipment, such as cycling or Nordic skiing. So long as you know you are using the right size gear, and things seem to be improving with time, it's all part of the fun. However I would contrast this with a patient I saw recently: an experienced cyclist who had to take a Motrin before any ride over 20 miles due to upper back pain. Without going into too much detail, I think you get the point.
- In general, acceptable pain should be commensurate with the intensity or duration of your training. Your legs will start to burn when climbing a monster hill on the mountain bike. Your shoulders will become sore after a few hours of kayaking. However a big problem I see with athletes is ignoring or misinterpreting unacceptable pain signals their bodies give them. You shouldn't be having sharp left knee pain half way up that hill, or stabbing right upper back pain after paddling.
Here are some "rules of thumb" to help you understand when pain should be viewed as a warning sign:
- First and foremost, don't ignore what your body is telling you. If you're running a 5K race and looking to set a PR you know it's going to be a painful experience. There are times you do need to go into the appropriate mental space to block out the pain. As Lance says, "Pain is temporary. Quitting is forever." However this is different than ignoring that nagging hip pain that kicks in at the end of every training run, thinking that you can just tough it out. Persistent pain during or after exercise should not be ignored. This may sound like common sense, but you would be surprised what some people are willing to live with and train through.
- Sharper, localized pain that is not resolving should not (and often cannot) be ignored. If you have sharp pain during running on the inside of your knee or front of your shin for example, bag the run. If it continues during the next few runs, go get it checked out. Sharper pain often indicates a joint or bone issue.
- Duller, achy pain usually indicated a muscular issue. When pronounced it may turn into more of a throbbing sensation. Note however that while a muscle is usually the actual pain generator, there is probably more to it than that. Individual muscles rarely just decide to spasm or "pull" on their own; there likely is a biomechanical issue happening in the associated kinetic chain, causing the offending muscle to over-compensate and become irritated. One example would be a mechanical foot issue causing same side gluteal inhibition; the gluts are what wind up hurting but the issue is really in the foot.
- Many sports injuries follow the pattern of not necessarily hurting during the actual training, but afterwards. This is extremely common, but shouldn't be misinterpreted by the athlete to mean there isn't a problem.
- The longer you allow a muscular issue to continue, the worse it will become. With time and repeated cycles of inflammation, you get actual changes in the texture of the muscle as adhesions (scar tissue) become layed down in the area. These adhesions will further compromise the involved muscle(s), setting up a downward spiral.
- Eventually muscle pain may go away. Chances are though, unless it went away in response to something specific you did such as buying new running shoes, your body has just shifted the stress somewhere else. Your body has an amazing ability to compensate to allow you to continue functioning when things aren't right. Chances are that hip pain was in response to an issue in your foot. Moreover you may notice that when that hip pain finally did go away was right around the time your upper back started hurting, and then your neck, etc. Pay attention to developing compensations. If the pain goes away and nothing else develops, fine. But if you allow things to build then eventually when you do need treatment the scope of the problem will be that much greater.
- Assuming your form or technique for your sport are OK, persistent "tightness," especially of one particular muscle or area, also often indicates a biomechanical problem elsewhere. Many athletes tell me that they have always had tight hamstrings despite a lot of stretching. This may just indicate the need for a better stretch routine, such as yoga. On the other hand, if one hamstring tends to tighten up after, say, you cycle more than 20 miles, there is more to it than just a tight hamstring. Similarly, many athletes dismiss muscle cramping or spasm as dehydration or electrolyte imbalance. If it happens to the calves at the end of a long exercise session on a hot day, this may indeed be the case. But if it happens repeatedly to the same muscle even when you know you are properly hydrated, it's probably the result of a mechanical issue. Typically a muscle prone to tightness, cramping, or spasm is attached to a dysfunctional joint; the joint is the real culprit. It is actually pretty rare for a muscle to just spontaneously spasm without a concomitant joint issue present. Massaging or stretching this type of muscle issue may help temporarily but won't really solve the issue.
- For most sports injuries simply resting isn't the real answer, despite what some doctors would tell you. There are some notable exceptions, such as a stress fracture. However beyond that, virtually any type of sports injury is going to feel better when you stop doing the activity. The key is to find and fix the source of the issue and address any ergonomic/ training factors. Otherwise, the injury will just likely re-occur when you resume training. There certainly may be some training time lost, but to simply stop altogether can be counter-productive. *Note: I'm not advocating going against your doctor's orders. But use some critical thinking: if your family doctor, who doesn't see a ton of sports injuries, tells you to stop running for six weeks and take ibuprofen as the only means of treatment, I would be looking for a second opinion.
- Beware the cycle of taking over-the-counter medications regularly to get through training. Pain is usually mediated through inflammation; taking anti-inflammatories basically just masks the pain signal. It's one thing to take a small dose after a particularly grueling endurance event. However relying on medication to get through or recover from training on a regular basis is a slippery slope that usually leads to greater injury.
- Know the signs of over-training:
- Behavioral: Apathy, lethargy, poor concentration, changes in sleep pattern, irritability, decreased libido, sluggishness, sugar cravings.
- Physical: Reduced performance, weight change, muscle soreness, swollen lymph nodes, diarrhea, infection, loss of period, slow healing cuts.
Having several of these symptoms at once, especially associated with a recent history of intense training, should have you thinking about rest. Part of the art of training is knowing how far you can push your body before it starts to break down. There are times when you want to over-train and thus reap the benefits of super-compensation. It's one thing if you are an experienced athlete who has been here before, and have a recovery week planned. Otherwise you need to back off your training and consult with a coach or other resource to learn how to proceed. Continued intense training beyond this point will surely lead to injury or illness.
As you can probably tell, training is an art form as much as a science. The better you are in interpreting the signals your body is giving you the more successful an athlete you will be.