What Should I Do If "X" Hurts?

The question we receive most in ATG For Coaches and the question you will hear most as a coach is what should I do about my sore "X."

What is the formula behind answering this?

In some cases people can't stop doing what they know will hurt, if they are in season as a professional athlete. That's ok. But we have to acknowledge the recovery will probably be slower / less linear.

For the obsessed recreational athlete, it's worth considering "What For?"

No judgement but gaining muscle and athleticism by pushing through joint pain doesn't happen the way you might like. The body is intelligent. Pain decreases muscle activation in order to prevent further damage to the joint.

Movement is life. Circulation heals. It maintains the neural connections and decreases the need for chronic pain signals by restoring ability and confidence to the area.

The challenge is to work without pain and to monitor for the next 24 hours if you did too much.

Scaling back if needed is the key here.

Movement is great, but chronically aggravating tissues that you want to heal is not the answer.

For the knees we can start with walking backwards or 1-inch step-ups.We can progress to sleds, uphill walking and backwards running depending on goals and access.

The same is true for every joint! Generally we want short range movements that can be used in the 100+ rep range.

5 to 20 minute intervals work well.

Sleds ONLY will create shortened muscles over time.

AFTER heating the area... IF it feels good THEN...

Lightly train length or lightly static stretch to gain / regain long range strength and connective tissue tolerance to tension.

For the knees this is:

Couch Stretch which by its unilateral nature and position can create significant leverage like a weighted stretch.

OR

Reverse Nordics starting with the feet elevated. This movement is bilateral and can be made gentle. It creates more lower quads tension in the connective tissue.

If all goes well then building into strength training in the 20-50 repetition range is the next step. Do this after your blood flow and length work if symptoms are improving.

Don't train strength on top of pain if it's a 2 or more out of 5. An exception to this might be if the athlete is going to continue to compete.

For example, consider an athlete who has a hamstring tendon injury but is able to warm up and play. They would need to keep working on hamstring strength to avoid ACL / hamstring rupture risk, which is more catastrophic than the tendonitis.

These types of injuries are quite common. Someone is competing through chronic pain but stops strength training the area, then a tendon or ligament snaps as a result.

Time frames... getting back to 20-50 repetition strength generally happens within 1-3 sessions of resting from the offending activity.

The short answer is > decrease mechanical tension while maintaining blood flow.

1. Look at decreasing the intensity of the pleasure pump. Some people have found using floss / occlusion can help increase the metabolic flush and healing effect to the area with less mechanical tension.

2. Stretch less intensely.

3. Regress the strength work.

While I haven't seen this method fail, that doesn't mean other areas can't contribute to faster gains.

X. Look for other solutions in:

DIET - Many people report decreased chronic pain when going on a nutrient dense elimination diet. Gut health impacts tissue health.

PSYCHOLOGY - Chronic pain has complex psychology... generally there is a mechanical / chemical problem that must be dealt with, but sometimes the attachment or other cause of pain can interfere.

We have to be more specific.

If it's the joint capsule, then increasing blood flow from closest to the position of anatomical normal - standing position makes the most sense as it would cause the least tearing of scar / connective tissue.

Unless it's very sore / acute, short range movements can often be performed with a band.

Initially the movements don't matter too much. We simply want BLOOD and NERVE FIRING in the general region.

As the range of pain-free options increases, we can add to the number of movements we use.

What is happening during the Pleasure Pump?

1. The tissue is being energised & heated. Warmth, laser, etc can do this but adding movement increases the neural and structural adaptations, and it's free!

2. The muscle is being worked more than the connective tissue relative to long range or explosive movements.

3. Where successful pain-free contractions are happening over and over again, the neural connection to the muscle is being re-established and strengthened.

4. Neural and vascular density are being established.

5. Fascia and its fluids are being lightly stimulated.

Gradually decrease repetitions towards 10's 5's or even singles and balance the full strength curve for the muscle.

Increase tension by progressing into special repetitions.