Strengthening for Pain and Performance (Part 2 - Pain)

In order to understand how strengthening is beneficial for pain, it is important to first understand where pain comes from. I will preface this explanation of pain with the fact that pain is a complex experience that we do not fully understand. That being said, here is a brief synopsis of what we do understand about pain:

You feel pain when your brain perceives a threat. The more your brain thinks you are threatened, the higher level of pain you will feel. You have no doubt felt a variety of intensities of pain from time to time. A dull ache, a sharp shooting pain, and all the sensations in between are all outputs from the brain in response to a perceived threat. Here’s how it works:

1. You experience something (let’s say you place your hand on a hot stove)

2. The nerves in your hand carry a message to your brain (“Hey brain, there is something hot on our hand” - say the nerves)

3. The brain interprets whether or not the message is a threat to your survival based on:

   • Similar past experiences (What happened the last time we touched a hot stove?)

   • Your current environment (Are there other threats around us or are we safe right now?)

   • Your beliefs (Does touching a hot stove have meaning in our culture?)

   • Your thoughts

   • Your emotions

4. Nerves from your brain carry the interpretation back down to the body and we experience a sensation

   • The sensation might be pain if the brain determined we are under threat

   • There might be no sensation at all if the brain determined no response was needed

   • The output might be any number of other sensations or responses depending on what the brain deems an appropriate response

Here is an entertaining synopsis of this explanation from one of the world’s leading pain researchers.

So, pain is telling you that your brain thinks you are under threat. But your brain is just doing the best it can with the information it has. If you give your brain different information, it can respond differently. Pain often leaves us afraid to move and definitely afraid to move against any kind of load. That’s where strengthening can perform a profound role in de-threatening the experience of moving your body. When you experience using your muscles to exert force against a load, this sends an empowering message to your brain. Lifting a weight without any immediate negative consequences forces the brain to re-evaluate the threat level of that activity. If nothing bad happened, the logical conclusion is that there is no threat and thus no need for pain. The more times the brain is exposed to a positive outcome after moving with weight, the stronger the message becomes that this activity is safe. As loads gradually increase, this further increases the message of safety. 

Strengthening exercises can be simple (think, squats or bicep curls). The fact that a simple exercise can reduce pain levels is another powerful message to send to your brain. If a simple exercise can reduce pain, then the threat can’t possibly be large or even existent at all.

Strengthening exercises must be done by you in order for you to experience their effects. No one can perform the exercises for you. This provides you with all the power and sends another de-threatening message to your brain. If you (a person with no special healing powers) can perform the treatment for your pain, the cause of the pain must not be that threatening.

Strengthening exercises can show your brain that:

• movement is safe

• muscles working against a load is safe

• simple movements that you can perform on your own can control your pain

Do not underestimate the power of simple things. We humans are so smart and have used our brains to create so many wonderfully complicated things. But simple things can have profound effects, and thank goodness! Although the reasons may be complex and not fully understood, that doesn’t stop us from enjoying the effects.

The appropriate application of strengthening exercises when you are in pain is something that should be left to medical professionals, like physical therapists. There are absolutely times when strengthening exercises, or any kind of exercise, is the wrong thing to do. If you are currently in pain, you should consult with a healthcare provider before attempting any treatment on your own.

References:

• Therapeutic Neuroscience Education: Teaching Patients About Pain. Adriaan Louw, Emilio Puentadura. copyright 2013

• http://www.choosingwisely.org/societies/american-physical-therapy-association/

• Physical Therapy Continuing education courses

• Explain Pain - Bob Johnson, NOI

• The Biopsychosocial Management of Complex LBP: A Stratified Care Approach - Gail Sowden, Keele University

• Reconciling Biomechanics with Pain Science - Greg Lehman