Does pain mean injury?

Tissue tolerance is the foundation of the body’s ability to perform and protect itself from injury. The inefficiencies and movement dysfunctions can cause the tissue to work harder, burn more energy, and becomes weaker with time. Fatigue builds-up, creates more stress, requires more effort and at times it translate as pain.

Pain is not always a signal of damaged tissue or an injury. Tissue damage can occur without the sensation of pain, just as pain can occur without the existence of any tissue damage. The two may well exist together but they are not inter-dependent.

An athlete can have a lot of pain with little to no damage, or a lot of damage with little to no pain.

Understanding that pain does not necessarily mean there is significant damage or degeneration occurring in the body has helped bring relief to many athlete suffering of pain. Pain is real, very real, but in some cases (not all) understanding it can actually lower it. Being proactive and listening to your body is key, when pain occurs in any form it’s time to slow down, even if it’s only for a few days, and assess the cause.

Correlation between pain and fatigue in endurance athlete
Form related overuse injuries (poor mechanics) is often due to accumulates fatigue, which comes in the second half or towards the end of a workout and race.
Time becomes the intensity, more volume, more intensity sessions and not enough recovery can result in compensatory mechanics, fatigue tissue unable to take on the load, leading to discomfort, soreness, tightness, and even pain.

A tight muscle will pull a joint into a dysfunctional position and a weak muscle will allow it to happen ; soreness, muscle fatigue, less efficiency, longer recovery or maybe even injury can occur.

We all have musculoskeletal weaknesses and postural molding. The more time training in a single sport can actually enhance imbalances, our strength becomes stronger and our weaknesses become weaker. To avoid this pattern a routine of dynamic functional exercises is a must.
(For specific trail running exercises see my book Trail, les clé pour performer sans se blesser, Glénat 2020)

Depending of genetics, tissue tolerance, and individual mechanics some athletes feel pain or discomfort more than others.

Many athletes have high tissue tolerance even if they have poor mechanics or are overtrained. It does not mean they are free of injury or there is no long term damage. Friction, compression and shear force in joints can still be a reality. At times it just takes longer to surface and unfortunately can turn out as degenerative joint disease, hip labral tear, lumbar spondylosis, arthritis, chronic Achilles or patellar tendinopathy… just to name a few.

Athletes are in constant architectural renovation

Maintenance is key, taking care of imbalances through dynamic exercises and prioritizing sport specific mechanics will make a big difference. The following should also be part of a training regimen ; eating healthy food, quality sleep, regular massage and hands-on treatment from physiotherapist is also important.

When you start feeling discomfort, soreness or mild pain
Don’t stop exercising
Reduce volume
Don’t get discourage
Focus on proper technique & mechanics
Keep legs moving quickly, be light
Seek sports med advice for assessment
Include preventative exercises to correct weaknesses and imbalances

Chronic pain can persists after tissue damage has healed. Most tissues in the body are healed as well as they can be from 3-6 months.

When do you feel pain?
Only first 5-10 minutes of workout
Only towards end of workout
First thing in the morning
Only in sleep
Ongoing, day & night
After extended time sitting at desk
…etc monitor your pain and share this with your physiotherapists

Understanding basic anatomy can help you understand your body better.
Muscles cross either one or two joints and pain is usually felt in the belly of the muscle
Ligaments attached bone to bone and help stabilize joints,
Tendons attached muscle to bone so pain is felt distal from a muscle and closer and across a joint, for example the ankle for the Achilles tendon and the knee for the patella tendon.

Pain varies depending of the tissue & nerve affected.
When nerves are affected shooting pain, numbness, tingling will be felt. A compress nerve in the lower spine for example starts in the lower back and travels down the back leg, meaning the nerve has become compressed, perhaps due to a slipped or worn down disc in the spine.

Keeping track of when and where you feel pain and how its evolving from day to day and week to week is a key component to share with a rehab specialist.

Recovery versus healing
Complete healing can be achieved without full recovery, and this is all too often the recipe for disaster which results in recurring injuries.
For example
Tissue damage to a muscle or tendon following an ankle strain may be perceived like it’s healing quickly since pain is almost non-existent but the ankle is still weak and hurts when moved in certain angle- but the athlete is quickly back to regular training to be soon injured again. This is commonly the result of poor, rushed or no attention to rehab. Often we take for granted what happens on the trail & snow. The likelihood of re-injury is greatly increased since the joint as poor stability and muscles surrounding the joint are weaker due to the strain. Unfortunately it is a common pattern with endurance athletes with the pressure of high volume training and competition schedule. It is important to keep strengthening the injured (weaker tissues) area with functional exercises through the entire season post injury. It is key to decrease the chance of recurring injury.

Back on track
Pain management is about addressing the nervous system, I always encourage athletes to remember what it’s like to move in a safe environment. Fear and anxiety need to be gradually eliminated to ensure full recovery, especially in high speed mountain sports like mountain biking, downhill and ski mountaineering due to variation of terrain and snow conditions.
As an athlete you still need to enjoy riding/running/climbing/skiing even if training is limited. Its time to focus on mechanics & drills, skill set, mobility, muscle balance, elasticity… and sports specific dynamic exercises.

Learn to have confidence in your skills again

By reducing training volume and incorporating preventative exercises, recovery is quicker, stress is minimize to the injured and fatigue tissues, it stimulates healing and help remodel tendon, muscle, cartilage and bone matrix. Doing nothing for and extended period of time can be one of the worst thing for healing- tissues get weaker, loosing all fitness.

Take care of your body like you take care of your bikes & skis!

Tips when exercising with mild discomfort
Think of moving lightly & quietly
Focus on quality of movement, optimizing mechanics for sport specific
Move quicker than slower to reduce impact on joints, be light on the ground
Listen to your body, focus on your sensation
Relax and exhale!

Tips to help manage pain and promote healing & recovery
Daily cold spray directly on the affected area before the hot shower
Self massage (lightly) with Bio Freeze
Put legs up against the wall for 5 minutes after training
Hydrate while exercising : use electrolytes
Healthy meal within 30-50 minutes of workout
Two days off in a row
Focus on quality vs quantity of training

When pain persist it’s important to seek professional advice from a sport medicine specialist who has expertise in sports rehabilitation. You know you are in good hands when a proper assessment of mechanics, musculoskeletal imbalances, and joint stability and mobility are tested.

Finding optimal training load to maintain good fitness while recovering is key.

Don’t get discourage, be inspired, take rehab like training, focus on each session at a time, and be consistent.

Be a stride forward, harness your drive and take good care of yourself.

Merci for reading !

The Running Press, fresh news to educate & inspire

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