Physical Pain is a universal human experience, we all have felt it. Whether it was a paper cut, stubbed toe, or a more serious injury, it is a phenomenon of the human condition. Most pains are minor. Some are major. Others are life changing.
When I first began training clients yeas ago, I did not expect pain to be such a common factor in training. I had experienced chronic pain myself due to injury, but that my personal history. I was not aware of how COMMON chronic pain is in most adults.
Low back pain is experienced by somewhere around 80% of the population, and chronic pain by 1 in 4 adults.
Additionally, you have the experiences of intermittent pain without clear cause, and the experience of delayed onset muscle soreness, which many people characterize as being painful.
As it was, pain was a recurrent conversational topic. Experience is what has always driven my learning, and by necessity I had to educate myself on the subject.
Before We Begin
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Lets Talk about PAIN and What you will Learn today
Pain is brain-made, not body-made. There’s no single pain receptor — your brain constructs pain from nerves, pressure, heat, visual cues, and your own expectations.
Your mindset changes your healing speed. People who believe they’re tough heal faster; people who believe they’re fragile become more sensitized to pain over time.
Medical imaging lies more than you think. MRIs routinely show damage in pain-free people and clean results in people with chronic pain.
The 1-10 pain scale was invented to sell drugs. The opioid industry created “pain culture” to convince you pain itself is a condition — but numbing symptoms doesn’t fix the cause.
A Personal History for Context
My personal standard for pain is when I contracted viral meningitis when I was 13. I was in school, and I started getting severe headaches to the point that I was PASSING OUT at my desk.
That level of pain is hard to describe. It was like a volt that would run through my brain, my head feeling as though it was about to explode, I would lose consciousness, and then wake up again. This being a public school, no one noticed.
I got home from school that day and was immediately taken to the hospital. The diagnosis was Viral Meningitis and Encephalitis (inflammation of the brain membrane) as I found out can kill people if left untreated. I was hospitalized for a week.
I don't remember much of this. I was hallucinating for half of it and had to have a constant IV as I was vomiting to the point that even sucking on ice was impossible.
Since then, thats been my pain metric. Am I passing out? No? Then I'm fine.
A few years later, I began my experience with chronic pain from an injury.
It was during a wrestling practice in high school, the head coach did his own version of hell week to wash out anyone who was not physically up to par.
I remember the experience distinctly, it came at the very end of practice, on Friday, and we were a few hundred reps into doing partner leg raises. My training partner pushed my legs down, and on the very last rep I felt a distinct pop in the lower right side of back, I learned later this was the quadratus lumborum muscle.
My back spasmed and locked up, something I had never experienced before. (for those unfamiliar with the term, A spasm is a protective action of the brain to prevent movement and further damage . The muscles of the affected area will become hypertonic and tight, preventing motion)
I was unsure what to do, but thankfully upon arriving home my father had muscle relaxers on hand from a prior prescription for himself for a past back injury.
As it was, I made it to practice on Monday, but from that point onward, my lower back was prone to spasms, and my low back would "go out" every 3-4 months for the next FOUR YEARS.
It was an unusual experience to have a “bad back” when you are in high school, and by the time I'd graduated, I'd estimate that I'd had at least a dozen painful episodes of severe back spasms and congenital low back pain.
Pain is a Catalyst for Learning
My chronic low back was the catalyst for my interest in fitness, as I did not want to live with this pain, and was determined to solve it. It was unacceptable that this was something I would live with the rest of my life.
The information age we live in today was not the state of the world in 2007 though. My experiences with doctors were hugely unhelpful, I was told the generic advice of “don’t do that if it hurts”, and the tired warnings of not to lift weights. I was given multiple prescriptions of muscle relaxers, and told to take NSAIDS whenever I needed them.
Any faith I had in doctors was largely diminished by the time I got to college. Most doctors didn’t lift, their knowledge (if it could even be called that) was lackluster, and it was obvious that I would need to solve this myself.
The life changing moment was sophomore year of college, when I discovered deadlifting through a Muscle & Fitness article.
At one time, fitness magazines were resource rich, with excellent content from experienced trainers and coaches. The article contained a 12 week program for deadlifting, along a with length written tutorial on all the benefits of the deadlift, strengthening the posterior chain, and why these muscles were essential for performance.
I began that 12 week program deadlifting 110lbs. I finished it 12 weeks later deadlifting 275. After repeating it again, I achieved a double bodyweight deadlift of 405 pounds.
This experience with both progressive overload and effective strength training was a revelation.
-If you have an injury and/or chonic pain you want to solve, become an expert in that injury. Healing yourself will require more knowledge than you have now
Training is the Power to Change yourself.
My back pain was gone, and while I admit I would later injure myself from deadlifting too frequently (what heals you can also hurt when done to excess), the mindset shift was permanent.
Whatever pain and injuries I might experience, there would ALWAYS be a solution to overcome them. (Barring death or literal paralysis of course).
As I would learn later on, one’s mindset toward pain matters as much as the pain itself.
Pain and Mindset
In my training career Ive trained alongside IFBB Pro Bodybuilders, World class level powerlifters, Strongmen, and various pro athletes.
I've seen people tear hamstrings, pecs, lats, shoulders, and every muscle you can think of. I've seen people bomb out on lifts and snort blood out their nose. I've watched people push themselves to the point of vomiting, convulsing, and passing out.
I've seen A LOT of people hurt themselves. (at the highest levels of sport, performance has nothing to do with health. The limits that true elite athletes push themselves to are not models to follow)
And I've also seen the same people come back from supposed "debilitating" injuries and get even STRONGER.
And Bigger.
And not give a shit that they got injured.
Training and learning from people that live on the extreme margins of bodily performance teaches you a lot about the body.
You see something in common among physically tough people: Pain does not stop them.
Pain is an Opportunity to Heal, and to Learn.
Their attitude towards pain is never catastrophic. And it is not dumb machismo either. Your belief will in your toughness (or fragility) will play a major role in the healing process. Believing you are TOUGHis always superior to believing you are weak.
How to Think About Pain
Firstly, lets start with Central Sensitization Theory: Pain science research shows that people generally fall into mindsets with how they think of Pain
1. The Strong Mindset-The individual inherently believes they can HANDLE pain. They don’t welcome it, but they are not afraid of it either. They view they body as being strong, resistant and capable. When exposed to pain, their perception of its intensity Decreases with time.
You can simplify their mindset to “what can’t hurt me makes me stronger”
Or...
2. The Fragility Mindset-These people view their body’s as being inherently fragile and easily hurt. They are fearful of pain, and when exposed to it, they become increasingly sensitized to it, so much that their perception of pain INCREASES, to the effect that what would be MINOR pain hurts MORE, and would be "moderate" pain is severe.
Whats even more fascinating is that pain can be present without ANY physical trigger at all. The BRAIN can create a "pain" status in the complete absence of physical trauma of any kind. The thought of pain is enough to trigger Pain
-I've known people who laughed at fracturing their SPINE. They were in horrifying pain and were laughing.
I've also known people who get worried if they feel the slightest discomfort doing any kind of exercise. They would be afraid of hurting before any actual exertion.
Your psychology directs your physiology
Its been well known in pain science for a very long time ones mental attitude alters the pain experience, and recovery process.
You heal faster if you BELIEVE you heal faster. Pain is psychosomatic, its not purely physical. How you think about it changes the experience of it.
What is seen see over and over again in clinical evidence and anecdotal practice are the people who recover from injury and tolerate pain well have the aforementioned “Strong Mindset”, which grants them both a high pain tolerance, and confidence in their ability to heal.
Believing you are tough, believing you can heal, and believing pain is a temporary obstacle appear to do as much for healing as any physical protocol.
You can think this is chest beating machismo, but pain science backs it up many times over.
You want to heal FAST? Get like Wolverine and brainwash yourself into believing you have a mutant healing factor. It will help.
Secondly, Pain is also not objectively quantifiable or measurable. There is no singular cellular receptor responsible for Pain in the body. Pain is a multi-factor experience that is 100% Brain made.
Pain IS an Opinion (this does not mean that pain is real, pain is very real, but what pain is cannot clearly be defined)
Medical science has found that sensorial pain and physical trauma do NOT coincide like you think they would.
What are the factors that create Pain? They are as follows
-You have the nerves that run through the muscles
-You have the nerves that run through the skin
-You have the innervation of fascia
-You have the innervation of the joints
-You have receptors for pressure
-You have receptors for heat
-You have your own visual assessment (ever seen a little kid freak out when they see blood, but be perfectly fine the second prior to seeing it? Seeing is believing)
-You have your attitude towards pain. High pain tolerance and low pain tolerance will experience events differently
All of these inputs get sent to the brain and turned into “I am HURTING”. The experience and perception pain is shaped by the brains interpretation of information from the multitude of nerves and various receptor cells in the affected area, as well as the individuals attitude and expectations.
When you realize Pain is a biopsychosocial signal that the brain creates, it becomes quite a weird thing to think about.
A Systems Perspective is Better than a Compartmentalized One
The opioid industry is largely responsible for the 1-10 pain scale and leading people to believe that PAIN was something that required its own treatment. (The 1-10 scale is entirely a creation of drug companies to sell more drugs).
This 1-10 Scale and the subsequent development of “pain culture” has created a common perception that pain itself is a unique individual factor that must be treated.
Are you in PAIN? My god, you need drugs then! How could you hope to function while in pain!
While you can numb and sedate the nervous system into not feeling pain, this DOES NOT solve for the conditions that created that pain. What exactly are we treating with pain killers? Inflammation? Psychological sensitization? A neurological neuropathy with no root cause?
There is no CLEAR answer to these questions.
For some forms of pain, there is a clear relationship between stimulus and experience:
Compound fractures, burns, tearing a muscle or tendon off of bone. Immense physical trauma absolutely hurts, no question.
But pain from trauma is very different from the chronic and general pain that most people experience. Trauma pain is arguably easier to solve.
For things like rotator cuff tears, discs, joint degeneration, muscle strains, knee degeneration, there is no clear connection between these conditions, the pain experienced, and the objective decay/damage to the area in question.
Sham Surgeries to solve these pain relieve pain as much as REAL surgeries.
Low back pain is common in 3/4 of people. Most of this is Non Specific, there is no injury.
Medical imaging is notoriously unreliable for low back pain. And shoulder pain, and even knee pain.
Many people have abnormal imaging, but they are experiencing zero pain. Someone else can have a perfectly healthy joint on an MRI, but their pain is chronic.
In fitness practice, it is common that people report pain from their “bad” posture. But there is no medical definition on what GOOD posture even this, and many people have spinal abnormalities that could be called “bad” but they are pain free.
Medical science is also riddled with people who suffer supposedly debilitating injuries and they walk around nearly pain free. Or walk into the hospital with an injury that you would expect to incapacitate a person, and they are…fine, aside from their grievous injury
The Belief itself that pain can be explained by physical structural issues is questionable and unproven.
Pain is NOT a Linear Process
There is a strong desire in medicine, and the general public, to be presented with straightforward, “A is because of B” models of explanation, and then have that followed with a “Just do THIS” simple solution.
Pain is not that simple.
Modern Science does NOT know much about Pain when you get nitty gritty, but we can establish a few concrete Premises
A) Its a problem for people, and they want to get rid of it
B) A lot of things seem to work, and not work, for fixing it. Exercise seems to work the most reliably
C) A positive mindset is a reliable factor in healing. Thinking fragile will not help you.
Now that Ive likely blown apart most of your preconceived beliefs about pain, what do you actually DO for injuries and rehab? Where do you start?
Important-I am of the position to always give credit where credit is due, and I want to reference the Painscience.com website by Paul Ingrahm as the definitive site for all things pain related, Ive been reading it for years and linked to it multiple times in this article. If you would like to explore pain more and enjoyed reading this, please go read his site.
Your stuff has been genuinely incredibly helpful for me as a med student. You and the rest of fitness twitter have sufficiently upped my self-education game when it comes to health. Our lectures are fine, but definitely not sufficient.
Looking forward to the part 2 of this series.