Pain & Performance: Staying Injury-Free in the Gym

Pain & Performance: Staying Injury-Free in the Gym

Pain is much more complex than we realize. Everyone correlates pain with injuries, but the data simply doesn’t support that. So, be very careful when someone tries to sell you on absolutes.

“You should never do this ___________ (insert any movement here) exercise.”

“This will always cause pain in your __________ (insert any body part here).”

Human bodies are exceptionally good at defying the odds. Have you ever seen gymnasts and contortionists?

Whenever someone tells me that human bodies should always or never do something, I always think back to those performers who defy absolutes.

Gymnast performing a back bend experiencing no painConsider the individual above, and then reexamine your current thoughts surrounding pain…

What Is Pain?

Is pain really the result of a single biomechanical movement? Can we just simplify the process into a logical deduction of 1+1=2 (aka your spine + this movement = pain)?

The short answer is no, probably not.

Interestingly enough, many studies have shown that significant joint wear or structural changes to multiple areas of the body doesn’t correlate with pain whatsoever.

  • Rotator Cuff Tears: 31% of subjects aged 27-87[1] (n=411)
  • Hip Labral Tears: 69% of subjects aged 15-66[2] (n=45)
  • Knee Meniscal Tears: 61% of subjects aged 50-90[3] (n=991)
  • Disc Degeneration: 37% in 20yr olds // 96% in 80yr olds[4] (n=3,110)
  • Knee Osteoarthritis: 4-14% in subjects less than 40yrs old // 19-43% in subjects greater than 40yrs old[5] (n= 5,397)

n = number of people in the study

That’s a lot of data … let me break it down a bit. For rotator cuffs, 31% of 411 test subjects aged 27-87 experienced no pain, even though imaging showed significant damage. In the case of hip labral tears, 69% experienced no pain. And for 80-year-olds showing signs of disc degeneration, a whopping 96% experienced no pain!

So, are you sure that pain is simply a biomechanical phenomenon relegated to movement, or is the brain running the show?

Lies, Deceit, and Corruption – Maybe Your Brain Is Wrong?

I’ll be the first to admit that articles on “dangerous” exercises – ones you should NEVER do – in the gym are a dime a dozen. I’m sure I’ve even written some in the past. But rather than repeating the typical answers, such as knee extensions, the torso rotation machine, and dumbbell side bends, I’m going to throw a curveball your way.

The most dangerous exercise is telling people that certain movements are dangerous and must be avoided completely.

Seems dangerous, no?

I’m sure you’ve been told multiple times, “NEVER round your back.”

Except gymnasts constantly take their spines through repeated cycles of flexion and extension with no issues. In fact, this exercise has been programmed at the highest level of gymnastics for many years.

Fear of Pain

Do you see the narrative here? Most people are being sold on the idea of fear and avoidance. We’re trying to create a simplistic solution to a multifaceted problem – this never works. 

Exercises are tools. And just like any carpenter, you have multiple tools in your toolbox. However, if the job is completed incorrectly, is that the tool’s fault?

No, of course not … it’s the professional’s fault for selecting the wrong tool for the job.

I’ve worked with multiple clients who were in constant pain when sitting in flexion. But yet others had debilitating pain and stiffness when moving into extension (aka arching their back). These two scenarios both contain an IMMENSE degree of context and different solutions.

If you start assigning labels to specific exercises, you subconsciously create a neurological bias toward that movement.

This is very similar to the influence of a placebo. This inert intervention shouldn’t do anything, but it produces a positive physiological result because the subject believes something good should happen.

But in the world of research and neuroscience, you also have something known as a nocebo. This inert intervention shouldn’t do anything, but it produces a negative physiological result because the subject believes something bad should happen.

When you tell someone (or believe) how their body should or shouldn’t move, you start playing with a neurological fire that’s likely going to burn you down the road.

Ignorance About Pain Is Avoidance

If you jump down the Google rabbit hole on this one, you come up with some very interesting results…

List of bad exercises from a Google search that are said to cause pain

Continuing on with the fear-mongering, the first result from the search yields:

List of 7 exercises that are deemed bad and may cause pain

Kind of makes you scared to workout, huh?

But what if I told you that I’ve programmed behind the neck pulldowns or kipping pull-ups for clients with excellent shoulder mobility? They actually enjoyed doing them and didn’t have any pain.

Or what if I told you that we routinely used partial squats when I worked at an Olympic training site? We used these during certain stages of an athlete’s training cycle to enhance specific portions of the strength curve.

I’ve also programmed physioball crunches for physique competitors and given ballistic stretching movements to track athletes, given the dynamics of their sport.

See what I mean?

The waters get murky when you really dive deep. The most important concept to take away from this entire discussion? CONTEXT IS KING.

Sure, some exercises lend themselves to higher injury rates based on the nature of the movement. And, the fact that many people don’t understand how to do them (Olympic lifting). But does that make the movement itself dangerous? Or rather, does that make the unqualified and inexperienced user the dangerous one in this situation?

I think you and I both know the answer to that one – 9 times out of 10, it’s user error.

So, How Can I Avoid Getting Injured in the Gym?

Good question! More people should be asking this if they want to avoid an unexpected appointment with their orthopedist.

Use appropriate progressions and regressions

Most people struggle with barbell back squats and conventional deadlifts off the floor on day 1. It’s the simple fact of the matter … biomechanics are complex, and lifting weight is an acquired skill. Either spend an immense amount of time understanding progressions or pay a professional who can do the work for you. Here’s a common progression scheme I implemented in the past:

Squat
  • Dumbbell Goblet Squat
  • Double Kettlebell Front Squat
  • Belt Squat
  • Safety Bar Squat
  • Front Squat
  • Back Squat
Lunge
  • Step Up
  • Split Squat > Front foot elevated
  • Reverse Lunge > Front foot elevated
  • Single-Leg Squat to Bench
  • Lateral Lunge
  • Bulgarian/Rear Foot Elevated Split Squat (RFESS)
  • Single-Leg Squat From Bench
  • Walking Lunge
  • Forward Lunge
  • Single-Leg Skater Squat
  • Pistol Squat
Push (Horizontal)
  • Band-Assisted Push-Up
  • Eccentric-Only Push-Up
  • Push-Up
  • Barbell Floor Press
  • Dumbbell Floor Press
  • Dumbbell Bench Press
  • Barbell Bench Press
Push (Vertical)
  • Forearm Wall Slide
  • Half-Kneeling Bottoms-Up Kettlebell Press
  • Tall-Kneeling Bottoms-Up Kettlebell Press
  • Half-Kneeling Landmine Press
  • Split Stance Landmine Press
  • Seated Dumbbell Press
  • Standing 1-Arm Dumbbell Press
  • Standing 2-Arm Dumbbell Press
  • Behind the Neck Press
  • Military Press
  • Snatch Grip Behind the Neck Push Press
  • Push Press
Pull (Horizontal)
  • Inverted Row
  • Incline Chest-Supported Dumbbell Row
  • Incline Chest-Supported T-Bar Row
  • 1-Arm Dumbbell Row
  • Dumbbell Bent Over Row
  • Barbell Bent Over Row
Pull (Vertical)
  • Flexed Arm Hang (Jump up to a bar and hold yourself at the top of a chin-up for as long as possible)
  • Band-Assisted Chin-Up
  • Eccentric-Only Chin-Up
  • Eccentric-Only Pull-Up
  • Chin-Up
  • Pull-Up
Hinge
  • Cable Pull-Through
  • Kettlebell Sumo Deadlift
  • Romanian Deadlift (RDL)
  • Trap Bar Deadlift
  • Sumo Deadlift
  • Conventional Deadlift

Now obviously, you don’t have to start at point 1 on all these different movements. These are spectrums, so move forward or backward, depending upon how your joints feel at any point in time.

Be VERY careful with plyometrics (jumping)

As you get older, you lose some elasticity in your tendons due to changes in collagen metabolism. Not only that, but most people stop jumping because they’re stuck behind a desk and have forgotten how to play – running, jumping, hopping, and skipping. As such, you run the risk of tendon and ligament-related issues, which can flare up when you start randomly jumping for no reason.

This often occurs in group exercise or CrossFit classes – the programming is haphazard with little concern for long-term joint adaptations. Most musculoskeletal injuries occur during the following conditions:

  • Landing
  • Deceleration
  • Change of direction

I’m sure you’ve seen it before – the weekend warrior ruptures an ACL or Achilles in a recreational basketball game and ends up in excruciating pain. This happens because they’re trying to cut or jump when their joints aren’t ready for high velocities and large impacts.

Progress SLOWLY with jump variations and work to maintain some semblance of hopping/jumping/skipping as you age. Jumping rope is likely your best option from a coordination and consistency approach. Simply add it to your warm-up!

Always warm up

It pains me to have to say this, but this is non-negotiable. If you watch most people walk into the gym, they usually hop on a bike/elliptical/treadmill and plod along for 3-5 minutes before sauntering over to a machine and diving into their first set.

Please don’t do this.

Ask for help from a professional or dig into some of the references that Focus Personal Training Institute (FPTI) puts out about designing warm-ups.

If you’re still stuck on ideas, head over to my YouTube channel. I have an entire playlist dedicated to just warm-up ideas. These include barbell-based warm-ups, bodyweight only, banded versions, and all kinds of other activation drills.

It may seem complex, but don’t overthink it. If you’re overwhelmed, just stick with progressively larger joint circles across all the joints in your body. It’s the same thing you probably did in PE class growing up.

Just please do something to warm up … your joints will thank you.

Warming up before exercising

Pay a professional

If you don’t want to invest the time and effort into learning all this yourself, please consider paying someone who does this for a living.

I have worked with countless people who told me they felt “perfectly comfortable” in the gym. But afterward, they were overwhelmed at how much they learned after a single session or Zoom call.

Despite what you may have read or heard, you could probably benefit immensely from working with a highly skilled and trained professional. I’ve studied this field for over a decade, and I still have a lot to learn.

Listen to your body

This goes without saying, but you must pay attention to your intuition. If something feels off, shut it down for the day. Try it again sometime later and see if it feels different.

Better to shut yourself down and lay low than try to push through and spend the next 3 weeks hobbling around in pain.

Everybody is different, and some things just don’t feel right to some people. Either continue experimenting or pay someone who can figure it out for you.

Your body is usually right … you’re just not listening.

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