How to Listen to Pain
Unfortunately, most of us have been there. The sharp pain that shoots across your
shoulders during your last set of sumo deadlift high pulls; the radiating pain down your
thigh after heavy squats; the low back ache that lasts longer than normal after deadlifts. No
matter how properly you train, pain is inevitable.
During my 5 years at CrossFit gyms, members have often approached me once they learn I
am a chiropractor. They frequently ask me for a quick assessment or an easy answer to a
nagging injury and, like many of us, they may not have the time for a proper assessment,
which would include a detailed history, orthopedic testing and a treatment plan to figure
out the true cause of their issue(s). What I have learned from such interactions is the
importance of listening to pain, specifically, the questions that it poses.
What is pain? When should one power through a workout versus stopping? How should one
respond to what the body is saying and what needs to be involved in this thought process?
How do we define exacerbating and alleviating factors and when is it time to consult a
professional? Understanding these questions will not only help you to develop a better body
awareness but will also help you to avoid injury and better communicate when speaking
with a doctor/therapist/trainer.
What is pain?
Remember the phrase “no pain, no gain”? It is antiquated and dangerous when applied to
the type of WODs (workouts of the day) crossfitters endure. Pain is there for a reason. It is
the body’s way of telling you that something is being compromised biomechanically or that
you are actually aggravating an existing injury.
There are many different types of pain and all athletes endure some form of it. We will be
focusing on a certain kind of pain, however. We’re not talking about the delayed onset
muscle soreness (DOMS) that you get over the days following an intense workout. That is
actually a good pain. That signals those tissues were fatigued and are now rebuilding to
become bigger and stronger. It’s a sign that your body is adapting. More on DOMS later.
We’re talking about the type of pain that comes from a soft tissue injury (sprain/strain/
contusion), hard tissue injury (bone), and dislocation or overuse injury. It is important to
consider whether these sensations have been caused by an acute, repetitive or cumulative
trauma so we can figure out the best way to fix them. In other words, recognizing if these
injuries were caused by a macrotrauma or have accumulated from microtraumas, which
would include poor flexibility, posture, muscular imbalances and your body’s
compensations to your old injuries as well as activities of daily living (ADLs). This is called
“pathological” pain.
Chapman and Stillman (1996) defined pathological pain as "severe persisting pain or
moderate pain of long duration that disrupts sleep and normal living, ceases to serve a
protective function, and instead degrades health and functional capability."
(Chapman CR)
Thought Process and Journaling
Whether I’m treating patients in the office or training hard in the gym, I’ve learned that the
body gives us a variety of messages. To ignore them is to set yourself up for failure. The
intense burn that we feel as we power through a MetCon (metabolic conditioning session) is
a very different feeling from the sharp pain in the knee, shoulder or low back that causes us
to compensate with altered mechanics. This needs to be interpreted as the alarm bell.
Of course, you don’t need a medical degree to manage your health. The trick is knowing
when to seek professional advice and when to make a change on your own.
The purpose of tuning in to your body is to rule out the following:
●
●
●
●
●
Soft tissue injury (sprain/strain/contusion)
Hard tissue injury (bone)
Dislocation/fracture
Overuse injury
CrossFit Burnout
So what is the thought process in deciphering the different types of pain experienced?
Let’s say that you’re working out and all of a sudden you experience pain, discomfort or a
“wonky” feeling.
It is helpful to record details in your workout journal. Doing so on a spreadsheet allows you
to save it to the Cloud, and keyword search more easily for data, such as benchmarks or
pain events.
Step 1 – Alert a coach
Step 2 – Define chief complaint (low back pain, shoulder pain) and how it happened, if
possible
Step 3 – Describe provocative and alleviating factors (pain at low back with bending forward,
lifting arm overhead alleviates pain in shoulder, etc.)
Quantify your level of discomfort by subjectively rating the severity on a 1-10 pain
scale, 10 being the worst, or giving a percentage of how strong that region of your
body feels.
Step 4 – has this happened before and is it getting worse?
Here are a few common injury situations with suggested action responses. They correspond
to the flowchart attached to this article. Some may seem like obvious reactions, but, in the
name of progress we often ignore our pain and sometimes make it worse by continuing past
it.
SITUATION 1 Knowing when to quit and recognizing CrossFit Burnout
Maybe you’re feeling unenthusiastic about working out and/or noticing more than the usual
soreness? This is what’s called “CrossFit burnout”. This status highly elevates risk for injury.
Over-training means that you are exercising in excess of your body's capacity to repair
itself and adapt to the stresses you are presenting it with. Be mindful of CrossFit burnout. If
you are overtraining, your body's repair mechanisms are overloaded and you're in prime
position for injury.
In this situation, scaling back on intensity and weight or taking a few days to a week off
would be the most appropriate response. Most likely you’ll feel reenergized after a few days
off. If the complaint does not improve, however, then it’s time talk to a coach to reconsider
your training program or to a health professional who is familiar with high intensity
training.
Common but subtle signs of overtraining are:
Losing strength
Feeling tired at the gym
Loss of motivation to work out
Generally feeling burned out
Contracting illnesses such as colds and the flu
SITUATION 2 A visible change in a joint or region of the body
Is the location of your pain showing discoloration, abrasion, scars, edema (swelling) or
deformity* (DASED)? If so, stop training, alert a coach and proceed to rest, ice, compress and
elevate (RICE). Try to clarify the qualities of the pain. These may include the following:
aching, sore, cramping, pounding, sharp, throbbing, dull, nagging, penetrating, shooting,
number, tingling, spasm, burning, radiating, stabbing, tender, knife-like, etc.
Is it getting better after a few days to a week of rest? If yes, then you may resume training at
less than full intensity. If not, consult a professional.
If you are feeling even slightly symptomatic, then performance and intensity SHOULD NOT
be your primary goal. But rather consistent movement patterns conducted with proper
biomechanics.
When you are feeling asymptomatic (presenting with no symptoms), preventative
maintenance is key. It is unfortunate that most people wait for a cavity to see the dentist or
excruciating back pain to see the chiropractor. But we don’t wait for our car to break down
to get an oil change. Think of your body as a high performance machine that requires
routine maintenance to keep it running optimally. Proper alignment of your spine and the
release of muscle adhesions you may or may not have been aware of will certainly make you
less injury prone. In fact, it will most likely lead to performance enhancement. More on
preventative maintenance and performance enhancement in a future article.
SITUATION 3 Nerve-y stuff
Deformity means that the joint or region appears abnormally swollen, bent the wrong way
or moving in obviously abnormal range of motion. This requires immediate attention.
*
Are you experiencing pain or numbness that shoots into your arm(s) or leg(s)? If this is the
case, then you are experiencing pathology to the nerve roots in the spine. You should
definitely stop training and see a healthcare professional.
SITUATION 4 Dislocation or fracture
Are you unable to move a certain body part, such as a shoulder or ankle, and do you
suspect dislocation or even a possible fracture? In this case, you will need to immediately
immobilize that region with a splint or sling, RICE it and visit the ER where they can provide
more advanced real-time diagnostics.
Sample Journal Entry 1
Sample 2
In both examples above, I’ve described location, provocative factors and sensation of my
ailments, quantified the level of my discomfort and progress. While neither situation
required discontinuing my workout, I recognized a pathological pain, gave it a concise
description and made the appropriate modifications, which lead to an elimination of trauma
to my toe.
Should you train with sore muscles?
It depends. Mild to moderate DOMS is normal and not likely to increase your risk of injury.
On the other hand, if a particular region of the body experiences severe soreness it is
advised that you allow it to rest and recover. For instance, if your low back is extremely sore
after Grace (30 Clean and Jerks of 135lbs for time) then you may want to avoid working
heavy deadlifts, a very similar movement, the next day. Pull-ups or running instead may be
a less risky progression, as they are less taxing on already fatigued muscles.
Let’s say you have done a heavy 5-5-5 overhead press WOD. You can expect to feel some
soreness/fatigue in the shoulder muscles later on in the week. If you notice excessive pain
and soreness in or around the shoulder joint then this is a sign of pathological tissue
damage and you need to refine your technique with less of a load. Again, this information
needs to be recorded in your journal. Make a note of where you feel sore and share this
information with a trainer to help you improve your technique.
Consulting a professional
Who is a professional? Your CrossFit coach can do a lot to help improve your performance,
remove inefficiencies and make other helpful recommendations. However, it is outside of
their scope to make a medical diagnosis. This falls within the scope of your sports
chiropractor (DC), physical therapist, general practitioner (MD) or an orthopedist.
If you continue to feel tingling and numbness, pain that does not resemble DOMS or if
discoloration and deformity has not subsided significantly within a week, then it is time to
consult a professional.
Conclusion
You don’t always have to do what’s on the whiteboard, also know as the prescribed workout
of the day. While healing from an injury, modifications can always be made. Do not hesitate
to ask a coach to help you come up with alternative movements. My toe injury for instance,
which became exacerbated by bending my toe upwards in reverse lunges, was modified by
simply being prescribed forward lunges. I still made all of the same gains without any of the
pathologic pain.
A word on over the counter anti-inflammatory medications. Pain is there for the purpose of
preventing further injury and by artificially reducing it you run the risk of silencing this
alarm. Also, there is no evidence that these medications help you to heal any faster.
Aches and pains should be accepted for what they are – useful feedback from your body
telling you to give certain areas some rest. Everybody has different healing rates and you
must learn to grasp yours.
Just like good listeners strengthen a relationship, hearing your body’s pain, and devising an
appropriate response to it, will better equip you with enduring strength.
Chapman CR, Stillman M: Pathological Pain, Handbook of Perception: Pain and Touch. Edited
by Krueger L. New York, Academic Press, 1996, pp 315 - 340
What Is Your Pain Telling You
About the Author
Jason Fidler is a chiropractor serving the athletes and members of the CrossFit community
in Brooklyn and lower Manhattan. He regularly trains and has office hours at CrossFit South
Brooklyn and CrossFit 718. He is also a regular physician at many of the NYC endurance
races and CrossFit competitions. As a crossfitter and chiropractor since 2008, he is
schooled in the functional movements that crossfitters routinely perform, their commonly
associated training injuries and the most effective forms of treatment.
Dr. Fidler holds full spine Active Release and Kinesio taping certifications, two very effective
sought-after treatment protocols. To learn more, visit FidlerDC.com