Tri PT: Pain, Friend or Foe?
Pain plays a valuable role in our livelihood as triathletes. The trick is understanding what it’s trying to tell you.
By Christopher Johnson and Joe Brence, PT’s.
Despite the bad rap pain receives, we would like to persuade you that it’s not always a bad thing, but an elaborate and necessary alarm system to protect the body.
An analogy we often use in educating triathletes suffering from pain is that of a smoke alarm. When a smoke alarm is triggered, it serves as a warning system that prompts us to take action. In some cases, the alarm may sound simply because of excess heat or smoke from cooking on a stove with poor ventilation. On the other hand, it may indicate that the apartment is on fire and danger is imminent. Sometimes, the alarm may even go off for no apparent reason due to a simple malfunction. Can you imagine, however, if the battery had died and the smoke alarm was not working yet there was carbon monoxide in the air? This would pose a potentially lethal threat. Similarly, what if the body’s pain system had malfunctioned and we tried completing a run with a shard of glass in our shoe?
According to the International Association for the Study of Pain, pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain plays a vital role in protecting us from any actual or potential danger so we take prompt and appropriate action to get back to training in a timely manner. Unfortunately, a common motto among triathletes is “no pain, no gain.” Though pushing through aches and pain often comes with the territory, triathletes would be better served to adopt the slogan, “know pain or no gain.”
Below are nine things we would like you to understand about pain.
1. Pain is an output of the brain. This is one of the most important facts about pain. There are several examples illustrating this point. A common example is that of the phantom limb. Many amputees will often complain about pain in a limb, which no longer exists. This freaky sensation occurs because a road map to that limb, which exists within the brain, has not been re-written since the limb was lost. So the person will still feel pain, in a limb, despite that limb being gone. Even crazier, research has been performed on treatment approaches which use mirrors, to make the intact limb reflect a healthy image to appear as the amputated limb.
2. Pain relies on context. Have you ever noticed that your aches and pains often magically disappear as you are closing in on the finish line of a triathlon? This most likely occurs secondary to hormonal regulation through what we call the neuromatrix. I can personally attest to this experience during the final year of Ironman St. George, which took place under treacherous conditions. Despite finding myself in a bad way during the second half of the marathon, I somehow managed to find yet another gear during the final two miles of the race.
3. The amount of pain does not necessarily correlate with the amount of tissue damage. All we need to do is consider how painful a hangnail is to appreciate this pain fact. As it relates to triathlon, the amount of pain doesn’t necessarily correlate to the amount of tissue damage. We can sometimes run on a fractured foot, and feel no pain, or have a hangnail and experience a lot of pain. Pain is a warning system but its intensity, is not always predictive over a major injury.
4. Novice triathletes will likely experience more pain than a seasoned triathlete. After being involved with the sport of triathlon for a few years, one starts to become acquainted with certain aches and pains. To a beginner, however, such aches and pains may very well be perceived as a greater threat because they are most likely foreign sensations. This may wind up triggering a pain response, which could prompt them to briefly halt their training whereas it may not even register as pain to a veteran triathlete. Again not only do the tissues need to adapt to threats, but the brain does as well. Conditioning should cultivate both mind and body.
5. Findings from diagnostic test results may not be a direct correlate of the amount of pain a triathlete experiences. Given the relatively high incidence of low back pain associated with cycling, it is not uncommon for triathletes to eventually wind up under going diagnostic tests. In many cases, triathletes have marked structural changes in their spinal structures yet have minimal to no complaints of pain. On the contrary, I have worked with certain triathletes, who have pristine MRIs, yet are complaining of extreme pain. This reminds us that findings from diagnostic tests often do not correlate with subjective complaints of pain. Diagnostic tests rule out major pathology; not pain.
6. Weather conditions are not truly predictive of the pain you will experience that day. Perhaps one of the most common questions that we receive as physical therapists is, “Do you think the weather has anything to do with my symptoms?” As we all know, it is easy to find so many woes when it is pouring down rain. The truth of the matter, however, is that bad weather does not mean that you are going to have more pain that day. So stop pretending you are a weather forecaster based on how you knees feel when it’s raining.
7. Core strengthening is no more effective than general exercise for pain amelioration. While core strengthening may afford performance benefits, it has not been shown to be any more effective than “general exercise” when it comes to pain amelioration. Despite this information, medical and fitness professionals continue to tell their patients and clients that they need to “strengthen their core” to improve their low back pain. So be careful of subscribing to such misinformation because such advice has been scientifically invalidated.
8. Pain is simply telling you that some behavior needs to change. There are countless examples that illustrate this point. One example that comes to mind is developing the development of low back pain from trying to holdholding an aero position while time trialing. At some point, when the pain becomes too unbearable, we are forced to make a change. This typically takes the form of lifting your bottom off the seat to stretch the legs or to simply come coming out of the aero position to decrease the static strain on the tissues of the low back.
9. Motion is lotion. As humans we always love hearing soundbites and this is one that I often use with triathletes. The human body is designed to move. Through movement we are able to provide our joints and tissues will valuable nourishment and overall health. This is particularly important when it comes to the joints of our bodies, which are typically lubricated with synovial fluid. Exchange of this fluid plays an integral role in the integrity of our joints. So I always tell triathletes that “motion is lotion,” and that “your next position is your best position.”
In closing, pain plays a valuable role in our livelihood as triathletes. It provides us with critical information that fosters good decision making that ultimately allows us to continue participating in the sport. While pain may sometimes get us down, trust in the body’s inherent ability to repair itself. By taking the time to better understand pain, it will hopefully be perceived as less of a threat and more as an alarm system working to protect our bodies.
Chris Johnson is a leading New York City physical therapist who specializes in the care of endurance athletes. In addition to being the owner and director of Chris Johnson PT, located in the Flatiron District of Manhattan, he is also a co-founder of Formula Triathlon Club, and an all-American triathlete. Chris also shares tips and advice for multisport athletes on his blog, Critter’s Corner, at chrisjohnsonpt.com. Joe
Brence is a physical therapist based in Pittsburgh, PA who specializes in pain management. He runs forwardthinkingpt.com and is actively involved in research.