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Self-Assessment, Nocebo, and Pain

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  • Self-Assessment, Nocebo, and Pain

    Hi Austin and Jordan,

    I have a few semi-related questions inspired by your content, and I was hoping you might be able to provide some insight:

    1. How can I perform a realistic self-assessment without running afoul of the nocebo effect? For example, I've been having some elbow pain lately, and I think it might be caused by the introduction of some new exercises. However, that could be a complete coincidence, since my elbows often hurt for no discernible reason. If I start paying close attention to how my elbows feel in an attempt to discover the truth, my suspicion is that I will end up noceboing myself into thinking that the new lifts are the problem, regardless of whether there is any real physiological effect.

    2. How do you determine whether a given amount of pain during a training session justifies stopping or modifying the session? I recognize that it's very unlikely that anything I'm doing during a single training session is going to cause any long term problems, but I've had plenty of experiences where pushing through the pain in a workout has had a significant impact on my training and quality of life for weeks. On the other hand, there have also been plenty of times when I ignored fairly significant pain in a workout and it had no negative effect at all. Do you have any suggestions for how to distinguish transient/irrelevant pain from "I'm aggravating a problem that's going to haunt me for weeks" pain while I'm actually lifting?

    3. Do you have any suggestions for how to make myself more resistant to elbow problems? My elbows start hurting at the drop of a hat, with many lifts (pullups, heavy rows, triceps extensions, bench press, too much volume on pretty much any upper body movement) potentially aggravating them, as well as normal activities like computer use. I've gotten halfhearted diagnoses of a few different kinds of tendinopathy over the years, but the physical therapy never seems to help very much. My suspicion is that they have focused on a particular diagnosis (e.g., lateral epicondylitis), even if it doesn't explain all of my symptoms, rather than trying to approach the problem in a more holistic manner. I'm mostly resigned to just programming around my elbow issues as best I can, but I'm curious if you've worked with anyone who has been able to correct an issue like this.

    Thanks for any advice you can offer on these topics!

  • #2
    1. This is just hard to do for most people, particularly those who are not trained clinicians of some sort. It may not be the exercises as it is the change in overall load, or something else entirely. Even if you chose to rotate those exercises out for a period of time, just try them again in the future to see how you do with them.

    2. Pain that is worsening more and more as the load increases is usually a sign to do something differently. Pain that is tolerable / unchanged or improves with warmup is usually fine to work through.

    3. Unfortunately not. I agree with the approach to program "around" things as much as possible. I've had elbow issues too on the bench - and most recently have found that by using a neutral-grip "football bar" I can bench fine, which is my way of working around things.
    IG / YT


    • #3
      Thank you for the advice; that lines up pretty well with what I was expecting.