Central Sensitization Syndrome

Do you have experience training someone who has Central Sensitization Syndrome? I’ve recently gotten into barbell training and love it and I think it would be beneficial to someone close to me who has CSS. FWIW I’m completely sold on the biopsychosocial model of pain which in my limited experience has a lot of explanatory power for something like CSS. I’m new to the forum so hope this post isn’t off topic.

Hi, thanks for the question!

I’m familiar with the concept of central sensitization, but I’m unfamiliar with it being referred to as a syndrome. Do you have any more information on how this diagnosis was made and what their presentation and symptoms are? Looking forward to discussing this, just will likely need more information before diving into it. Thanks!

Hi, thanks for the response. Maybe I’m wrong to call it a ‘syndrome.’ I’m not a medical professional after all. The symptoms consist of a decades-long pattern of chronic pain affecting different joins at different periods (e.g., sternum, currently the coccyx) and hypersensitivity to stimuli. All of this most likely stems from suffering through decades of trauma beginning at a very young age. The way it has been explained to us is that these experiences train the brain to think the body is constantly in danger, to the point that it overreacts to stimuli in a misguided effort to protect the body. The treatment, so we have been told, involves first educating oneself and then retraining the brain so that it realizes it is no longer in danger. My suspicion is that subjecting the body to the sort of stress that is experienced in barbell training would be a useful way of doing this - teaching the brain that not all stress is dangerous so that it builds up a tolerance, and also building confidence in the individual that they can improve themselves and take control of their body. All that is nothing more than conjecture on my part at the moment, so I’m wondering if anyone on this forum has experience with someone who has Central Sensitization undergoing barbell training. My thinking on this topic was influenced not only by my own experience (as an otherwise healthy person) doing barbell training, but also by this podcast about a treatment program for people with AMPS: The Fifth Vital Sign : Invisibilia : NPR.

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Thoughts on when you determine central sensitization, the yellow flags are extremely evident, at what point do you refer out? Do any doctors here do GMI or laterality in their clinic? Do you have someone you refer out to for those things?

That makes sense, thanks for clarifying. I can only speak for myself (however, this is definitely not an uncommon phenomenon), but I have trained/rehabbed people with barbells who have demonstrated central sensitization-type symptoms. However, there’s a few things to unpack here that might help with the understanding of such a complex topic:

  1. I would say there’s nothing inherently more stressful about barbell training vs other training methods, unless the individual is limited by the starting weight of the barbell available (45lbs). Barbell training may allow for a higher ceiling of intensity and more incremental loading, and while it’s my bias when it comes to training and rehab (it’s in the name of this company), I always try to align the methods with the individual’s goals. If it’s something they are interested in and open to, then it’s definitely something we will explore. That being said, it can be very appropriate for someone with persistent pain, as it can provide a method for progression in graded exposure and expectation-violation, but as long as you keep in mind the individual’s beliefs, expectations and goals.

  2. The concept of central sensitization can take on several definitions and meanings, which is usually the issue when it comes to these types of discussions. According to the IASP, central sensitization is defined as “increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input”, and according to Moseley and Butler in Explain Pain Supercharged it is defined as “enhanced sensitivity of danger transmission in the central nervous system…encompassing everything that is not peripheral sensitization”. From there, we need to establish what the purpose of this model is*, which can be equally as challenging, since it’s difficult to ascertain what the initial questions were when this was first being studied. The way I’ve made sense of it in the past from my readings, central sensitization can provide us a physiological explanation for what may contribute to someone’s pain experience by taking into account the increased probability of cortical and spinal descending facilitation of nociception. That being said, I’m not sure I would extrapolate it much beyond that, because it can lend itself to problematically separating brain from body**, as you are mentioning. Without getting too deep into a rabbit hole, the simple way to think about it is that your brain is a part of your body and you are your body. This article which expands upon this may interest you, we will be interviewing the authors in our upcoming podcast soon: Stilwell Harman enactive approach to pain.pdf - Google Drive

So for the TL;DR version: Barbell training can be beneficial for someone experiencing persistent, wide-spread pain, but it’s not specific to barbells or central sensitization.

*For more on the philosophy of scientific models: https://drive.google.com/file/d/1_nY-8EXI3ah1fseQxEFpDRjp4IsEhqzo/view?usp=sharing

**Here’s a short editorial by Mick Thacker talking a bit more about this concept: https://www.ingentaconnect.com/content/ppa/pr/2015/00002015/00000039/art00002