Preventing pain: What matters?

So I’ve been absorbing a lot of the information on pain that ya’ll have been putting out, and I’m trying to figure out how I can apply this information as a coach and as a lifter myself.
I gather: Poor fatigue management can lead to pain. What are the main areas you look for as a coach to prevent fatigue?
I understand that programming often plays a large role in managing fatigue (deloading, autoregulation, correctly dosing stress)
I’ve read that poor technique doesn’t play as a big of a role in injury/pain prevention as people tend to expect. That being said, can poor technique using progressively heavy weights over time lead to fatigue and ultimately pain?
I understand that people can often worry too much about being “under-recovered” (a poor night’s sleep, a poor diet). That being said, could a poor diet or poor sleep habits over time lead to poor fatigue management and ultimately pain?

Hey jwicken,

I applaud your interest in the topic. I do want to initially express caution with attempting to assign ANY premise with the idea “will lead to pain”. This topic is extremely complex and we don’t have much evidence on what will lead to pain. The inherent flaw in this premise is we then like to think if we figure out what leads to pain then we can prevent it from happening which is also extremely unlikely. We do know of some things to address once someone is experiencing pain (acute or persistent). Things that we can monitor with athletes in hopes of reducing likelihood of injury (we’d have to define injury) and maintaining improved performance include:

Training load management: See Eckard et al: The Relationship Between Training Load and Injury in Athletes: A Systematic Review - PubMed
Fatigue management: See Jones et al: Training Load and Fatigue Marker Associations with Injury and Illness: A Systematic Review of Longitudinal Studies - PubMed
Psychosocial Variables: See Ivarsson et al: https://link.springer.com/article/10…279-016-0578-x

Regarding technique - no. We don’t have supportive evidence that a particular way of performing movement or a loaded lift is likely to lead to injury. If someone is progressively loading, as you mention, then that means they are adapting over time and this would mean the person is less likely to incur an injury. But again this is a shaky premise to operate from regarding pain. Pain does not equate to injury and injury doesn’t equate to pain. Most athletic based research studies are defining injury as merely a loss of practice/game play time due to reporting of pain. This isn’t a great standard but it’s the best we have right now.

Poor recovery methods such as load/fatigue management, nutrition, and sleep may decrease performance…linking to pain is difficult. Austin wrote about placebo sleep recently and you may find the article interesting: Placebo Sleep? | Barbell Medicine

We do have evidence that loss of sleep may be linked to pain perception but how much and how influential is the effect on pain, we aren’t sure yet. Admittedly, I’ve often heard about this claim and not looked strongly into it but this may motivate me to write a blog on pain and sleep (thank you).
See: https://journals.lww.com/pain/Abstra…_alters.7.aspx
See commentary: http://sci-hub.tw/https://journals.l…but_how.2.aspx

Pain was never meant to be prevented. It is a necessary unpleasant emergent property of our consciousness. (IASP-pain.org)

Without it, we are in trouble (nail in foot, ruptured appendix, impending myocardial infarction). All species have a built in withdrawal reflex to noxious stimuli (damaging OR threatening to tissue). We need it for protection, but without it, we are in trouble.

Fatigue falls into a similar category. What is fatigue? Is it peripheral, is it central, is it multifactorial? How is it measured? It too is an emergent experience based on an infinite number of factors. We need it to protect us, but its presence may be maladaptive and non-protective.

Might there be.a relationship between fatigue and pain? Sure, but attempting to create a cause/effect relationship is impossible. Might a fatigued state create an Allodynia or hyperalgesic response to stimuli? It would be easy to test use cold pressor tests or pressure algometry.

I look forward to other’s input on the topic…

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Solid points regarding prevention Matthew. I have this video in our prior con-ed course that opens the pain lecture: https://youtu.be/gYtiQxYJuUM; which is attributed to Nietzsche - “To live is to suffer, to survive is to find some meaning in the suffering.” Pain is a part of life. A necessary biologically adapted aspect that without it we’d likely not have survived for as long as we have. More to the point, given pain is a part of life then so should be acceptance of pain (which can lead to some interesting discussions on tolerable/acceptable pain).

The topic of “acceptance,” “coping,” or “resilience” is one typically reserved for researchers, a small % of clinicians and conferences. It is under-appreciated, overlooked and arguably (my bias/opinion) one of the most important drivers of persistent disability.

It comes with engaging and interesting discussions and one I wish more in healthcare and society were open to learning about. If those in healthcare were more up to date on a “positive health model” (see Lancet series on low back pain) and those is society taught appropriate coping strategies, we might see a reduction in the iatrogenic nature of most MSK conditions (or as I think of them: predicaments: See Nortin Hadler).

Good points here, Matt. A few relevant resources on the topic:

  1. Supporting your point regarding the complexity of fatigue - Translating Fatigue to Human Performance - PMC

  2. “Pain and fatigue in sport: are they so different?”: https://bjsm.bmj.com/content/52/9/555.long

Wow, this helps a lot! Thanks so much for all the replies! Looks like I have some reading to do.

jwicken,

Your original post correlating pain and fatigue is a lot like PT/chiros/DO/MD linking one body part to a distant unrelated painful complaint (i.e. high arches to back pain or contralateral shoulder pain). Could these things have a relationship? No, kinda, maybe, sorta, yes, who the hell knows???

Charlatans, gurus or those with financial or intellectual incentives will promote this stuff to their grave. We’ll need WAY more appropriately designed research in the future to see what the relationship is.

So far I’ve learned: Everything I know is a lie and nothing is real.

Also I comprehend at most like 50% of what I read in these studies, but I guess you have to start somewhere.

Also, are there any secret tips out there for getting access to studies behind a paywall? I’m using the “unpaywall” extension, and I’ve contacted the sales department for one of the journals, but I was wondering if there were any more tips for getting around paywalls - currently trying to get access to the “pain and fatigue in sport” article in the BMJ. Sorry I’m a noob at this -

Jwicken,

I don’t think you are making the appropriate conclusion. What you’ve learned is, don’t accept someone’s statements and conclusions at face value. You need more. You need to critically appraise the entire breadth of evidence on a topic. Start with high quality systematic reviews and/or meta-analysis if they exist. Understand the research and statistics. Then make an informed decision on what they mean and how you apply them to practice, real world settings.

As far as finding articles:

google scholar is easy to access full text. Searching for articles using “filetype: pdf” will give you full text options. Pubmed.gov will have some free full text. If you go to pubmed.gov, they have tutorials for searching for articles as well. If you’re part of a university, they typically have access to countless databases. Center for Evidence Based Medicine (cebm.net) also has tutorials on finding and critiquing the evidence.