A major personal struggle of mine is my tendency to always stubbornly push through pain during a workout when I shouldn’t. I do this until, of course, I have nerve impingement that’s unbearable and I’m forced to change my behavior. For most people, the response to pain when one can no longer ignore it is to seek a doctor’s treatment. Whether you seek treatment from a medical doctor, chiropractor, physical therapist, or any combination thereof, depending on the source of advice the approach to the problem will be vastly different. Doctors will likely prescribe a round of muscle relaxers or pain killers, rest, and sometimes physical therapy. Physical therapists have useful “modalities” for treatment including ultrasound therapy for breaking up scar tissue in muscle fibers and a barrage of useful stetching and strengthening exercises for the problem area. Chiropractors will approach any issue first and foremost from the standpoint of manually manipulating the spinal column back into alignment and then rooting out the problem further down the kinetic chain if it still persists. (“Kinetic chain” is a fancy way of saying the way that a group of muscles work together to produce a body action such as raising your arm above your head.)
Sport/over use injuries are never isolated. The spot where pain is experienced may in fact be linked to another spot in the body that is the real source of the problem. (Pain can be experienced further down the kinetic chain than where the scar has formed or the tear has occurred.) A great source of information on pretty much any injury is the video blog of Kelly Starrett – Doctor of Physical Therapy. I was introduced to him through the facebook page of Mr. Mark Reifkind (a certified Russian Kettlebell instructor). You can find his video blog at http://www.mobilitywod.com. Starrett’s big idea is that everybody needs to take more responsibility for their own aches and pains, to learn about them, and to commit to self-treatment before seeking professional care. The funny thing is that you can really solve a lot of your own problems with a few simple tools and a commitment to grit through some purposeful pain (an important distinction from bad pain). With a $3 lacrosse ball and knowledge of some simple stretches you can pretty much massage and stretch your way out of most sport injury and over use injuries.
Starrett is adamant that the only way to really solve a problem is to correct both the poor mechanics of the problem area as well as the resulting damaged tissue. You can’t solve either without solving them both. Take for example, my problem. I have shoulder impingement syndrome (a “garbage bag” term for a garden variety of shoulder pains). The shoulder, being the most mobile and complex joint in the body, can run into problems from many different things. Shoulder pain, huh? Well, that’s your rotator cuff. Yeah, no shit. But what does that really mean? The rotator cuff is a group of four muscles that include the subscapularis, the infraspinatus, the teres minor, and the supraspinatus. Note that we can’t really SEE any of these muscles unless you really know what to look for. The large shoulder muscle, the deltoid, is what we think of popularly when the word “shoulder” is used because it’s what we can see in that area, but it is not part of the rotator cuff. Any of the four muscles in the rotator cuff can create a major problem for lifting the arm, moving the arm away from the body (abduction), rotating the arm, or doing anything with your arm. If one of these muscles gets partially torn, tightens up, develops tendonosis (a hardening and scarring of the muscle from overuse), or is less than sufficiently conditioned you’re probably going to be diagnosed with shoulder impingement syndrome. Here are two useful visualizations of the muscles and bones of the shoulder region and how they work together to produce motion.
Visualization #1: Bones of the shoulder and abduction
Visualization #2: Muscles, tendons and ligaments of the shoulder region with impingement syndrome illustrated (just before the injection-I’m guessing of a corticosteroid of some sort-is shown)
In my case, I’m pretty sure it’s the teres minor that I’ve screwed up the most. (I say “the most” because I’m sure there is something else going on in there.) At least, that’s where the massive scar lump (aka trigger point, or spot that when you press will hurt and make you want to throw up) on my body is located on the anatomy chart. Somehow, the tightness from this injured muscle tissue is affecting the way my entire right rotator cuff is firing and so I’ve developed a compensation down the kinetic chain. My right biceps tendon is also tighter than hell and I’m starting to experience some tennis elbow symptoms. I suspect that all of these problems are due to the high volume I’ve been putting in with vertical pulling exercises. The pain started at the shoulder and now continues on down the arm to the elbow. It could be that the rotator cuff and biceps tendon problems are unrelated, but I’m treating them both because they both hurt and I want them gone.
If you’ve got shoulder problems (very common for athletes who weight train), or knee, hip, lower back, etcetera problems you owe it to yourself to take a little responsibility for your pain and to learn about how to approach it. I personally don’t believe that pain is forever. It is inevitable and is a fact of life, but in most cases it can be treated. Your body is trying to tell you something, but much like a crying baby it can’t tell you in words what it wants. It’s up to you find that out.
Sources that I recommend for learning more:
* Muscle Medicine, by Rob Destefano D.C., and Bryan Kelly MD
These guys are the doctor/chiropractor team that helped the New York Giants to their 2008 SuperBowl victory. Linebacker Michael Strahan wrote a very powerful forward to the book about their approach to muscle medicine.
* Athletic Body in Balance, by Grey Gook MSPT
When I mentioned the necessary two pronged approach to a sport injury (mechanical problem AND tissue problem must be addressed), I was referencing Kelly Starrett. Gray Cook is another well-known physical therapist that has done work focusing on how movement patterns can point us in the direction of where something is mechanically wrong with the body (ie the muscles are too tight, imbalanced, or not firing in the proper sequence). This is a good, dense book.
If you don’t like reading (which ironically wouldn’t be the case for someone who’s made it this point in my blog post) there’s always the extremely well done video blog of Kelly Starrett.
In Starrett’s words, pony up! Get to the root of your problem and get going again.