Training With Pain
Training with pain is a form of graded motor exposure, meaning you slowly introduce a stressful and painful stimulus to your body. The body adaptats. Stressing the body makes it stronger. We want to stress the body and experience a little bit of pain so that with time our pain threshold will creep up as we slowly expose ourselves to the threatening activity. However, if you hammer through pain and persist into extreme pain you can actually get better at dealing with pain. So how do we do this?
A triathlete might only be able to run three kilometres until knee pain sets in. Around the time that knee begins to ache the athlete should slightly modify his or her gait. For example, try running with a forefoot strike, an increased step cadence, run with a wider stride or a shorter arm swing arc. Pay attention to the pain. If the pain is removed or only slightly increased continue with that gait modification but only run for five to 10 more minutes. If there is no increase in pain the next day, this pain exposure activity can be performed again.
This small amount of increased stress is how we sneak under the brain’s alarm system. If we can expose our brain to the offending trigger, but convince it that there is no need to be threatened you can increase your threshold where pain begins to be felt. By increasing exposure to running slowly you can increase your volume slowly and safely and can save a lot of time from avoiding the detraining effects that prolonged time off can have on your training.
Unfortunately, there is not a lot of research in this area. One area that has received the attention, however, is exercising with persistent tendon pain. In a paper in the American Journal of Sports Medicine, Dr. Silbernagel showed that a group of athletes who persisted in their sporting activities (running and jumping) while still experiencing pain at perceived to be less than five out of 10 showed comparable improvements to a group who avoided those painful activities.
A warning: this does not work for recent damage that has resulted in an acute injury. When you have acute injuries, bony pain or unexplained pain you need the usual time to heal. Graded exposure only works when there is a disconnect between the pain perception and tissue damage. Real injuries require us to respect the pain. As always, working with a health professional that understands pain and performance can help in instituting this form of rehabilitation, and get you back to competition and doing what you love.
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