This is a very common phrase to hear in the fitness industry and when undergoing exercise. And often a statement thrown at me by patients that are consistently overdoing things. This blog will discuss the validity of this quote, some education around pain and exercise and ultimately debate the reasons for the attitude of ‘no pain, no gain’ to not be true and how it may be hampering someone’s rehab as opposed to helping them.

To understand why ‘no pain, no gain’ may not be the best method when trying to change a painful state, we must understand some of the biology that happens during this.

As mammals we learn and improve by practice and repetition. We repeat the same stimulus over and over until we become very finely tuned at it. In the very way we learn to ride a bike, speak a language or even cook a new recipe. We associate and make constant links with the environment and world around us, in the very same way we hear a song and we think of a certain holiday, or a certain smell can remind us of a certain person.

This can happen during a painful experience too.

Long-term potentiation

During any sensory or perceptual experience, we undergo a process where we stimulate neurons (nerve cells) within the nervous system that undergo a chemical process of transmitting electrical activity from one neuron to the next. Very similar to a large cabling system of a computer or telephone line. This is how information is sent to and from our brain to the rest of our tissues.

The more they get stimulated the better, stronger and quicker they get at transmitting that message. Hence the more we listen to Ed Sheeran’s new single, the better we will get at remembering the lyrics.

Now if we do this with a painful experience and we repeat it a senseless amount of times then we run the risk of the very same process happening, where the sensory neurons will send the same information going up to the brain and the body will produce the same response (pain) when it receives the same information as before.

And if you are thinking “so he’s saying its all in our heads” then please read my previous blog on this.

 

Image result for long term potentiation
Long term potentiation at a neuron level

 

As you can see above, a neuron after repeated stimulation has an increased chance of the signal being sent – represented by the increase in purple circles within the nerve cell, and the signal being stronger and lasting longer – represented by the increase in the graph at the bottom.

So when a patient says “so basically, it’s no pain no gain” this might be a nice way to show them that its not the best way and that pushing through the barrier is likely to hinder rather than help.

So when is it ‘normal’ to feel during/after exercise?

Let’s face it, most exercise that we do is not an enjoyable experience at the time. And on the flip-side to what I have mentioned above, discomfort during resistance and endurance training can be a normal response. Similar to how stretching a certain muscle or joint can be uncomfortable. And some pain post exercise can be a normal and expected response.

Delayed onset muscle soreness, (DOMS), is the sensation of discomfort with movement and to touch; most commonly in the skeletal muscle following physical activity that your body is not used to. This is normal and the intensity of discomfort will increase in the first 24 hours of exercise, peaks between 24 and 72 hours, decreases and then goes by 5-7 days  post-exercise.

DOMS is a normal painful response to exercise and there is no conclusive treatment as of yet to prevent it or stop it (reference). So if you have been encouraged by a Physio or another healthcare professional that exercise can help decrease your pain levels, to experience an initial increase in pain can be a fairly normal result. However once your muscles become accustomed to a new activity or exercise the sensation of DOMS should start to reduce.

So when may pain during/after exercise not be normal?

As mentioned above, if pain is persisting longer than 5-7 days post exercise, this may not be just DOMS. If it is actually preventing you from doing the exercise you are trying to do this may not be normal, so if you are unable to complete a movement due to the pain levels. Or if the pain is severe enough post-exercise that it is actually disabling, then again it might be time to think about seeing a specialist or trying a different approach.

On the other hand…

Some of those that exercise regularly enjoy the ‘pain’ or ‘discomfort’ they feel when exercising and this shows how pain can be a perception based on the context for that individual. Which is why it is only ever a problem if it becomes unmanageable or unacceptable for that person.

I think it is also important to consider someone’s capacity to a certain action when thinking about pain response. After injury or pain state, naturally the body will seek to protect ourselves by producing pain against an action/activity that is perceived to harm us more. So if I have had shoulder pain for the last 2 years, it is unlikely I am going to be able to shoulder press a vast amount or play squash a few times a week with no issues.

What used to be manageable for our bodies is now likely to be deemed excessive and may result in pain when we try to do the things that are considered unreasonable as you can see below:

Ca6zJinWwAQBVoM
Dye’s Envelope of Function (2005)

Again like in any rehabilitation programme, as we start to increase our capacity with graded exercise and activity to increase the ‘manageable’ load, we are starting to push into the boundaries of overload and a painful response after or during these tasks, (similar to that of DOMS), can be expected and not entirely unusual.

But as always ever in doubt, get checked out!

Summary

  • Pain can be a memory, and can be associated with events or experiences just like anything else
  • These memories/association can be reinforced by repeating the same stimulus that produces the same output (pain)
  • Pain is REAL and not in our heads
  • Some pain after/during exercise such as DOMS can be expected
  • Although ‘no pain, no gain’ is not true, it is not uncommon to experience pain whilst you gain

As always thanks for reading and please feel free to like, subscribe or leave comments. Alternatively you can contact me on twitter. Anyone that is interested in enquiring about a Physiotherapy appointment, please visit www.physiocat.co.uk

Charlie

 

 

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s