We have published numerous articles before about CHRONIC PAIN and what strategies and methods you can use to prevent it and rehabilitate an injury. One of the more interesting concepts we discuss is the difference between "good pain" and "bad pain". Many people suffering from chronic pain are looking for a remedy or a solution to remove the pain and suffering. But the big problem with this is, that removing the pain is rarely addressing the real problem, WHY the pain was there in the first place. We have been taught to see pain as a real inconvenience and that there must be some kind of pill, tablet or medical intervention to make it go away. Often when there is pain there is significant stiffness and tight muscles that will require some "good pain" via massage, stretching and exercise to restore the body back to balance. Without this "good pain" being implemented nothing will change. And unfortunately this is the cycle most people are stuck in as they are just seeing to get rid of symptoms and not address the true cause of the problem. In this article I am going to help you see how to approach your problem in a different way.

Pain Is Not The Problem It Is The Signal

The heading above is a quote from Gray Cook a world renowned therapist and trainer in the field of rehabilitation and sports. This really sums up what pain is and how we have been programmed to treat it in the wrong way. Use of anti inflammatory medication, cortisone injections and various other remedies used for treating pain, while necessary in the initial stage of inflammation is not fixing anything. Really this is just turning the alarm off. This is the equivalent to removing the batteries from your fire alarm when it starts beeping loudly, instead of finding where the fire is and putting it out!

On the flip side of this is the person who ignores the signals of pain entirely and pushes through the pain barrier. This is very common to sports and exercise enthusiasts embracing the "no pain, no gain" philosophy who believe that they can out smart pain by becoming stronger. We tend to worship these people and put them up on a pedestal as outstanding achievers. Now while there is some merit to the "no pain, no gain" mantra which I will explain shortly, it can get out of hand very quickly and ultimately end up becoming a very big problem with a very big price to pay.

There must be a balance between finding a certain degree of pain, to eliminate the "bad pain" and this all comes down to knowing two things.

1. Intensity - How much intensity is just right to ensure you have a positive change
2. Frequency - How often to implement this strategy to ensure a positive change

Sometimes we have the right strategy with exercise and rehabilitation but the dosage is wrong. For example if saw a person with knee pain and in our assessment we identified several key muscles requiring stretching and foam roller work in combination with some strength exercises would greatly restore balance to the knee joint and reduce your knee pain how much dosage would be enough?

If you only did this once a week it would not be enough dosage to change anything, and your pain would gradually increase. However if you did this workout twice a day for an hour each time it would be too much and would also create more pain. In this case it is not the exercises or method that is wrong, but the dosage of how often and at what intensity it is implemented that matters.

Fear Of More Pain

When someone is dealing with chronic pain there is a real fear of moving in certain ways that will produce more pain. Our instincts are wired to find ways to avoid the pain and in the initial stages of an injury this is essential so the body can have time to initiate the healing process. For example after a sprained ankle, the ankle swells up and we are unable to weight bear on it. We have to rest the leg for a period of time until the swelling goes down and allow the healing process to restore the joint back to normal.

But this is more of a traumatic incident, what happens when the pain originates from nowhere? And you cannot trace what caused it, what aggravates it and what to do about it? This is common type of pain that so many people deal with for back pain, neck pain, shoulder pain, knee pain. At first it is only mild symptoms that come and go, and most of us think it will go away. But if left unchecked the symptoms become more acute and more often until they eventually become chronic. Rest in many cases now will make matters worse. Dr Stuart McGill has proven that back pain is significantly worse with too much bed rest or lying on your back. This is due to the swelling of the discs with fluid from horizontal lying for long periods which can push the vertebrae away from each other and touch the nerve.

The main thing to understand is that there is a big imbalance or dysfunction that must be addressed in order to eliminate the pain. The one thing that is going to solve the long term problem is EXERCISE. Not fitness exercise, but learning how to move and improving stability, mobility, strength and movement function.

But………

The same thing that will help you is likely to be the same thing that has potential to make things worse! For example learning how to bend correctly or perform a deadlift is a great way to rehabilitate a bulging disc back injury, if done correctly. But this same movement or exercise is also the same one that will cause severe damage if done poorly!

I love the Tony Robbins quote when it comes to this paradox.

"If you can't, you must".

This also means that there will be a certain degree of pain required during this exercise stage. For this corrective stage is never smooth sailing, and exercise prescription is never black and white. There is a lot of grey area and fog to get through which is why you need an assessment to find where to start.

The key is in 3 things

1. Knowing good pain from bad pain
2. Finding the right balance
3. Improving movement quality

Remember the body will prefer to continue compensating and keep the dysfunction as it knows nothing else. It has to be shown a better alternative to it's current strategy of moving.

How To Tell Good Pain From Bad Pain

In the 14 years I have been working with people suffering all types of injury in our rehabilitation programs, this can be quite difficult to distinguish, especially for people not used to exercise. Often normal muscle soreness that occurs from strengthening muscles is confused with pain. Some simple tips for each are below

Good Pain

• Muscle soreness also known as DOMS (delayed onset muscle soreness) and usually goes away after 2-3 days
• Massage & trigger point release
• Acupuncture
• Stretching -normally stretches should not produce intense pain, but there is some instances where you must break through scar tissue to prevent permanent stiffness.

Bad Pain

• Nerve pain
• Joint pain
• Affect sleep and daily activities
• Does not go away after a few days

Understand that some good pain will be needed to get rid of bad pain. Here is two examples of where good pain is needed and how it can easily be avoided or misinterpreted as bad pain.

If you had a shoulder impingement there will most certainly be nasty trigger points around the shoulder trying to provide better stability to the joint. See video below for how to work around this problem using a combination of trigger point release with stability corrections.

Unfortunately this is a poor form of stability for the shoulder joint and ends up creating stiffness that leads to loss of movement with daily activities and also neck tension that can cause headaches and nausea. These trigger points need to be released and it can be quite painful to do this. But it is absolutely necessary. In addition to this you will need to begin the strengthening process of the muscles that are not performing their role and educate the body how to move correctly. And again this will require some "good pain" via exercise to do this. You will find more about shoulder rehab process in our detailed report you can get by clicking here.

Another example is with an ACL tear. A horrible injury for anyone to suffer and known as a season ending injury in sports. The biggest mistake I see countless people make with this injury in their rehabilitation, especially after surgery is not spending enough time to get flexibility of the knee back. You MUST get full knee flexion and extension back as early as possible for if you do not your knee will be permanently stiffened and you will never be the same ever again. These stretches are extremely painful to do in the beginning which is why so many people avoid doing them for it hurts too much. I know first hand how this feels having done this myself. See pictures below of some stretches we use in the weeks post op from knee reconstructions surgery. This can take several weeks before you are close to full range.

Again this would precede any strength work which would also begin to produce pain symptoms that can easily be confused as bad. You will find out more about our ACL rehabilitation program in our step by step report by clicking here.

Here is two great case studies to read about clients who suffered from terrible neck pain, and the other with hip pain, and how they went through this process to correct their problems.

• Shoulder Pain Case Study
• Hip Pain Case Study

With exercise that is used to correct dysfunction muscle fatigue is very likely, that will lead to some "good pain" over the next 48 hours. But you must understand it is absolutely necessary and without it nothing will change. The chance of the wrong muscles completing these exercises is very common which is why tremendous care and emphasis on technique and gradual progression is so important. For even the right exercise can cause problems as the body uses a corrupted program to execute the movement. This is a delicate process and will vary from person to person. You must find the right balance.

Finding The Right Balance

We know that too much good pain will result in bad pain. Not enough good pain will also result in more bad pain. Let's look at this more closely with some pictures to help explain this. I got this concept from Dan Pope who has some great articles and programs to read, and I really loved the way he explained this with images to help people visualize this process.

Take a look at the slide below and this describes how someone can perform all these activities at home, at work or in the gym before they have any pain. Bad pain would not be experienced until something harder than a loaded deadlift was completed.

Now let's take a look at where their pain threshold is after they have hurt their lower back. We now begin to see not just gym movements hurting them, but also many of the daily activities hurting their back and producing symptoms.

We then introduce a corrective exercise program, but the person who fears more pain does not either complete their exercise program with enough intensity, or volume to change anything, and the chronic pain remains the same. This is typical of the beginner to exercises or the person looking for someone to make their pain go away without having to do anything. Usually these people will be quick to resort to surgery. Unfortunately surgery does not change the reason this person developed their injury in the first place and chance of re-injury is very likely, as is the chain reaction of a host of new problems which in many cases is worse than the original problem.

On the flip side of this is the person who does way too much. Either they train too often, increase their intensity too quickly and do not allow the body enough time to repair the good damage. This is common to athletes looking to return to sport quickly or the gym junkie who believes that more is better.

Lastly we have the person who has found the right balance with their corrective program and constant, steady progression is evident. Their symptoms are less acute and less often as their body responds positively to the exercise intervention. This person will have a great long term result. The key was all in finding the right balance.

Movement Is Everything

Now I wish I could explain what the right amount of training is but it is impossible to quantify this for everyone is different. It takes trial and error and lots of patience to find the amount. With years of experience it is a bit easier, but often things just do not make sense and you have to rely on assessments to guide you on what to do. Without assessments you are flying blind and then just guessing as to what to do next.

I cannot overstate how important learning to move efficiently is. As opposed to just treating the area in pain and using isolated methods to either loosen a muscle or strengthen it, movement is much more effective and faster for it does all of these things at the same time. The nervous system and brain control all the systems and when they work at a high level they change hundreds of things all at once. Moving better makes it easier to restore the body back to it's optimal function. Older people lose their ability to move well before they lose their strength. You could therefor conclude they lose their strength because they lost their movement efficiency first!

Take a look at the videos below that give you a good visual of how movement is used in daily life and how it can be trained effectively in the gym.

Very, very rarely to muscles work in complete isolation or anywhere close to it. When we move some muscles contract, others stretch and elongate to while some muscles provide stability, and all of this is done within a split second without you having to think about it. This is what is known as a pattern of movement and these patterns are like groups of movements linked together in a big chunk of information. The chunk of information is known as a motor program (like software on a computer). These motor programs link many movements together all at once to complete a specific task.

When working with injury our goal is to define what you current movement strategy is versus the optimal movement and work out how to progress to where you need to be.

I suggest downloading the FREE report below that detail how to do this.

Also some great articles with stacks of information about these movement patterns and how to learn them are below

• How Functional Movement Can Help You Live A Better Life
• Movement Not Muscle
• Stability Training What Is It Really & How To Do It Correctly

How To Safely Progress

We have mentioned several times in this article that you must gradually progress. Move forwards too fast and you risk going backwards. Go too slowly or do not progress at all and you also risk going backwards. This is known as the success formula and was something I learned from Paul Chek many years ago and is a valuable tool to refer when trying to restore function back to an injured body.

There is a simple method we use to help us know when to move forwards. We want to get to the strengthening stage, and if you play sports we definitely want to get to the power stage for this is the intensity demand of the body during sport. But we cannot skip the first two important steps of regaining mobility and stability.

Learning to move efficiently which we already discussed falls into the category of stability and you can see how important this is before you try to strengthen anything.

"Don't add strength to dysfunction, move well then move often" - Gray Cook.

1. Flexibility & mobility help to reduce pain and ensure the joint has restored full range of motion. It does not however mean the job is done.
2. Stability teaches the body more efficient movement patterns and motor programs to eliminate compensatory patterns.
3. Strength holds the changes made at the previous two levels together and is essential for long term success.
4. Power ensures it can withstand the demands of sports or even occupations and home tasks that come with risk

This order is a great way to gradually increase the intensity, but also be able to regress easily if you overdo it. An invaluable tool to use in your programming of exercises.

Summary

I hope this article helps to explain the process of getting out of pain is going to require some pain! Quite a difficult concept to get around, but it is the secret to a long term solution. Surgery, use of anti inflammatory medication and other modalities that do not address the real cause of the problem only serve to make things worse, and create new problems. You must find a way to move more efficiently with greater stability and strength. Taking your time with gradual progression and not skipping steps will ensure you remain pain free and complete the activities in life more easily.

There is several programs I refer to throughout the article that you can get by going to our online shop.

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 200 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily.

If you do need specific help with setting up an exercise and nutrition program please feel free to reach out to me for help by clicking the image below and we can set you up a free consultation to discuss how to get you started.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• Functional Anatomy of the Pelvis and the Sacroiliac Joint - By John Gibbons
• The Vital Glutes - By John Gibbons
• Movement - By Gray Cook
• Corrective Exercise Solutions - by Evan Osar
• Back Pain Mechanic - by Dr Stuart McGill
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Dr Stuart McGill
• Ultimate Back Fitness & Performance - by Dr Stuart McGill
• Core Stability - by Peak Performance
• Athletic Body in Balance - by Gray Cook
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek
• Twist Conditioning Sports Strength - By Peter Twist
• Twist Conditioning Sports Movement - By Peter Twist
• Functional Training For Sports - By Mike Boyle
• Athletes Acceleration Speed Training & Game Like Speed - by Lee Taft
• Knee Injuries In Athletes - by Sports Injury Bulletin
• The ACL Solution - by Robert G Marx
• Understanding & Preventing Non-Contact ACL Injuries - American Orthopaedic Society For Sports Medicine