Why focusing on strength doesn’t fix pain
One of the biggest mistakes when someone is trying to get out of pain that I often see as a Physio here in Tallahassee is starting with a focus on strength. They’ve often been told that, with low back pain for example, is that they have a weak core, or that their posture muscles are weak or that they have a weak rotator cuff if they are dealing with shoulder pain. So, why should someone in pain and who is feeling weak not start with strength? Believe it or not, your body is actually inherently strong and stable. Did you know that your spine can handle 2000 pounds of pressure? That most everything we do daily are far below the threshold where a part of our body can get injured. Yet most people in pain will be told that they are weak, frail, or unstable and for the vast majority of you are completely untrue and even if it is partly true is likely to be irreverent to how you feel. First, often the feeling of weakness is the body trying to protect you. It is trying to not allow the muscle or muscles run at full strength because it is not quite sure that it is safe to do so. That’s really what pain is. It is your body trying to figure out if something is wrong and whether it is safe to move or do something. In addition, many who focus on strength may eventually feel better, they often spend weeks and months hurting longer than they should because they keep “poking the bear” when they try to strengthen their core, rotator cuff, or legs and often feel worse after trying to strengthen those areas. This is especially true if someone is dealing with chronic pain like fibromyalgia, chronic fatigue, rheumatoid arthritis, among other persistent pain conditions. So, where should you focus? First let’s do a bit of a deeper dive into pain, what it is, what it isn’t, and what are the things that can make it better(or worse).
First, pain is your alarm system going off. Just like different brands of alarms, some are more sensitive than others, some detect when a window is opened while others will even let you know when somebody gets too close to the house. Your body’s alarm system works in the same way. While some need to actually break something to set the alarm off, others just need to move the “wrong way” or sleep wrong to set off the alarm. While others used to be able to, for example, reach up to the top shelf in their cabinet before their shoulder hurt but now hurt just lifting it up to the counter. Others used to be able to touch their toes but now their back pain flares if they just lean forward to brush their teeth. Your alarm system is armed with “danger detectors” called nociceptors. These danger detectors which are part of your nervous system don’t know what is actually going on, they just know that whatever just happened is intense enough that it zips a message off so you know about it. But, these danger detectors can actually become more sensitive in an effort to protect you before you ever get close to something it feels might be damaging. What’s more is that these danger detectors also have sensors for things that don’t equal pain. They have sensors for stress, pressure, temperature, blood flow, and if you’re sick. That’s why, if you’re stressed you might notice that you have MORE pain or if a cold front comes through that your pain might get worse. Now, here’s a bit of good news. Just like your alarm system can become more sensitive, figuring out what triggers it is the key to figuring out what will start to reset it and eventually turn it off. Now, the longer you’ve been dealing with pain, the alarm stops being accurate as to whether or not the area that is hurting is actually in danger. (Speak with one of our pain specialists to see if that is the case with you.)
So, where should you start?
The most important question I ask as a Doctor of Physical Therapy is “what do you do that makes it worse” followed by “is there anything that you do that makes it feel better”. Often people will say that “if I sit or stand too long it gets worse” or “If I go for a walk it gets a bit better before it gets worse”. Whatever your answer is, it is often one of the clues that will help figure out what will start to make you feel better. Why? Because it hints at something mechanical and movement based that either irritates your danger detectors or provides comfort. This is true even if you’ve been told that you are “bone on bone” or that you have a bulging disc, one leg longer than the other, or if you have a curve in your spine or have lost the curve in your neck. How can those not matter? If we happened to take an MRI or Xray of you on your worst day and then again on your best day-they would not change. What’s more is that many of the same findings(bone on bone, bulging disc, curvature of spine, degenerative disc disease) are found in people with no pain.
So, now, how can you use that?
If you notice that you can only sit for an hour before you have to get up and move but you also notice that you can walk for a bit and be better then we need to pay attention to when you first become aware of the pain. We don’t want to wait until the pain gets so bad that we have to do something about it. That’s the key. If I can only walk 15 minutes before i notice a problem then I lower the amount of time that I’m walking. The key, especially if you are trying to get back to being active is that you “dose” that activity that lowers your pain several times a day. Then as you are able to tame the pain, you can then get a better picture of what is truly missing strength and then focus on that. Need a bit more guidance? Get your free guide to get ideas of what to start doing and more importantly what to not do here.
Does making this roadmap seem like only wishful thinking? Are you confused about where to start? Speak with one of our chronic pain specialists for free from the comfort of your own home. Interested in getting to the root of your pain? Schedule your free in person consultation, our Total Body Diagnostic Test. During one of our free consultations, the Total Body Diagnostic, we offer expert advice about the worry and frustration of life-changing aches and pains – for FREE, in under 30 minutes.
If this article describes your story and you are looking for some help with chronic pain, we offer FREE consultations, which give you the opportunity to come in and meet us and see for yourself how we can help you.
Here are just a few of the things you will learn in one of our free consultation:
What is the underlying cause of your pain? (hopefully nothing too serious!)
Roughly, how long will it take to fix the problem?
What to do to help – which doesn’t include painkillers, resting or surgery etc.
What other, natural, drug free methods are there to speed up recovery alongside treatment?
About the author
Brandon Alkire, DPT, CSCS, FMS, Cert. DN, Doctor of Physical Therapy and Strength Coach
Dr. Brandon is the owner and a Physio at Body Mechanix Physiotherapy and Fitness. Four of his favorite people call him daddy while he's been married to his other favorite person for 20 years. He enjoys teaching martial arts and is a Mestrando in Capoeira while in the mornings, he can be found working out with the guys in F3 around town. He's the author of 4 pain relief guides for sciatica, low back, shoulder, and knees and the lead contributor to the Active Tallahassee Blog.