Training and Pain
Training should not hurt. Nope not ever. Training should certainly be uncomfortable, often. But training should not ever cause acute or chronic pain. Ever. If you are in pain during your training you are doing it wrong. Full stop. No exceptions. Your job is to ensure you are training towards health and a state of ease, rather than dis – ease and injury.
Soreness for days after training is normal. Sharp pain during training is not normal and is a strong sign that you are doing damage to yourself. Stop immediately.
I had suffered elbow pain for 2 years. The pain was most likely caused by tendonitis or tendon degeneration. Basically the tendon that joins my left hand ring finger to my elbow has been painfully inflamed for a long time now. Initially this was caused by residual range of motion issues caused by a finger, wrist and arm break sustained during a mountain biking accident. It took me 2 years to resolve the injury. There was a few setbacks, lots of mistakes and overall I learnt a great deal about treating and rehabilitating connective tissue and training with pain.
It worth noting at the start of this blog – I currently have no elbow pain! Happy days.
head in sand approach Ignore the pain
So after a night of partying I returned home to my share house, where we had a climbing rope permanently installed in the lounge. After very little encouragement a climbing competition ensued and after exhausting myself climbing up and down the rope I noticed that my elbows hurt, as I may have been intoxicated a little at the time I thought nothing of it. Fast forward a few more weeks and I was training at my local CrossFit affiliate, knocking out an absurd number of pull ups when bang my elbow was on fire again. This was the start. As all young men know, if something hurts it’s best to ignore it and push on hoping it will go away.
Total rest is a mistake
So after a prolonged period of adopting my ‘head in the sand’ approach to the chronic elbow pain, I decided to see a physiotherapist. I was diagnosed with elbow tendonitis and told to rest it for 2 weeks. I struggled through 2 weeks of limited activity and to my delight my elbow no longer hurt. So I decided to revisit my rope climbing… my elbow immediately hurt, very badly, again… So it turns out the rest heals the inflammation but did not make my elbow stronger. So while I do advocate rest for severely inflamed joints or connective tissue, I certainly don’t recommend excluding any movement.
Avoiding stressing the joint is a mistake
So I continued training, with some modifications: I no longer did bar muscle ups, they hurt. Nor did I climb a rope legless, that hurt too. Ring muscle ups where bearable but front rolls to support hurt. Basically my tactic for the rest of that summer was to train as best I could but ignore the pain and avoid movements that hurt.
regrow my elbow
So at this point I started asking for help, talking to coaches, exercise physiologists and physiotherapists around Perth. I spent some time playing with a theraband to some success. I won’t go into detail on theraband work, but basically it is a method of constriction that enhances short term blood flow to the area.
The best piece of advice I received during this time was – look at the joints either side of your elbow. Is your shoulder and wrist and fingers moving through full range of motion? Well the answer to that question was simply – no they certainly were not.
Mobility is king, always
So I found out my internal and external rotators on my shoulder where severely compromised in terms of strength and range of motion and that my wrist and finger flexion was very poor on my left side. My workouts now focused on correction these movement deficiencies. My elbow still hurt but was less aggravated by certain movements than before.
Train full range of motion and flexibility
Things were getting better, this was the first time in 12 months that my elbows felt like they were improving. But there was still the issue that my tendons were not healing. So it was time to revisit my biological study days and learn about tissue regeneration.
you Can’t rush biology
It is pretty straight forward. Muscle replaces itself every 3 months. Connective tissues (ligaments and tendons) take up to 9 months to replace themselves in our body. So this gives you an idea of how fast these tissue are capable of regeneration. Also blood flow to muscles is high and blood flow to connective tissue is low. So what does this all mean? It means that no matter how much you want that muscle up you can’t rush the development and adaptation of your joints. If you do you will end up with very sore joints.
You can only train as hard as your joints can recover
So what this actually meant to my training in daily life is that instead of knocking out 15 strict ring muscle ups for my bent arm training, I now completed 5 sets of 15 ring rows. Replacing load with repetition. Sure I could train the high end stuff, but should I? I was beginning to think not. Completing 5 sets of 15 ring rows gave me some severe arm pump but, importantly I had no elbow pain!
It was at this point I saw this graph:
Don’t ignore light load, high rep basics work
What this graph basically means is to develop, grow and heal connective tissue you want to work the 15 – 30 repetition range. Which means for most people, reducing their load to a point that they can do this many reps in each set. Can you do a muscle up? Well, maybe. Should you do a muscle up rather than ring rows? Probably not! Don’t ignore the basics, ever.
High rep bodybuilding to rebuild my elbow worked
So the final piece of the puzzle was to find a way to promote healing in my elbow. So with my basic understanding of biology, I needed to move more blood into the elbow to heal an area. I took a page out of the bodybuilding here and worked on chasing a ‘pump’ or engorging the muscle in blood. Using a pair of embarrassingly light dumbbells I proceeded to do 3 sets of 30 dumbbell curls and tricep extensions every day as my warm up. Gradually, over months, I increased my weight from 5 kg to 10 kg (very conservative considering I could curl 40 kg without too much trouble, but my elbows hurt). The goal of this training was to pump my arm full of blood without inflaming my elbow. So I had to work carefully, paying attention to riding the line between discomfort and pain. Remember, training should not hurt.
It’s a Wrap
So there you have it. Preparing joints for exercises is just as important as preparing muscles. Joints take a long time to strengthen so be patient with your training. You can’t rush biology regardless of how bad you want it. Also any tension in your body due to compromised mobility and flexibility is likely to eventually manifest itself as joint pain. For body-weight training, flexibility and range of motion is king, before strength and before fitness.
So elbow pain? Here’s the deal:
Training should not hurt
Rest will not make your joints stronger
Ignoring the pain and training on will not make it go away
Mobility, mobility, mobility – Look to the joints either side of the sore area
Flush the area with blood using high rep low weight work
Train the basics often, train the high end heavy load work less with caution especially in your first 5 years of training
You can only strength train as hard as your joints can recover