Anthony Gurule  00:00

Hey what’s up guys, welcome back to the Live Loud Life podcast. For those of you who are new here, my name is Dr. Antonio, your host of the Live LOUD Life podcast. My wife and I, we own Live LOUD Chiropractic, we’re based here out of Lafayette, Colorado. And our big mission and focus is to help make stronger families to then in turn make stronger communities. We hope to help fill the gaps between the information that you’re getting from your providers, whether it’s clinician, a pediatrician, an obstetrician for prenatal/postnatal, whether it’s your nutritionist, or your your strength and conditioning coach or your personal trainer, it’s just being that sounding board. And that advocate for helping connect all the dots for those things that you’re maybe just not quite getting answers to. And we do have some specialties that we focus on primarily, but what we really want to help is just have that, at least initiate that conversation, and going through this diagnostic process of helping you find the right person, even if it’s not us. Because while we do work on a number of different conditions, whether that’s musculoskeletal neck pain, lower back pain, mid back pain, knee pain, hip pain, shoulder pain, you know, your kind of traditional thing, We also work extensively with prenatal postnatal, on pediatric issues from milestone tracking from your peds, lactation issues with your infants, how to work out safely and effectively and efficiently during pregnancy, as well as how to return to fitness during postpartum. So you know, there’s a number of different issues and things that we would love to be able to help you with. And if that’s something if any of those sparked your your curiosity or generated a question for you, please do not hesitate to reach out.

Anthony Gurule  01:52

But today where we’re going to talk about is one of my specialties. One of the things that I primarily love working on and focus a little bit more on in particular, which is lower back pain. And in this particular case, we’re going to be talking about the myths, myths plural, the myth of sciatic pain in particular, we’re talking about piriformis syndrome, or the piriformis muscle being the primary cause of sciatic issues. Now, for those of you who are watching this video, this podcast on YouTube, we have a number of different videos that talk about this issue that dive into a little bit more than anatomical considerations, which, if I remember to, and I will promise I will try to, is I will overlay some of the anatomy on this video as we’re speaking so that you can get a better understanding of what we’re talking about if you do not have anatomical knowledge. Because most of us, to be honest, we’ve seen a picture of the piriformis muscle and you know, a physical therapist or another chiropractor or someone pointed out and said this is what’s causing your issue because you’ll see the nerve going through it. And that’s really where things get mixed up and, and then all of a sudden we get stamped with this piriformis syndrome sciatic issue, and lo and behold, right, that’s what that’s what the cause is when really, it’s a lot more complex than that. It could be more complex, sometimes it’s a little bit more simple, but more times and a little bit more complex than just a muscle that’s tight that’s pushing on a nerve. So that’s where we’re going to be diving into today. So if you are someone who has suffered from piriformis syndrome, sciatica, or lower back pain with radiating pain down your legs, or anything around that, this video is definitely for you.

Anthony Gurule  03:42

So let’s back up here. How does, or where does the sciatic nerve, your “sciatica,” quote unquote, when you say you have sciatica? That is what it means it’s coming from the sciatic nerve. And where does the sciatic nerve come from?

Anthony Gurule  04:00

Well, breaking it down as simplistic as we can, you have your brain, your brain then goes down and goes into your spinal cord and then from your spinal cord, you have a bunch of nerves that come out. And those nerves come out of this space that is in between your vertebral bodies or your spine. So your spine is not one just stiff rod, there are multiple bones and joints within your spine and those stack on top of each other and there’s a little space called the parameter in between those two bones and that’s where the nerve comes out. You also have arteries and veins that go in and out of that space that go in and out that and kind of follow the same path. and then from there, those nerves Then branch out. Some of them combined together and you have these really intricate they’re it’s called the plexus is really intricate weave of nerves that then distribute to the rest of your body.

Anthony Gurule  04:59

And the reason why this is so elegant and great is that if you were to have damage at a single nerve root level or other areas, you have multiple innervation orientations, or spots that originate from, to help you maintain a lot of function sales. So for instance, when you’re looking at a lot of the the nerves that make up either your arm or your lower leg, you’re gonna have anywhere between two, three, and sometimes even four nerve roots that then come together to Then branch out and make a larger one. So if I had an injury, like a disc herniation, on the L3 nerve root, I still have innervations input from L4 and L5. So that allows me to maintain a lot of functions. So where I wouldn’t just be, it’s not just like one nerve root then goes out to one particular area. And if an injury happened, then it shut off, and you can’t do anything therefore moving forward. Right, so it doesn’t work that way. And that’s what’s beautiful about it. Now, that being said, the sciatic nerve is again, a conglomerate of a bunch of these nerves that come together, and it’s actually quite big. If you were to take your pinky finger, someone even say your index finger, right? That is about the size of your sciatic nerve as it exits your pelvis and then starts to make its descent down your leg. Now from there, it will then branch off again, to make additional nerves that go into different areas of your body. So that you just have again, this this wide, vast distribution to for not only sensory, but also motor function.

Anthony Gurule  06:32

Now, where we want to go with this is understanding what are the main common injuries for nerves, right? The nerves just like any other soft tissue can be damaged, bruised or irritated. So for instance, most of us have felt this before you hit your funny bone, which is really your ulnar nerve, which goes behind your inner elbow. And when you hit it, you get a wide range of symptoms, most of these symptoms usually around like a numbness or tingling, some of which could be pain. And that and that is from direct pressure or input or impulse on the actual physical nerve itself. Now you can have an abrupt injury, if you will, if we call it an injury, an abrupt impulse on the nerve just as we described, which creates this immediate sensation and this immediate zing. Or you could have something that progresses a little bit slower over time. So it’s kind of like this slow occlusion of pressure that starts to be that starts to go on the nerve. Most of these, though, usually happen as a result of like trauma, if you will. And that trauma then has either direct response of pressure on it from a physical body itself, or it could be pressure from swelling, which is very common for like a disc herniation, or something like that doesn’t always have to be the disc that’s pushing on the nerve. But the acute injury then creates an inflammatory response. And then inflammatory response brings more pressure from fluid, and then that fluid, in turn then creates pressure on the nerve root itself. Now, again, you have to consider we had multiple levels that made up that sciatic nerve as it went down the back of our leg, the symptom that you feel, though, is down that same path. And it could be coming from any one of those levels. Now there are orthopedic tests, and different evaluations to help us determine to help us determine what level of nerve root or issue it may be coming from. There’s different ways for us to tease this out from whether it’s muscle test, sensory test, you could do more complicated, like EMG studies and things like that. And depending on the extent of the injury, would it would be beneficial to know but But oftentimes, it might not necessarily matter for us to specifically know what exact level we’re dealing with here to make progress. So you have to keep that in consideration.

Anthony Gurule  09:09

And this is why the conservative approach of understanding mechanism of injury and what things are making things worse, and what things are making things what things are making your symptoms better, are more valuable, in our opinion, to do first rather than jumping straight to diagnostic imaging, so on and so forth. Because you’re gonna get an array of different conflicting information that may or may not be pertinent to the actual case at hand. So you do have to take that in consideration.

Anthony Gurule  09:36

But what we’re talking about, now further is again, that direct pressure so when you’re now looking at the orientation of how the nerves go down through the pelvis, they they go through this sciatic notch which is this little notch, kind of near our sits bones, which sits bones being your butt bones like what you sit on and it through a going across that same sciatic notch from your sacrum to your femur is a muscle called your piriformis. Now, your piriformis is one of a few muscles that make up these smaller, external rotators that are that are essentially deep stabilizing muscles. And that sciatic nerve can weave through the muscle, but it basically is, you know, this kind of roof, if you will, that sits on it. And when you start poking around, with nerve related issues, you’re gonna get, you’re gonna see a lot of trigger points and a lot of different areas.

Anthony Gurule  10:42

So one thing that’s kind of a side note, which does add to the value of this conversation is, when a nerve is pissed off, the nerve has no ability to protect itself, it is sitting there on its own, it cannot protect itself, but it does influence as we know, through motor control and output, it does influence what the muscles do so if something is vulnerable, but yet it can manipulate and control the muscles around it, you’re going to see guarding, some relate this a spasm trigger point, so on and so forth, to help protect the nerve and muscles don’t know anything else. They don’t they don’t know how to do anything else. But squeeze, right, they can only shorten it, they can only squeeze. So when they get an impulse to protect something, they don’t know how to do anything else but squeeze and then they’ll develop a lot of trigger points and tightness. And when you push on those, depending on the innovation system, you’re going to elicit very similar ridicular or radiation patterns that your sciatic nerve will present as. And so what happens is people start poking around in the glute complex where the piriformis is, and the rest of external rotators are the glute medius, or the glute min. And they’ll be very tender. And sometimes they’ll radiate and create a radiating pattern that mimics what the sciatic nerve path would be.

Anthony Gurule  12:08

And this has been studied extensively and janitor val is kind of the the the innovator of trigger point research and knowledge where they elicited saline injections into certain  hyper responsive loci in the muscle, which would be trigger points. And then they had people map out where they felt the symptoms. And then you see these these distributions along the leg. So if you ever type in like trigger points, you usually see like a leg or a region or a body part. And you’ll see all these red dots. Those are all the areas which an individual within the study indicated that they felt symptoms, usually pain or something like that, right. And so then when you’re poking on where the piriformis muscle would be, which would again be very hard to determine where the piriformis specifically lies, and I can get the landmarks of the sacrum in the greater trochanter and go into the middle. But keep in mind, you have also other muscles there, such as operator internists, external, glute med, so on and so forth. So for me to be able to take my thumb through all that meaty layer of your butt muscle would be very hard for me to say the piriformis is this one. And this is the one that’s causing the pain because it’s tight and I’m recreating your symptoms, right. And that’s how piriformis syndrome gets diagnosed. It is this piriformis muscle is tight, and your sciatic nerve runs through it. And thus, when we push on it to elicit more pressure on the sciatic nerve, we recreate your symptoms, and that’s the cause.

Anthony Gurule  13:44

Now, one thing I will agree with, if you will, within this is the palpation diagnostic process if a nerve is irritated, for instance, if I hit my funny bone, that ulnar nerve, and it’s already irritated, and I go back with my finger and rub on it, it’s already sensitive  into the point where I would be able to recreate that pain a lot easier. So if you’re palpating in the area, and the sciatic nerve is already irritated, for whatever reason, then you’re going to be able to elicit a similar response. That doesn’t mean that it’s the  piriformis muscle that’s going to be squeezing on and causing the exact issue. Other ways the sciatic nerve could be aggravated, would be from a potential disc injury or an inflammatory response up near the lumbar spine putting pressure on a nerve root and then that nerve root through that track of the sciatic nerve is also hyper sensitized. Right. You can also see in a stretch injury we’ve seen individuals who assume that they are stretching their hamstring, go through a stretching protocol when in turn they’re actually putting more stress on their sciatic nerve through the branches throughout and they hypersensitize the nerve that way. This is through straight leg, supine straight leg raises, other things like that in which we can differentiate hamstring tension, calf tension versus sciatic nerve tension. And then other than that, we see what we what some refer to as like snags, and snags, meaning the nerve itself should have an ability to slide throughout our body. So if you’ve ever heard of nerve flossing, this is where this comes into play. And essentially, if for whatever reason, and typically we see this kind of in a very small, a hyper sedentary population, and when we say this, a lot of times people assume this is not them. And this will be a sep- that we talked about physical guidelines, activity guidelines, in a couple of previous episodes, which I encourage you to go check out.

Anthony Gurule  15:49

Most of us are more sedentary than we think–we sit at a desk for six to eight hours a day with minimal micro-breaks. But yet we do an hour of exercise a day. And we assume that that’s enough. Realistically, when you look at even if you were to track with your overall step counter, we are not that active throughout the day. And when when you’re sitting in, when you’re primarily in a city pattern, you create a lot of tension around the hips, and a lot of the musculature around the hips and the connective tissue in which, which includes ligaments and connective tissue and muscles right, in which the nerve is encompassed through. And it doesn’t have that sliding capability. So if you have a nerve that’s supposed to be able to glide and slide as you move, because you’re not moving enough, that creates this tension within that nerve. And thus then you can elicit symptoms again, right. So a lot of what stretching is also believed to be doing outside of hopefully elongating our tissues and making them more extensible is allowing us to be more aware and accustomed to the nerves stretching. you can’t go from you know, do you know the stiff rubberband and assume that you can just stretch and we’ll be fine, you have to work it over time. And all of a sudden the nerve, which is just a connective tissue, we’ll have a better idea of being able to stretch a little bit. And it won’t be as sensitive to that. But in addition to that, you’ll see the convergence factor of nerves moving being able to be more efficient. So a lot of this comes down to again, just having supple and mobile soft tissue that allows things to glide and slide well. So those are just again, a few of the reasons why the sciatic nerve might also be irritated.

Anthony Gurule  17:28

But what we wanted to highlight is again, the fact that the piriformis is such a small role and factor into the whole hip complex as itself into the whole lumbar plexus and sciatic nerve. You know, area that the majority and I would be confident to say the absolute, absolute majority, 99.9. And I’m making that statistic up, but 99.9 of the time, it’s most likely not your piriformis is most likely not piriformis syndrome, it’s your piriformis isn’t so tight, just because you can’t get into a pigeon pose, which again, piriformis in that position is one of a few muscles that are being stretched in pigeon pose just because you can’t get in the pigeon pose doesn’t mean your piriformis is so tight. And that’s what’s causing your sciatic issues. Now, will it help for you to address a deep pigeon stretch and doing trigger point work in your hips and stretching? 100%. 100%. But you don’t get confused that just because you did something correlation not equal causation, just because you did something and you got a positive response, that does not mean that you fix the actual issue as to why it was coming through.

Anthony Gurule  18:38

That is dealt with primarily through the diagnostic process of understanding how it came on in the first place. What are the movements that you’re doing? Where are the range of motion limitations that might be adding more load to a certain area? But again, it’s most likely not your piriformis muscle causing your sciatic, your sciatica, or your sciatic nerve pain or numbness or tingling down your leg? So then the question would be well, what else was it? Well, we again, we highlighted a couple of the potential things that could be what is your particular cause? I don’t know you have to go through an evaluation and assessment. If you don’t have someone to do that for you, we’d be happy to team up with you and we can set up you know, online consultation or an in person session to help you deal with that. But we see time and time again, movement helps tremendously. That’s why we’re not discounting the pigeon stretch and the trigger point work and just going through general movement. we know that helps.

Anthony Gurule  19:32

and those that have this sciatica, and one thing I did not mention, which is critical to understand, is acute versus chronic.  So many more of these cases are chronic. sciatica issues like I’ve had sciatica since high school which is a patient recently that just comes to mind and realistically through his occupation, very sedentary so the so the referral stuff that he’s having down his legs, it’s not really true sciatica. it only goes just past the hip. And it’s very dependent on hip movement as opposed to like some of the other diagnostic or differentiation movements that we’ve done.

Anthony Gurule  20:09

And what we simply started with was just a movement mindset of starting to do supported squats, and hip hinging, and just loosening up that whole posterior chain. Lo and behold, everything has gotten better. And yet his belief was that because he was told by a physical therapist back from high school is that his piriformis was too tight. And that was the cause. he always just that was piriformis syndrome and that he wasn’t able to ever stretch it out or release it out. And that was the Doom factor for him and constantly having sciatic pain. So this sciatica in any nerve related issue, needs proper diagnostics, consultations, workshopping of understanding triggers, causes of pain or increasing the symptoms, because it’s gonna be very hard to get out of those if you don’t know what those triggers are. But more specifically, finding the specific thing that helps alleviate the nerve pain, whether that’s opening up the foramen through an opener that allows perforation and signaling to go through. whether that’s anti inflammatories, depending on the extent of how acute the injury is. whether that’s flossing–nerve flossing exercises to make that nerve excursion smoother, if you will.

Anthony Gurule  21:28

So I see it more as (and I’m not saying a cop out because it’s the other, the other provider Whoever didn’t necessarily know anything else.) But we see this more or less as kind of a cop out diagnosis. We did a recent podcast on you know, how Fibromyalgia is diagnosed, which essentially is an exclusion criteria just like hey, we couldn’t figure out anything else. Right. sciatica. You know, they’ll do a couple orthopedic tests to try to determine but there may be inconclusive, it’s just like, ah, you know, your hip’s tight. I’m not quite sure what the cause is, it’s most likely your piriformis muscle because we poked on the end, and it’s tight, right? That’s usually how this is laid out. And that is really just not a service to you as a patient or a client.

Anthony Gurule  22:15

So I hope this was I hope this was helpful. Again, if you if you’ve been told you had piriformis syndrome before, or you have a tight piriformis and that’s causing you sciatica, I think this is a very important video for you to go through and send to, you know, a loved one, a family member or friend who’s who’s been complaining about this as well. Because in what we’ve seen, and in in our mind, it gives a lot more confidence about what you can do in the future. Because if you think it’s a tight muscle, and you’re still having symptoms, and you’ve just been stretching the hell out of it, you’re not getting anywhere, that’s super frustrating. You’re like, Well, shit, that’s what it is, you know, I’m not going to be able to change it. And when you have a different lens and perspective about what’s actually going on, it gives you a lot more. It really helps empower you to be able to do more about this.

Anthony Gurule  23:00

We appreciate you tuning in guys. Again, we’re Live LOUD chiropractic here in Lafayette, Colorado. If you’re local, we’d love to connect with you and help you with your aches and pains to help you live a fuller life to help you feel stronger, more confident about your movement. If you’re not local, we do offer online consultations because we want to again, be be in a role and a position to empower you, even if it’s just a consult to help you navigate what that next step would be. A lot of people don’t have that. And if we can do that for you, we’d love to be able to help out. So be sure to like and subscribe to our YouTube channel or podcasts. You can also find us on Instagram where we’re doing much more shorter pieces of content but still very valuable and useful to parents, to families. To you know if you’re a prenatal if you’re postnatal, if you have little ones at home, we’d love to be able to share that content and that information to help you live a loud life. Until next time, guys.

Anthony Gurule  00:00

Hey what’s up guys, welcome back to the Live Loud Life Podcast. My name is Dr. Antonio, your host of the Live Loud Life podcast. This show is brought to by Live Loud Chiropractic and Coaching. That is our practice in Lafayette, Colorado. My wife and I  own Live Loud Chiropractic and Coaching. We help families through a variety and wide range of issues really starting with prenatal, postnatal, and pediatric care, while also then supporting the rest of the family from birth up into grandparents, older age, whatever that is. And our big focus is really just helping making families stronger. So that we can make our community stronger as a whole. And that you can express this loud life that you want to be able to live and pass that on to others just by setting an example about what health, fitness, strength, whatever that is to you looks like. And being that prime example I don’t know if you can hear right now. But in the background here we got some little baby chickens and ducks that are currently, they are hatched, they are currently baking under a heat lamp, as we are planning on closing on a property soon, which is amazing for us and our family and we’re gonna have just a little bit more space and hope we’re going to be having some chicken and some duck eggs. So that is what you may or may not hear in the background, not sure if you can hear that in the post edit.

Anthony Gurule  01:44

With that, a couple couple things we have coming down the pipeline. Nichelle is working with one of her good friends on a postnatal course. And what this postnatal course is, essentially, here’s all the things that we wish we knew, after we had babies, we been shown her, her friend who are doing this project again, not me. But there is application obviously to partners and husbands within that as well. From nutrition, from postpartum rehab, to postpartum mental health, you know, whatever that is, that’s going to be such an amazing course. And the reason why, when you’re pregnant, when your family is pregnant, all of the time, energy and focus is on you, up until birth, and then baby comes along, obviously, we want to make sure mom and baby are healthy and doing well. But then the focus starts transitioning on to baby– making sure that they’re gaining weight, making sure that they have everything they need. And oftentimes outside of the six week checkup that moms get, there’s not a lot of love given to the postpartum mama. And so they want to be able to fix that. So if that’s you, if that’s a friend, you know, if that’s you coming up in the future, be sure to look out for that we’ll be posting that on our Live Loud page, on our Instagram accounts, Nichelle’s personal Instagram, as well. And we don’t want to share too much about it, because it still kind of in the developmental stages, but that will be coming down the pipeline this year. Aside from that, speaking of pregnancy and postpartum, I generated-created generated-whatever you wanna call it. A course, that’s how to not suck at giving your pregnant partner massage. Obviously, us being body workers that’s something that we’re doing on the daily basis, helping our prenatal mamas. But it’s something that we advocate for at home, because there’s a ton of benefit for reducing aches and pains, for your pregnant partner, for the birth and labor preparation process of reducing restrictions within the abdominal wall and the pelvis so on and so forth to help with baby positioning and labor. But also from a connection standpoint, there’s a lot of changes going on in pregnancy. Again, I don’t know what those are, because I haven’t lived it. But I know when I’ve seen it happen through and with my wife for all three of our kiddos. And it’s a very challenging time when especially when it comes to touch and intimacy and different things like that. And not that this is an intimacy course. But the whole touch aspect is your as your body changing, it just it just feels different for not only you but also the partner. And so we wanted to help provide you a little bit of guidance on how you can give your pregnant partner some basic massages from hands which helps with carpal tunnel symptoms, from rubbing feet which helps with swelling, from working on the hips or the lower back, which is one of the main achy points or pain points when being pregnant. So if you’re interested, if you are a partner listening to this, and you’re interested in being able to provide your pregnant partner a better massage experience or have that touching connection point with you, I think I think you’d find that very handy and helpful. We’ll link that in the show notes and we all So I have that listed within our linktree in our Instagram account.

Anthony Gurule  05:06

And if you’re pregnant, or you’re about to be pregnant, or you know someone who’s pregnant, and you think that they might benefit from that, that’s a great, not passive aggressive, but insinuating gift to give to someone who’s like, Hey, would you watch this so that you feel more comfortable about giving me a massage, talking from the brain or Mama’s perspective. So it’s, it’s very, it’s very easy. We give some anatomical landmarks, it’s not clinical by any means we help describe what parts of hands can be used to make it more comfortable. It’s a short, it’s a very, very short, like, four hour course but it’s extremely, it’s extremely, extremely handy and beneficial to build upon that.

Anthony Gurule  05:53

Now, enough of the introductions, what I wanted to talk about today was arthritis, and tendinitis. Itis being the key and some different ways that I want you to, to look at arthritis and tendinitis As it pertains to what’s actually going on. Now to better describe, itis simply means inflammation. And usually associated with pain, right? Inflammation, usually associated with pain. It’s not always the case but usually associated with pain. So example, we’ll just use a bicep tendonitis. Bicep tendonitis, there could be multiple reasons as to why the bicep tendonitis in there and that first and foremost, what we’re trying not mean, first and foremost, but within the process of diagnosing and treating injuries, understanding the potential why something happened is a critical component. And this This is slightly foreshadowing for our conversation here. But also just knowing which tendon is irritated or inflamed is highly important to for knowing how to load properly, so on and so forth. But it essentially means the tendon is inflamed and irritated. Could be micro damage could be more damage, but the bicep tendonitis, tendon pain irritated. Okay. And usually that’s due to what as if you were to type this in, over use injuries, or, or too much loading or something like that, right? Does that make sense? Like usually it’s it’s described as wear and tear, or overuse, so on and so forth. And I’m going to dive a little bit more into that, hopefully help describe what that means.

Anthony Gurule  07:53

Now, we also can look at arthritis. arthro, meaning joint we can have inflammation of the joint. And most people associate this with knees, hips, shoulders, like these big major joints. Now, again, assumed and described as an overuse type of injury. For instance, if you run too much, you’re gonna destroy your knees and create arthritis, because of the wear and tear and impact. Now, that is not to say that load and too much load will not cause arthritis. But what we also have to we also have to know, not assume, but know is that load and force is one of the things that actually makes things stronger. Our body has this amazing ability to adapt and respond to the forces opposed upon it. Pending It is done at a level enough to elicit adaptation, and not so much that we create detrimental or possibly damaging effects. Okay, so there is this sweet spot of adaptation of loading just enough, but not too much that we create an issue. And that’s really where the magic happens. Now, what is that load? Well, it’s different for everyone. It’s different on a number of different criterias from your experience with lifting or loading or doing anything else. Not only that is how long you’ve been doing it, so for weightlifting, they they oftentimes called like your ‘weightlifting age’ of like how long you’ve been doing this because that that essentially will help someone determined how much how much your tendons have been under load and how much response and density they’ve built up over time.

Anthony Gurule  09:58

There’s also a number of just metabolic factors and conditions that would more so be in response to how your body recovers. So for instance, someone who might have like certain autoimmune conditions or certain conditions that just makes it harder for them to recover, that’s obviously gonna  make your recovery from that adaptation more challenging. So there are, there are a number of things to consider. And we’re not going to dive into all those because that’s not what’s most important. What’s most important to understand, though, is that load is a good thing. But just like anything else, too much of a good thing could be a bad thing. But I think, more times than not, we’re erring, too far on the conservative side, assuming that too much load will create damage, and thus you will have more degeneration, or more arthritis or more tendinitis, thus leading to more damage, thus leading to more pain, thus leading to further intervention down the road, ie steroids, injections, MRIs, possible surgery. make sense? And the reason why we have to look at this is we have to have a conversation about how much you’re currently doing. And then we try to meet in that zone of adaptation.

Anthony Gurule  11:20

So for instance, right, in the the example of the bicep tendonitis, let’s say, for instance, hypothetically, that someone is working out, doing some form of HIIT training, which usually involves a lot of upper body stuff, five to six days a week, and they’ve only been doing this type of training for six months, okay, six months, relatively new. they’ve been lifting before, but it’s been mostly kind of like your basic bodybuilding. You know, less intense, less dynamic type of movements. Six months ago, they decide to start hitting trading, they start hitting it harder on they’re doing a lot of different things at speed and in a more dynamic fashion. So we can see that there is a direct change in the amount of load in which the shoulders were being exposed to, with possibly less recovery time and or not enough recovery time based on the new training methodology and style. So we can see a direct link and change to why an instance of a bicep tendon  might be hurting. And so the question would then be, well, what’s the best approach to deal with this? Now, outside of an MRI, we wouldn’t necessarily know the extent of the possible damage to the tendon. But even with the MRI, you’re not going to fully know that unless there’s gross major damage and changes, okay, which your function and limitations and ability would would most likely be down because of that. So with, you know, with this story and example, making that assumption is that it’s slowly and gradually kind of crept up on us over the last six months, or realistically, maybe over the last six or eight weeks, we can make an assumption that we are above that zone of adaptation and the load is too much. Now, that does not mean we have to cut out all load. There are other factors that would be leading into this. And part of this is the biomechanical approach of leverage. There are certain movements in which when we’re talking about upper body movements, we might be loading or leveraging the bicep tendon too much and not sharing and distributing the load across other joints, such as the elbows, or other muscles, such as the pecs, the triceps and to your delts, so on and so forth. And they’re all involved in some capacity, but we’re really just looking like do we are we are we leveraging well enough, so our bigger muscles such as pecs, and delts are not taking as much load restraint as the bicep tendon might be?

Anthony Gurule  14:08

that’s a factor, the other factor would be recovery. The other factor you know, recovery involves diet, sleep, so on and so forth. So we can see a clear indication representation of why the tendon irritation or tendinitis occurred. But we cannot say that it’s because sorry, we know that it’s too much we’re just just above that zone of adaptation, but we cannot just assume that like the movement is bad because it just might be too much loading or too much weight or not enough recovery, then that’s part of the covering the rehab process is finding out what what really works, right. So I would argue that the majority of shoulder movements shouldn’t would be okay, pending we’re not significantly increasing pain within the shoulder and in thus in turn decrease in its function range of motion, swelling, and so on and so forth. Right? So we’re trying to find a middle ground of saying, hey, yeah, we would love you to keep working out, we just need to be a little bit more careful about what those might be based on those loading principles, so on and so forth. Now, what I, the reason why I wanted to share that story first was to go to the complete opposite way and talk about something as simple as knee arthritis-different. Again, we’re under the same assumption that load is the predominant factor that’s irritating, that irritating a tendon, a joint, a muscle, so on and so forth, right. And that is then in turn creating, itis, inflammation and pain. And we could say if we wanted to keep this consistent, we could say patellar tendonitis within the knee. We’re just going to say knee arthritis, patellar, patellar tendonitis and same, same region, same conversation.

Anthony Gurule  15:54

But here, we’re looking at an individual who’s been told they have knee arthritis. And they’re, let’s say, for instance, this has been an ongoing thing for the last three or four years. And essentially, the conversation is, hey, you’re doing too much on your knee, you need to you need to cut back and reduce how much load you’re putting onto your knee. Well, then the patient asked, well, what would those things be? What are your activities? Well, you know, I pretty much just walk the dog and that’s about all the extent of my exercise to do, I don’t do any resistance training or the like that well, walking, walking must be the thing that’s too much for your body. So you need to wait, let it rest, let it rest. And then you can get back to it. So we wait, and we wait. And we wait. And sometimes weeks, months, sometimes even years later, we’re still waiting for the thing to heal. Now, if you look at any, any sort of textbook, any sort of physiology textbook that talks about healing timelines, especially when you’re not doing anything, 12, six 8, 12, maybe 16 weeks is a pretty consistent timeline for when healing should occur. Right? Meaning that if you’ve been waiting that long, whatever has been quote, unquote, damaged, is healed, and that there shouldn’t be any more pain. But this is tricky about about this is the tricky part about pain. And we’ve had other episodes about pain before. But this is where you’re, we’re seeing well, if load is causing arthritis, but yet this person, or tendinitis, but yet this person isn’t doing anything, why are they still having this knee arthritis, tendonitis diagnosis, when they haven’t done anything, there’s no load even involved, but yet they’re still getting labeled as the knee is the issue and there’s some sort of damage, and that damage is irreplaceable and that it cannot change. And that’s what’s so interesting to then, you know, kind of tie this all back. Remember, the conversation of load elicits an adaptation response of strength. If you’re not loading tendons, connective tissues, muscles and joints, they will actually, I’m going to say it, I don’t want to say it but start to degenerate and weaken, if you don’t use them. It is a use it or lose it principle, right? If I was to not exercise, my knees would start to regenerate faster than if I did exercise.

Anthony Gurule  18:37

Are you argumentatively some of the extreme case, extreme extreme extreme case of too much exercise might be leading to some more damage on certain things. But you have to consider those that are doing those,  they’re in tune with their programming, they’re in tune with their recovery, they’re in tune with their diet. Right. So the the likelihood of more inflammation and issues arising actually reduces. because in order to even do that much, you have to be dialed in. And outside of that, usually those individuals that have tendon issues or joint issues, they’re more accidental just based on sheer statistics of how many repetitions one might do and the likelihood of running into an issue of a bad rep or something happening. That’s the reason why not because they’re doing too much per se. And they’ve actually looked at this with marathon runners. marathon runners predominantly which are done on concrete and street running. They don’t have any more knee arthritis than a sedentary population that does not exercise and are in some would say an argumentavely based on the radiographs that they’re looking at that the sedentary population actually show more signs of degeneration than those who are running marathons and are more active. And they’re starting to dive into this more where when we look at the joint, the joint is essentially two bones that meet each other. Okay. And then within that we have a cartilage surface, which essentially is like a smooth surface, which allows for the two surfaces to rub together with less friction, okay, and they’re contoured based on the shape of the other one, so that you have this nice sliding and free free moving joint. Now that is controlled, and the amount of range of motion is controlled through the muscles, but also the ligaments. And then within that the majority of our joints are what we call a synovial joint. So there’s a capsule This is a fibrous capsule that holds synovial fluid within the joints. So if we look at, I’m going to describe this and also show up but if I have my two knuckles together as a joint, I have, per se a piece of saran wrap that attaches the two joints together. And then within that saran wrap, I have this like oil, this like lubricant and oil that helps keep the joint a little slippery and lubricated. Okay, it is a fluid. And that fluid has a number of different properties within it, which helps keep it healthy. But as with most fluids within our body, that fluid ebbs and flows and moves as a result of movement. So as an example, the majority of our venus return, while our heart is pumping, and we have blood pressure is pumping through the rest of our body. And that pressure helps return that fluid back to the heart, the majority of that is actually pumped back through our body through movements. So our veins don’t have any contractile or tensile properties like a capillary would or your arteries, right sorry, arteries, not capillaries, per se, arteries would. And so they’re basically just a hollow tube, but they have a one-way valve. So as I move my arm, my muscle actually contracts and that squeezes blood out of the system, it goes through the veins, and then that backflow valve prevents, prevents essentially blood from backing up.

Anthony Gurule  22:00

Okay, so the joints are, are very similar in the fact that you need to move the joint in order to move new synovial fluid in and out it. is constantly be an interchanged. That’s the recovery model that we’ve been talking about, right. Unlike your automobile, which does not auto generate that lubrication, you have to drain it and refill it, we’re able to constantly do that on a daily basis through movement. And you need to do that, because what they’re starting to see is that you’re actually starting to see degenerative excess growth and changes to the cartilaginous surfaces and bony surfaces as a result of not moving. Think of it almost like like, like a self smoothing piece of sandpaper where we have two joints that are moving together that keep each other nice and smooth, not so much that they’re grinding into each other, but just enough to just smooth it out. So we have this nice slick piece of ice that the two sides can can have a relationship with, which is fantastic, because that allows the joint to articulate. Now, the question that we commonly get when we’re talking about this stuff is like, Well, what about what about a crunchy joint? Does that mean there’s more crud or crap in there that’s causing that’s, that’s going to be chipping away and wearing and tearing at it? No, it doesn’t. Now there are instances of a loose body where you have a fragment for whatever reason that has come off. But the majority of this is again, we have two surfaces rubbing together, you’re bound to get a little friction, and you’re bound to get some crunchiness. But you also have ligaments that are rolling over bones, you also have muscles that are moving, there’s a number of different factors. So if you have if you have crunchy joints, which we’ll do another whole show on, this probably does not mean that you’re wearing down the joint, you just have two surfaces rubbing together. Now it wouldn’t be different is if you move the joint and you had a significant pop or sound and there is a pain that listed with it. That could be an indication of potentially something more but we’re not talking about that right now. Right? We’re talking about two joint surfaces that need that need to rub against each other to help auto regulate their their borders and their surface in addition to moving more as helping synovial fluid pump in and out which keeps your joints nice and lubricated. All of which keeps a nice healthy joint so that you can load it and then you need to load it enough and more so that you reach the zone of adaptation to elicit and keep this auto regulation or auto regenerative properties going on. That is the whole reason why movement and skeletal muscle density which then in turn leads to healthier joints is a huge proponent of longevity. The more the more mobile you are right, the more you’re able to move around on your own, the longer you are more likely to live. Those that are required to have more assistance for basic movements, their mortality rate goes up. So if anything if all you do to live longer, is keep your muscles in your joints healthy. That’s good. Now the same goes true. That’s just a side note, why there’s a lot of talk about brain health and brain activity in stimulating your brain. It’s our body regenerates based on external stimulus. So if you externally stimulate your brain, if you externally stimulate your muscles, your joints, your tendons, you will continue to make them stronger. Now what what commonly happens is we get tripped up in this. And I’m not saying this completely wrong, but we get tripped up in this model of lightweight and high repetitions, assuming that heavier weight is more damaging, again, more damaging to our joints and our tendons and ligaments. That is not the case. There are benefits to a lightweight high repetition methodology and programming. But that is not the sole focus, there is a ton of benefit with doing slightly heavier again, relative to you. Resistance training, to again, elicit proper muscle adaptation, growth, strength, neurological conditioning, as well as conditioning for your joints. Now, even more important than that is full range of motion. So I was having this conversation with someone else earlier this week who was complaining of neck pain. And I hadn’t seen her for a year and a half for a few different reasons. But we were talking about workstation, ergonomics, and posture, and I just did an Instagram video on this as well, where I don’t demonize posture, I simply have a conversation about how posture should be dynamic. And yet we run into static positions from time to time, like I’ve been sitting here with you guys for 27 minutes. Now, I am hunched and I’m over. if I was to be doing this for 56468 hours a day, that might start creating some issues within my back, because I’m simply not moving the joints of ligaments, the tendons. See where we’re going with this, right. But what we start to see is, we live in this world, I am framing the image of me right now on the camera, I’ve only been looking here, and the majority of us, we only look here throughout the whole day, maybe down a little bit to a phone or a book or a laptop. But when was the last time you’ve literally looked all the way up towards the sky, right, or keeping your shoulders square as far left as you can. And as far right as you can. when was the last time you turn all the way to the left, or all the way to the right. When was the last time you took all three of those planes of motion and combined them together. So for instance, I could tip my head back to the side and then rotate left or right. So it would look something like this if you’re watching. Right, so I’m carving out this this 3D representation of all of the possible range of motion and positions that my joints should be able to go into. Now I’m not saying you have to use every single joint through its full range of motion every single day. While that would be awesome and ideal, it’s usually not going to happen. But for shoulders, when was the last time you extended back as far as you can, thus creating a lot of tension in the front creating restrictions within the joint. For the spine, we flex a lot. But do we typically don’t go through like a lot of true good flexion and or extension, not to mention lateral flexion and rotation. So we see while we’re trying to do our best efforts of exercising even functional training, which is, you know, just plastered everywhere. We still miss out on so many opportunities to condition, the muscles, the tendons, the connective tissue and the joints by going through just proper range of motion. Now this is not stretching per se, This is a movement modality if you will, which is specifically intended to elicit using your joints through full ranges of motion, right?

Anthony Gurule  29:00

So how would that look, let’s just, we already gave the the example of the cervical spine or the neck. for your wrist, it might just be some wrist circles, right? We’re constantly in flexion. Very rarely, we might be going up and down, side to side or rotation or any combination of that. Right. the shoulder we already talked about, a flexion we do a lot of flexion. And you know kind of out to the side. But even just bringing our arms over the head, it is surprising actually some of my patients who have not lifted their head, their arms over their head and in a while. I’ll say that right? And it creates a lot of stiffness around the joints. you can get it back but it makes it a lot harder if you haven’t done it in a while. now on top of just the shoulder. The hip. while we sit it goes through some flexion we walk it goes through a little bit of extension, but we hardly challenge it into internal rotation, external rotation or a reduction or bringing it away like we would with our arm So what I want to challenge you guys to do, and I don’t have I had a previously done like mobility challenge, if you will not like a competition or anything like that, but just encouraging this principle of moving your joints throughout the day and, and this, this reminds me, I need to revamp that and update that. But I challenge you to take and think about all your joints. And think about different ways in which you can move that. now you don’t have to be, you don’t have to be a chiropractor or, or a personal trainer or movement coach to do this. Most people understand movement to a basic degree, right.

Anthony Gurule  30:45

So for instance, let’s start with some of the more simple ones, your toes. your toes are flat when you’re on the ground. And then when you walk, they go through extension, so they bend up, right to propel yourself going forward. without shoes, when was the last time you will curled your toes underneath and kind of got the tops of your toes on the ground and push down on them, creating toe flexion? I guarantee I guarantee the majority of you haven’t done that in the last day for sure. The last week, and I bet the majority of you have not done that last month. Now, why does that matter? What’s you know, I don’t have any toe issues or pain like I’m doing just fine. Yeah, true. I mean, but I’m coming at it from a different model, right? As we already indicated, the movement model for mortality is is directly correlated, right. And what’s one of the main things that you need to be able to do as an adult as you grow older to regain and have as much, you know, independence and control? walking. So, you know, I would hate for anybody to have such stiff feet and toes, that walking does become painful. And I’m not saying it well, this is not a this is not a scare tactic, saying if you don’t stretch your toes, you’re gonna die sooner. That is not what this is. So, you know, calm down, all y’all out there. But this is just a brief example to explore and see how to take the movement process of just simply moving aside from stretching aside from strength training, both of which are still important, and just trying to move the joints through all this range of motion to re-lubricate your synovial fluid, to smoothen out the surfaces that are gliding against each other, to strengthen the connective tissue that surrounds it to densify and make stronger the tendons and the ligaments that are also there. Right. But again, there’s a load principle, you cannot just  mobilize and stretch your way to stronger, healthier joints. there is an element of loading that has to happen. We’ve talked about that loading the adaptation zone. And not enough is not going to elicit what we want. But yet sometimes too much. Most people assume we’re in the too much when I actually think we’re actually in the not enough. But yet, then we want to make good changes. And then we see this spike, remember the story of the crossfader they were lifting before we know they had good strong joints, but yet they did or sorry, cross it or hit training. But yet over the last six months, they change what they are doing, we saw a significant spike in load of the bicep tendon based on the activities that they were doing over the last six months. And we can then make a pretty accurate prediction and assessment that that was probably the cause of it. So just because we’re down here, majority of time, we call this the weekend warrior right? Throughout the week, most of us aren’t doing enough, we’re more sedentary than not but that on the weekends, we want to go play and we want to go play hard. And so we do a 20 mile bike ride, or we do an eight mile trail run. your body’s not conditioned to do that–the tendons the muscles, the ligaments have not been conditioned and densified and strengthened enough to withstand that. And then you see this tendinitis or joint pain or arthritis response because of a peak in loading not because the consistent thing so that’s where working with a coach is so beneficial.  they’re more or less just there to help you manage load to reduce injuries to get you to do the most that you can by also reducing injuries by keeping you know kind of control and reins on how far and much you want to push. athlete dependent, person dependent, recovery dependent. Okay, but I hope I hope that this at least sparked some questions that you can ask your providers. I hope that it gave you a little bit more confidence in your joints condition that the majority of you most likely do not have this life altering joint arthritis that’s going to require a replacement– a quote unquote replacement down the road, or significant tendon damage that you’ve been told, Well, you know, just keep going until it gets really bad. And then we’ll just do surgery on it. No, there’s so much you can do, you just need to know and understand the appropriate amount of what to do. And if you don’t know, that’s why there’s professionals, skilled chiropractors that are good at rehab, skilled physical therapists, and honestly, really good personal trainers and rehab professionals, that know training and loading would be phenomenal.

Anthony Gurule  35:32

And sometimes it’s just a console, hey, this is what’s going on. What do you think, Oh, well, what are you doing? And we go through the conversation of figuring out how much you’re doing? Is it too much? Is it too little? could you supplement some additional prehab,rehab, or strength training movements to further strengthen the ligaments connective tissue, and joints so on and so forth. And and I think that would be highly beneficial.

Anthony Gurule  35:55

Now, as a caveat, because I have heard this said before, and I just don’t want people to get caught up in semantics. Someone was arguing essentially, like joints, you can’t strengthen joints, you know, indicating that strength training doesn’t strengthen the knee, you can strengthen the muscles around it. But when we’re talking about strength then, think of it as again, like craving more density, making it more resilient. So in my mind, you can strengthen a knee, you can strengthen the cartilage, you can strengthen the bone, you can strengthen the ligaments around it, all of which can be strengthened because of the load response, the impact that’s actually being absorbed into the body will then feel oh, I am getting more load into me, I need to thicken, I need to strengthen, I need to become stronger to withstand what’s being asked of me.

Anthony Gurule  36:51

So I have confidence in you, I hope you have confidence in yourself. If you don’t you need someone in your corner that can help you gain that confidence to create more positive experiences with movement. No one wants to feel limited by basic activities, right? You want to be able to do the things that you want to be able to do. Now, There are things that I was able to do when I was younger that I’m currently not able to do if I wanted to do those I could, but I don’t have the time, or the training plan to be able to accomplish those right now. So don’t just assume that “Oh, I used to be able to do those things I’ll never be able to,” it all comes back down to the proper training and loading to help squash arthritis to help eliminate tendinitis, whatever it is that you feel like you’re struggling with. I know this can help.

Anthony Gurule  37:45

Live LOUD Life podcasts. Thanks for tuning in. If you got a buddy who’s you know always like oh my tendinitis is flaring up or, you know, my arthritis is so bad. Share this with them. you know, it’s it’s extremely helpful conversation, if not at least provide some ammunition so that they can go to their order their PCP or whoever is harping on them about arthritis and tendonitis and start asking some better questions, helps them start Googling maybe some different providers in the area to help again, create that confidence in your body so that you can move your joints more, make them stronger and live longer and live a loud life. Thanks, guys. See you next time.

Our Mission

What’s up, guys! Welcome back to another episode of the Live Loud Life podcast. My name is Antonio, your host of the Live Loud Life podcast. My wife and I own Live Loud Chiropractic and Coaching here in Lafayette, Colorado. We are a family-based practice, we love working with the littlest of littles, all the way up into our generational health of grandparents and adults. Our big mission is we believe that families deserve more from their health care providers. We are trying to fill the gaps from the information that they’re maybe not getting from their OB, their PCP (primary care physician), but also the gaps from maybe their personal trainers or their coaches.

While we’re not saying we’re a jack of all trades, we really find that it’s important to connect all those dots and to help be that coach or liaison, if you will, to help our patients and our members really set themselves up and their families up for the best health possible. That’s really what our mission and our goals are. We love guiding you through the adventurous life you’re meant for and if we can do that in any possible way, shape or form, please do not hesitate to reach out and ask.

Overview of Today’s Topic

Today we’re going to be talking about pain. This is a topic that we’ve brought up in a number of different ways. I recently saw a post about this which coincides with the questions that we commonly get, so we just wanted to recirculate back around to this and have a discussion about it to see if it can help you with maybe some of the pain that you’re having. This is specifically towards pain when you are training.

Headline wise, clickbait wise, you see “do this so that you never have pain training ever again” or “if you have pain when training, do this and it’ll stop it.” And I’m not going to lie, I’ve been guilty. It’s what you’re trying to do. You’re trying to get someone engaged and curious about certain things because they obviously have pain. I just hope that I can have a better discussion around it rather than simply saying, “Hey, if you do this one small thing, it’ll eliminate pain.” Because we know that pain is much more complicated than just, “Oh, it hurts when I do this and thus if I just do this exercise or this stress, then it’s magically going to disappear.” That is not how it works. It’s obviously a lot more complicated, as we just stated.

But questions that we get are:

Hey, I’m having pain when I’m doing this exercise, what can I do so that I can continue doing this exercise? So obviously there’s a certain amount of discomfort or pain that’s making something not enjoyable for someone, that would normally be enjoyable.

Or vice versa: I’m having pain when I’m doing this exercise, is it going to get worse? That’s a loaded question that we oftentimes will get.

And/or: Hey, I’m doing this type of exercise, is there anything I should be worried about or mindful of so that I don’t get hurt?

There’s a lot of different ways in which training with pain comes into play. Based on the last question too, a lot of times people have a fear associated with a movement that they don’t even have pain for but they’re worried about it. Maybe because previously they’ve had pain or someone else that they know has had pain or gotten injured when doing it and so they’re going in with his hesitancy. Which is good, they’re being smart about it. Hey, what do I need to be mindful of or prepared about in case something does come up? We’re going to kind of just lay out in general how this conversation goes, and the background of this conversation always starts with a relatively simplistic breakdown of what pain actually is.

What Is Pain?

Pain is the perception of a stimulus within our body. For instance, let’s just use a pinprick or a thumbtack. If you hit that on your finger, your body’s going to feel that sharp point and that mechanical stimulation–mechanical meaning just like pressure, if you will but there’s obviously very pinpoint pressure. Your body will feel that and it’ll send a signal to your brain, and it’ll say pain and then you’ll get that reflex jerk. Depending on the type of pain, you might just do a short circuit where it goes through your spinal cord and comes back, so you have this jerk response of pulling away. The same thing happens when you touch something very hot, it’s just because it’s faster–we want to immediately move ourselves from that potentially harmful situation.

Now let’s say there’s something else that’s a little bit more slow burning, if you will. You’re running and your knee starts to hurt. Obviously, it’s not like a pinprick where you’re going to feel that pain immediately, but yet it starts to grow and fester and your body’s continuously processing like “hey, my knee is not feeling good, it’s starting to hurt, I’m running further and it’s starting to hurt more and more.” So you’re starting to process what the mechanical impact or stimulation upon your knee is actually occurring.

Perception of Pain Is Real Pain

That in a sense is how our body perceives pain, but again the perception of pain is what’s important. This is where things get complicated, right? Pain usually always starts when there’s some sort of a stimulant, meaning something elicits it. The pain can then linger. The reason why we say usually is, let’s take for instance phantom limb pain. Phantom limb pain, there’s obviously not a limb there but yet someone could still be having pain there. There’s a lot of research that goes on to like why that is and how to deal with it, but we also did see the initial insult was there’s a reason why the limb had to be removed. Or if it was abruptly removed like let’s say in an accident, muscles, bone, and nerves were all damaged in the process of that, so there was still an initial insult to the tissue. Insult meaning injury, if you will. And then we have the lingering pain afterwards because of that.

What’s really important to understand is that it’s the processing of that, so the brain plays a huge role into this. One thing that I definitely want to make clear is that pain is real. Pain is real and this is where it gets harder. Because of this whole pain science movement, a lot of times people have been pushing for pain is in your head and we can manipulate it and that’s an easier way to manage it. While it’s a perception of pain, yes, that’s our brain processing in our head, it is still real and it’s very real to the person.

Acute Pain vs Chronic Pain

This dives down a lot more into like when we start talking about chronic pain and different things like this. In the instance of training with and without pain, while chronic pain is definitely a scenario that we do deal with…. And I actually really enjoy dealing with chronic pain patients because there’s a certain element of confidence that we try to instill and push to help deal with that chronic pain. And so when we’re talking about training, that’s an important lesson, that’s usually where we start talking about is this acute or chronic? We have the conversation about how pain is perceived and what’s going on, but going through our normal diagnostic questionnaire:

• Is this new?
• Has it been going on for a while?
• How long has it been going on?
• Have you had recurrent injuries here before?
• How many injuries have you had?
• Have you had surgery, so on and so forth?

We really get an idea of what the tissue, what the body has gone through, to determine is this something where the tissue is actually damaged or is this something in which the tissue was previously damaged but yet our body is holding on to this lingering perception of pain? Because of a lack of confidence, because of a lack of preparation (meaning we didn’t rehab properly) or because of a lack of a strength (which kind of coincides with that rehab process). Those are all fundamental to understanding where the person is and what to do.

Identifying the Root Cause–Some Practical Examples

Let’s play out some hypothetical situations here. We’ll say someone comes into the office: My shoulder is hurting, it recently started within the last week or two and I’m getting a pinch whenever I do overhead lifting. Has this ever happened before? No. This is the first time, never happened before, I’m not sure what’s going on. Did I tear a rotator cuff? Very common question. What’s going on? Depending on the intensity of the pain, we will run through a range of motion, orthopedic tests, criteria, so on and so forth. But the question they have is, can I still train with this shoulder? The answer is yes, you can.

Now, is there going to be some quick and dirty things that eliminate the pain so that you can go back to doing the exact same thing that was causing you pain? There probably are a few little tricks that could help, but understanding the reason why is important in the first place. And the example we always use outside of trauma (meaning you physically hurt it with an accident or an incident.) In this case like for a shoulder, let’s say you were mountain biking and you fell two weeks ago and now lifting with your shoulder is hurting. Okay, we want to look at that fall. But if there wasn’t an accident, there wasn’t some sort of insult, then the likelihood of there being tissue damage goes down. Not eliminated, but goes down.

But there’s a reason why the shoulder started hurting with the lifting that you’ve been doing so then we go through and ask more questions:

• Has your training volume gone up?
• Have you increased weights?
• Have you tried new movements?

So on and so forth, to kind of indicate to us maybe there’s something that we’re doing that caused that shift and that change. Which is, again, more likely the cause. And so this gives us a really good idea. Okay, now that we know how and why and what was happening previously, we can make a very good plan of attack so that you can keep training. So that we’re not losing, we’re not going backwards, if you will. We’ll allow you to train around the pain, multiple roads to Rome. We just have to understand, what are the things that are causing the pain? What are the movements that are causing pain and really making things worse? If we can’t modify, change those and work on technique, then we might have to eliminate them and do something else that replicates what you’re wanting to do but allows you to not keep picking at the painful tissue.

Two Ways of Dealing with Pain

This is important because I think people in this situation, they have very black and white viewpoints. Part of it is they just don’t know the modification process or how to kind of adapt. Which is completely fine and that’s what we’re here for, that’s what personal trainers and coaches are here for as well. But they either assume “it hurts and I just need to stop doing everything so that I don’t make it worse.” And that’ll help, but they didn’t deal with the issue on how it crept up in the first place. Or they have the “no pain, no gain” mentality and they think it’s just push through, push through, push through until it eventually just goes away. Can it work on both ways? Yes. One hundred percent, it can work on both ways. But is there a way to get us to where you want to be faster? I think so. And it’s just that whole method we laid out of understanding everything that kind of caused it in the first place right.

That is an acute onset type of thing, where we’re talking about something gradually coming up over the last two to three weeks. Usually these individuals are like, you know what, I can’t put a date on it. There was never a certain instance. I just know over the last few weeks it hasn’t been good and it’s not getting better because I’m still doing the thing, so on and so forth. That’s a very, very common situation. Plan wise, super easy. Just stop doing it, which is again what most medical providers will say. If you had the same conversation with the PCP or your primary care, they’ll just say stop lifting with your shoulders, let it heal. “Let it heal and it’ll get better.” Now, letting it heal puts us under the assumption that something was damaged or wrong in the first place, which is again very unlikely unless there was significant trauma.

That’s not to say that the tissue cannot be bruised or irritated. We use this concept of bruising very commonly because I can hit my leg on the corner of a desk or a table and have a bruise which would be micro trauma, if you will, but there’s no significant trauma to it. But yet I could be walking around with a limp for a little bit or it could be a little bit tight and sore (where I stretch and it hurts) and if I just let it rest, yes, it’ll be fine. But oftentimes, if you continue to move, it helps work through that bruising and helps keep the muscle from kind of binding up and spasming. And that’s really what I think is going on as opposed to this damage that needs time to rest and heal.

I think there’s a way for us to keep moving, which again, helps so many people just mentally. But not only that. Physically, where they feel so limited by having to constantly “heal” any little aches and pain that they feel, with the assumption that it’s always something that was damaged. I find that to be critical because if we always just say rest-heal, rest-heal, rest-heal, the first sign of pain or discomfort, we assume something is damaged, whether I tore a muscle or a ligament or something like that. Where it’s less likely that is the cause and there’s still more that we can do, and that’s super important. Specific example, though. Gradual onset over the last few weeks, could be last few months, depending on kind of what your load accumulation is, if you will.

Let’s use another example and we’ll just use the same thing–shoulder. My shoulders, I have been having this shoulder pain, it’s been going on for years. I hurt it a couple of years ago and I rehabbed it, I got it stronger, but it’s just never really been the same since. And once it kind of hit the status quo, it was basically like I’ve done everything I can do with it and I’ve given up on it. But yet, when you look at the things that aggravate it, the patterning of all the things that make it worse or hurt are almost the exact same. And this is very common for most injuries, just based on a mechanical loading pattern.

Pain Caused by Flexion Intolerance

For like lower back pain, the majority of people, at least that I see, are flexion intolerant. Meaning, when they bend forward is when it doesn’t feel as good and then they let it heal. A couple of weeks later, it’s good and then they do the same thing–back and forth, back and forth. How many times can you damage or injure it and then just let it heal back and forth? It seems a little weird, right? The shoulder is very similar. And we’re talking about a very specific population. We’re talking about training, we’re talking about lifting and training, not just an everyday person who’s not doing anything.

With shoulders, very commonly, we see pushing from a horizontal and a vertical perspective as being most aggravating for the front of the shoulder or the top of the shoulder. Yes, are there times when you’re pulling that can hurt? But I find that it’s probably more biased, that most of us are doing more pushing than we are pulling. And just the way that we’re loading the pushing as well is causing more load and aggravation to certain areas, such as the rotator cuff, bicep tendon, so on and so forth. Or training this “impingement” type of scenario where we’re constantly impinging it due to mobility restrictions. So injury previously caused some tightness, had some compensation patterns if you want to use that word. I like using just more altered movement patterns to achieve the task. It’s the same thing but it is what it is.

But what we see is now that we’ve rehabbed it, we’ve stretched, we’ve strengthened, we’ve done everything but yet we saw a pain, we never relearned or addressed how it happened in the first place. We commonly see this with pushing types of movements, whether that’s bench press, dumbbell press or even just your basic pushup. We see bicipital irritation and you can sustain a substantial flare up of tendonitis on this. And then you can rehab it, let it calm down, but you’re still doing the movement the same way. So oftentimes, we’re looking at this from a technique perspective of just understanding how mechanical load will stress you in areas, and what to do and how that can be the difference of training with and without pain.

It’s a trial and error. You have to understand that when you make cue and an adjustment, doesn’t improve it. Now, these are sometimes the tricks that we see, that if you have pain with the pushup, do this to eliminate it. Yeah, that can make a drastic difference and we see it time and time in our clinic care when someone’s having bicipital or front of the shoulder pain when they’re doing like pushups and we just cue how to tension better, how to draw back and support using the back. Oftentimes the pain immediately goes away, not because the bicep tendon is not still irritated or inflamed, but you’re not loading it heavier or putting more load to it, allowing it to actually calm down. That’s what you have to look at as far as being able to train in the presence of pain.

Pain Is Sometimes a Guide Rail

This is what I think is really important and this is off a case we had last week. This exact same situation. After we worked on the shoulder and addressed what we thought was to be the primary culprit of how she was basically dumping into the front of the shoulders because she’s hyper mobile in doing pushups. Can I still train even though it’s aggravated? Because her previous physical therapist was thinking it was a pec issue and an upper trap issue and told her to just let it calm down because they were really inflamed. Those weren’t the issue. The issue was the bicep tendon and the way she was doing pushups. I said yes, you need to train, I want you to train because the little bit of pain that you do have gives you a good rail guard of understanding how you’re loading. Whereas if you didn’t have any pain, it’s a lot more likely for you to just kind of fall into the same patterns.

So pain can actually be a very good guiding rail about how you’re moving and what ways we could potentially be moving more effectively and efficiently. Obviously, this is different than the no pain, no gain. If you’re training and your pain rails, your guide rails, you keep brushing up against them, you’re going to flare things up and make it worse. I’m not saying that you train in pain and you constantly are just bouncing around finding the edges until things get more flared up. You’re using it as a guide to make the appropriate adjustments so that you can continue training without significant pain. Because there is an element to training without pain but it’s not “no pain, no gain.”

It’s not uncommon and it is very common to have a little bit of aches and pains, to have a little bit of signaling. Pain is essentially your body’s way of signaling when things don’t feel right. It could just be tightness, it could be irritated tissue, it could be weakness. Weakness in the sense of like, hey, whatever you’re doing, your body might not be fully prepared to handle that load. And the muscles, tendons and everything are being maybe overloaded or overstretched. That’s going to send you a signal to say, hey, this is too much. Or slow down or de-load, if you will. These are all good signs to have if you have the understanding of what they might mean and how it is affecting the training that you’re doing.

Verbal Analog Scale of Pain

When it comes to rehab, getting back into training or doing something in the presence of pain or having pain, whether that’s newly acute or chronic, we use kind of like a green light system. And this is not something I created, multiple different providers talk about a similar system. But most people who are going to be training in the presence of pain, we’re looking at a pain scale of really no more than a 5. Like a 5 is fairly substantial. For those of you don’t know, I’m going to run down what’s called the verbal analog scale, it’s basically when someone asks you like rate your pain out of a 10. Sometimes they have like a smiley face, frown face, cry face, so on and so forth.

To give you a little bit better perspective of functionally what this means, if you have a 1, 2 or 3, you are kind of like I feel something but something is not right. If you have a 4, 5 or 6, it starts affecting your day. Example would be your lower back hurts, you’re having difficulty putting on your socks, your pants, your shoes, so on and so forth. If you have a shoulder, reaching up to the cabinets is kind of sore or reaching behind your car seat to reach for something can be sore. That’d be an idea of like a rough range of a 4 or 5 or 6.

A 7 or 8, you’re in tears. You come in and you say, yeah, it’s like a 7 or an 8 and you’re not like visibly uncomfortable, where you’re almost in tears. Just the smallest bits of movement or so are really kind of flaring you up and making you kind of like sweat or anxious or kind of tighten up–that’s a 7 or 8. And if you say a 9 or a 10, like you’re rolling around in pain. We’re going to call an ambulance, we’re going to get you to the hospital because we need to manage your pain with some medication or something like that. Like it’s that intense. That’s what we’re talking about. When someone comes in, they’re having a conversation with me and they say it’s a 9 out of 10, I know that’s not true. Whether you have a higher pain tolerance or not, when you’re in that much pain, you can visibly see it on the person’s face.

Training in the Presence of Pain

When we’re talking about training in the presence of pain, if you got a 4 or a 5, as we said, it’s already affecting your day. That’s going to make it a lot harder to train. Now, when we say train, there’s certain ways in which we can do it that are going to be helpful for the pain that you have. I’m not saying you just do whatever you were doing just lighter or slower (although that might be the case.) You might have to completely eliminate some things but we still want you training and moving and that’s the whole point.

If you’re at like a 1, 2 or 3, that’s a green light. You can still train. If the movements are starting to aggravate that pain, meaning that pain is starting to grow when you do it and/or if it’s worse after the day after, then you overcooked it and we know we need to modify and change things more. If you’re a 4, 5 or 6, that’s a yellow light, right? It’s like proceed with caution. Still okay but you’re going to be going a lot slower, you’re going to be going a lot lighter and we might be completely changing the movements that you’re doing to be more supportive with the pain that you’re feeling and where you’re at. Anything more than that, that’s a red light. Like if you’re in that much pain, yeah, training is probably not the best option for you.

But notice we did not say that at any point of feeling pain, it’s a no. So many times, we hear don’t train with pain. Don’t do anything if you’re having pain because you’re going to then create compensation patterns or you’re going to change how this is happening and this, and you’re going to create all these issues. And then it just turns into this cascading event of, well, a year ago you decided to train with pain and now you have this compensation pattern. No, it’s not. That’s way too complicated, way too involved. The movement process of training is what can actually be so therapeutic and beneficial for the majority of injuries or pain conditions that we’re talking about.

This is all predicated on the understanding that most of what we’re talking about are not significant injuries. You can have a full-blown rotator cuff tear and not a lot of pain. And so when we’re getting into these more complicated cases, that’s where you just need someone working one on one with you to really help you design in detail a plan. To just take this information and say, “Oh my pain is not that bad. Even though I know I have this, I got a free go to do whatever I want.” That’s not the case.

Now, it couldn’t be the case where it was a previous thing that has healed and everything’s good now, but it’s always good working with a sports chiropractor, a sports PT or a personal trainer who understands these things to help you design that best plan and course of action for you. But this is what I find to be critical when we’re having a conversation around pain because most people will come in to see us in pain and they want to keep moving. Let’s take for example the last situation where I want to avoid having pain when I work out or train. We have to define, what do you mean avoid pain? Because there’s certain amount of pain elicited based on micro trauma loading that you might feel–soreness, certain things like that. But yeah, we don’t want to necessarily just feel pain when we’re training.

Train According to Your Mobility and Strength Abilities

If that is the case, then it’s really going through a checklist or an audit process of ensuring that you have the proper mobility and strength and previous loading experience for you to be able to do the things that you want to do or that you’re getting into. Example, I had a new patient come in a couple of weeks ago. He’s a father, two young kids between the pandemic and everything else and COVID. Has been out of working out and training for two and a half, three years. Actually, three to four years because his kids were born. He did have his oldest before that and that’s when things kind of slowed down. And he wanted to get into CrossFit. Love it, man, great! Found a local gym nearby, we know the coaches there, we used to go to the gym ourselves, I find them to be phenomenal coaches.

But the downside of group training and having someone who’s never done CrossFit before, has not really trained or lifted in over four years, is not having the one on one coaching ability to really look at and understand what this individual needs. We’re taking that upon us here. It’s just like, hey man, great gym, I know they’re great coaches, they’ll give great cues, they’ll give great modifications if you need it. But we really need to put you under a microscope and look at the things that you want to do so that your concerns of not getting hurt doing CrossFit–because that was a concern of his based on other people that he knows and I think just kind of the general misconception that people get hurt doing CrossFit for reasons that are similar to this.

Okay, let’s look at those things. Works in IT, sits at a computer, lack of thoracic extension, poor shoulder mobility, really tight hips because he sits a lot. I’m like alright, here’s the breakdown. We see this going on with your body. Not a lot of pain right now but we see this stuff going on. Could you do CrossFit with all this going on and not get injured and be fine? Yes. Is it likely? Well, it depends on how hard you’re doing CrossFit and what movements you’re doing. Right off the bat, within the first few weeks, as a very common exercise you’ll see in CrossFit, they were doing overhead pressing.

Full shoulder range of motion is 180 degrees, meaning your arm is basically straight up overhead, bicep to ear. Obviously, you can’t see me from a side view or this sagittal plane. But where he was at, he was maybe 150 degrees. He’s lacking like 30 degrees of shoulder extension and he’s trying to then lift overhead. The likelihood of you not injuring something with that if you continue doing shoulder pressing, it goes down. It’s very probable that he’ll create some sort of a shoulder issue, whether that’s in impingement type of symptoms and/or overloading of the rotator cuff because he can’t stack his joints overhead and he’s having to go through that altered pattern. And so this is like, hey, if we can use this as our audit checkbox or the check points, we’re going to ensure that we have proper thoracic extension, proper overhead range of motion, proper scapular movement, while being able to still stack our core and being strong, then we’ll be able to do that.

Live Loud Chiropractic and Coaching Will Help You

Notice we didn’t say you cannot train, you cannot do these things because we didn’t get them all right, and that’s a very common misconception for a lot of sports chiropractors and sports PTs. It’s just like, hey, you don’t have the range of motion, you shouldn’t be doing any sort of training at all. We gave him the green light because he didn’t have pain but we set some parameters. And the parameters now, because he doesn’t have pain, it’s not a guide rail for pain as our parameters; it’s a guide rail based on function and ability. Your shoulders just don’t have the ability to do this so we have to do it in a different way that allows you to be able to have that full range of motion

And I think that’s so important because we’re trying to help them set guidelines based on function to help them reduce the chances of injuring something. We don’t know what that probability is. I can’t put a percentage and say you’re this likely to injure yourself if you don’t do it. No, but we want to set themselves up for success. If he’s just getting into CrossFit, why not help him and support him to our full capacity so that he reduces the chances of getting an injury, that makes it more likely that he’s going to stay at the gym, which makes it more likely that he’s going to be consistent with his training and get back to the health goals that he’s wanting to get. That’s a little bit of a different scenario when we’re talking about training with pain.

I hope this was beneficial. I know it’s a little bit more convoluted because everyone’s situation is a little different. But I want you to just kind of run through this:

• If you’re worried about training with pain, is it acute, is it chronic?
• What are the things that are aggravating it?
• Can we find different ways to help you maintain a good training cycle in the presence of pain?

Also, if you’re worried about having pain, really having someone help you set up that plan and go through that audit checkbox system, if you will, to ensure that you have all the necessary range of motion and strength to do the activities that you want to do and reduce the risk of getting injured.

Thanks for tuning in, guys. This is the Live Loud Life podcast. If you know of someone who is in that cycle of training with pain and restÞ let it healÞ come backÞ get injuredÞ restÞ let it healÞ come backÞ get injured… Send this over to them, I think it would be beneficial.

And as always, that’s why we suggest working with someone like myself, sports chiropractor, a movement chiropractor, a PT, personal trainer, and a coach. Just getting some one on one time to really go under those microscopes and determine what are the things of why you’re going through this recurrent pattern, if you are in that situation. And getting more confidence in training in the presence of pain and knowing that it’s really not going to necessarily make things worse if you know what you’re addressing and how to address it properly.

Till next time, guys. Live loud!