Can’t Go Wrong Gettin’ Strong

It is commonly believed that if something hurts, it’s causing damage or preventing healing. However, chronic pain is not “caused” by an injury that requires healing. In fact, healing has typically already finished based on tissue healing timelines. Even with acute injuries, painful exercises are not necessarily negative and can be helpful by promoting increased blood flow, reducing inflammation, and promoting greater cellular metabolism to the area of interest, but also by releasing endorphins from the brain which will help to reduce pain.

This fear of moving the irritated area has been shown to potentially increase pain and disability. This is likely to increase sensitivity and guarding to the area known as central sensitization. Central sensitization is a process where our body heightens our perception of pain and/or fatigue despite there not actually being a threat to our tissues. Think of a dog who has been abused in the past. That dog associates pain and fear with humans because someone in its past hurt the dog. So, when a well-meaning person simply tries to pet the dog, it reacts in fear. Even though the innocent person is only attempting to show the dog affection the dog perceives pain. Our past experiences shape our perceptions. So, if you have hurt your back when bending over to pick up something, you’re likely to believe that doing this same activity in the future will also hurt your back. When the slightest sensation of discomfort occurs while bending over, you may be quick to believe that you are experiencing the same pain that you experienced when you first hurt yourself, therefore you avoid doing the movement altogether.

Unfortunately, by avoiding bending, lifting, or twisting for prolonged periods of time, you may actually decrease your back muscles' ability to perform these tasks in the future, thus creating a greater risk of injury. However, by returning back to normal movement, even with the presence of pain, you can increase your confidence in your body as well as its capacity to perform these movements.  Doing activities that are difficult or even uncomfortable can actually decrease dysfunction by increasing confidence and trust in your body’s ability to perform difficult activities with the knowledge that you aren’t damaging yourself.

Rest and inactivity are likely not beneficial activities to do for a recently injured or irritated area. We’ve all heard of rest and ice for pain. Research shows that not only is this likely not beneficial for healing, but that it potentially reduces rates of healing and can prolong pain and dysfunction. For example, if you have sprained your ankle, instead of resting and icing it, opt for walking for 10-15 minutes every hour around your house. Try climbing up and down the stairs 2-3 times per day. Leading with your injured foot on the way up the stairs and leading with your uninjured foot down the stairs. This will stress your ankle muscles which increase blood flow and nutrition to the injured sites, thus improving healing. By not using your ankle it can also promote feelings of frailty and fear in the region which can eventually lead to stiffness, muscle atrophy, and dysfunction in the region due to disuse. This assumes you have not suffered any fractures to the region of course. If you cannot walk on your foot at all and pain has not decreased at all in 7-10 days it would be wise to seek imaging to confirm the lack of fractures.

Lifting weights is a very safe activity. Research has shown that fewer injuries occur with weightlifting activities than when compared to almost all team sports, with about 0.24-1 injuries for every 1000 hours of training (Keogh et al, 2017). Most injuries that occur with weightlifting occur due to a thing we physical therapists call “too much too soon”. As long as you follow an adequate exercise program, start conservatively, slowly add weight, and get adequate sleep you will significantly reduce your risk of suffering an injury due to weightlifting. Leave your ego at the door.

Surprisingly, this is a common question/concern I receive from patients. First off, stretching and mobility work has its place and will likely be involved in most plans of care for patients. However, it is highly unlikely that you will get “bulky” by accident from lifting heavier weights. That would be like saying I don’t want to play basketball because I don’t want to be able to dunk. Yes, lifting heavy weights can increase muscle mass, but without proper nutrition that emphasizes muscle growth and years of training, most people will not gain weight quickly enough to ever look bulky. Strength training is actually very beneficial for decreasing fat levels and creating a more “toned” look. I’ve also never heard someone complain about having arms that fill their sleeves from being so muscular.