Tissue tolerance is the foundation of the body’s ability to perform and protect itself from injury. The inefficiencies and movement dysfunctions can cause the tissue to work harder and burn more energy. The fatigue creates more stress, requires more effort and at times pain.
Pain is not a signal from damaged tissue informing us we have been injured. Tissue damage can occur without the sensation of pain, just as pain can occur without the existence of any tissue damage. The two may well exist together but they are not inter-dependent.
An athlete can have a lot of pain with little to no damage, or a lot of damage with little to no pain.
Understanding that pain does not necessarily mean there is significant damage or degeneration occurring in the body has helped bring relief to many athletes suffering of pain. Pain is real, very real, but in some cases (not all) understanding it can actually lower it. Being proactive and listening to the body is key, when pain occurs in any form it’s time to slow down even if it’s only for a few days.
Correlation between pain and fatigue in endurance athlete:
Form related overuse injuries is often due to fatigue, which comes in the second half or towards the end of a workout. Time becomes the intensity; more volume, more training sessions and not enough recovery can result in compensatory mechanics, leading to discomfort, soreness, tightness, and even pain.
A tight muscle will pull a joint into a dysfunctional position and a weak muscle will allow it to happen; soreness, muscle fatigue, less efficiency, longer recovery or maybe even injury can occur.
We all have muscular weaknesses, unstable joint(s), and postural molding. The more time spend training in a single sport can actually enhance imbalances; our strength becomes stronger and our weaknesses become weaker. Depending of genetics, tissue tolerance, and individual mechanics some athletes feel pain or discomfort more than others.
Many athletes have high tissue tolerance even if they have poor mechanics. It does not mean they are free of injury for years there is no long term damage done. Friction, compression and shear force in joints can still be a reality. At times it just takes longer to surface and unfortunately can turn out as degenerative joint disease; hip labral tear, lumbar spondylosis, arthritis, chronic Achilles & patellar tendinopathy… just to name a few.
Athletes are in constant architectural renovation
Maintenance is key, taking care of imbalances through exercises should be part of a training regimen, eating healthy food, quality sleep, and regular massage and hands-on treatment from professional therapists is also important.
Deep squats & lunges are high risk exercises even if we see them regularly in magazines and on social media as preventative exercises. One needs zero imbalances to perform them with good technique.
When you start feeling discomfort, soreness or mild pain:
Don’t stop exercising
Don’t get discourage
Focus on proper technique & mechanics
Keep legs moving quickly
Seek sports med advice for assessment
Include preventative exercises to your program to correct weaknesses and imbalances
Chronic pain can persists after tissue damage has healed. Most tissues in the body are healed as well as they can be by 3-6 months.
When do you feel pain?
Only first 5-10 minutes of workout
Only towards end of workout
First thing in the morning
Only in sleep
Ongoing: day & night
After extended time sitting at desk
Pain varies depending of the tissue & nerve affected. Understanding basic anatomy can help you read your body: muscles cross either one or two joints and pain is usually felt in the belly of the muscle; ligaments attached bone to bone and help stabilize joints, tendons attached muscle to bone so pain is felt distal from a muscle and closer and across a joint; ankle and knee for Achilles and patella tendon.
When nerves are affected shooting pain, numbness, tingling will be felt. A compress nerve in the lower spine for example starts in the lower back and travels down the back leg, meaning the nerve has become compressed, perhaps due to a slipped or worn down disc in the spine.
Keeping track of when and where you feel pain and how its evolving from day to day and week to week is a key component to share with a rebab specialist.
Recovery versus healing:
Complete healing can be achieved without full recovery, and this is all too often the recipe for disaster which results in recurring injuries.
Tissue damage to a muscle or tendon following an ankle strain may be perceived like it’s healing quickly since pain is almost non-existent but still feels weak and hurts when moved in certain ways- but the athlete is back to regular training quickly. This is commonly the result of poor, rushed or no attention to rehab. Often we take for granted what happens on the trail & snow. The likelihood of re-injury is greatly increased since the joint as poor stability and muscles are weaker due to the strain. Unfortunately it is a common pattern with endurance athletes with the pressure of high volume training and competition schedule.
Back on track:
Pain management is about addressing the nervous system, I always encourage athletes to remember what it’s like to move in a safe environment. Fear and anxiety need to be gradually eliminated to ensure full recovery, especially in high speed mountain sports like mountain biking, downhill and ski mountaineering due to variation in snow conditions.
As an athlete you still need to enjoy riding/running/climbing/skiing even if training is limited. Its time to focus on mechanics & drills, joint stability & mobility, muscle balance/ elasticity/ eccentric training, and sports specific exercises.
Learn to have confidence in your skills again.
By reducing training volume and incorporating preventative exercises, recovery is quicker, stress is minimize to the injured/fatigue tissue, it stimulates healing and help remodel tendon, muscle, cartilage and bone. Doing nothing for and extended period of time can be one of the worst thing for healing.
Take care of your body like you take care of your bikes & skis!
Tips when exercising with mild discomfort:
Think of moving forward lightly & quietly
Focus on quality of movement – proper mechanics for sport specific
Keep the legs or arms moving quicker than slower to reduce impact on joints
Listen to your body, focus on sensation
Relax and exhale!
Tips to help manage pain and promote healing & recovery:
Few minutes daily cold spray directly on the affected area before the hot shower!
Put legs up against the wall
Hydrate while exercising : use electrolytes
Healthy meal within 45 minutes of workout
Two days off in a row
Focus on quality vs quantity of training
When pain persist it’s important to seek professional advice from a sport medicine specialist who has expertise in sports rehabilitation and prevention. You know you are in good hands when a proper assessment of mechanics, musculoskeletal imbalances, joint stability and mobility are being tested.
Finding optimal training load to maintain good fitness and/or max performance while stating injury free is key.
Thank you for reading… Chloë
Educational articles for the passionate mountain athlete – New for 2018!
Coming soon, join me:
Injury Prevention Workshop for Snow Sports: uphill & downhill!
Friday November 24th / 19:30 to 21:00 / in Chamonix / 15euros per person