Prior Pain and Its Effects on Training

I would say about half, or more, of our athletes have had some sort of major accident or operation in their life. I often learn about these issues during our initial Get Started session. However, sometimes I don’t learn about them until after they have been training for a while. The conversation usually goes something like this: “Oh yeah, I had surgery on my knee/back/shoulder but that was a long time ago, I’m good now mostly. Sometimes my knee/back/shoulder gets a little stiff so I just have to be careful and warm it up.” A confounding issue is that they usually are pretty athletic, so when they are moving everything looks OK. However, when they have to move slowly and deliberately, the movement issue reveals itself. In the words of Gray Cook, they are just renting that movement, they don’t own it.

Here is the deal, we are not the movement police. First and foremost, we are a gym, a strength and conditioning facility. You can’t train if you are hurt. Our job is to keep you healthy and moving competently, not perfectly, so you can train hard. If you have hurt your knee/back/shoulder before, you are more likely to get injured again (see below). We, MDSoF coaches, need to make sure your previous injury is fully healed and you are ready to train hard.

Here is a study that shows when athletes have pain longer than three months they have less “tactile and proprioceptive acuity” which can lead to re-injury. Here are the juicy bits as the poster in the link is some what difficult to read:

Disruption in proprioception can occur as a result of direct trauma to the capsule, labrum, ligaments, or surrounding muscles damaging the mechanoreceptors that mediate normal joint propriocpetion. Even in the absence of trauma, individuals with non-specific chronic upper quarter pain [cervical or upper-extremity] can present with altered proprioceptive acuity of the back seen in chronic low back pain patients. The results of this study re-confirm that a relationship does exist between pain intensity and tactile and proprioceptive acuity.

Given these findings, it may be beneficial to incorporate retraining of a patient’s kinesthetic awareness into a comprehensive treatment program. Incorporating this type of kinesthetic training may provide treatment options for decreasing chronic pain in the upper quarter given the relationship between pain intensity and sensory acuity. As sensory acuity increases with training, the intensity of the pain will decrease as seen in previous studies by Moseley.

Kinesthetic changes may have occurred secondary to [due to] abnormal sensory processing due to chronic upper quarter pain. If kinesthesia is disrupted, muscular control may be compromised predisposing the surrounding body regions to insufficient protective repsonses, possible re-injury and further precipitation of the chronic pain cycle.

You need to take the following two things home with you:

As shown in the discussion above, if you’ve had upper shoulder pain, it can make your low back less stable and make you more likely to get hurt (and vice-versa, if you’ve had back pain, your shoulders will probably suffer too). An chronic injury in one area of your body that is not fully functional makes other parts of your body more likely to be injured.

Because the overhead squat, for example, requires balance, coordination, accuracy and a functional core doesn’t mean that you will get those characteristics if you train that lift. You have to build a functional core, balance, etc. first through appropriate exercises, then train the overhead squat at the proper load. It may seem overly cautious to have such a slow process but we have found over the years that athletes get stronger faster by building a foundation of good movement, then training the lifts (e.g. Back Squat, Front Squat, Overhead Press, Clean, Snatch, etc.) over that foundation, than by just starting to train the lifts immediately.