In our recent Success podcast, coach Tom sat down with Dr. Jake Salaba to take about understanding what pain is, the difference between good pain and bad pain, some influences that pain can have on our mentality with a certain lift and some of the variables that can affect confidence just to name a few topics.
Dr. jake is the owner and physical therapist for Ascension physical therapy and owner of Bear fitness. He has been practicing physical therapy for over 6 years and is a member of the Success Health Alliance. He and his team hosted the last SHA event and Dr. Jake had a presentation about the pain experience that we all thought was so interesting and enlightening. So, we invited him onto the podcast to learn more. This is a brief recap of the topics they covered.
The original theory of pain was developed in the 1600’s and it was thought that pain was a result of animals’ spirits tugging on tubes inside our bodies creating pain. This theory stuck until the 1900’s where the biomedical model was developed. This theory was thought that pain in the body resulted from tissues injury or in the head from not psychologically processing the injury correctly when person couldn’t determine where the pain is coming from. Dr. Jake tells us that every pain experience comes from more than just tissue damage. Pain comes from psychological background, social background, history and fears. This discovery leads us to evolution of the biopsychosocial model. This is currently the primary model of pain which is the understand that pain comes from biology, psychology and sociology and all three interact at once to create the pain experience.
So what is pain? Our best understanding is that pain is a threat detection of the perception of pain. This is not necessarily an error code but more of a regulatory feeling.
There is a difference between “good and bad” pain. Dr. Jake speaks about a study that’s goal was to see the benefits of working through pain over trying to avoid pain entirely. There were 3 groups in this study. First group is to avoid all pain, second group is to allow for a small amount of pain, and the third group was to lean into the pain. The results showed of this study along with several other studies that group number two tends to consistently have the best outcomes.
Another topic discussed was about pain relativity. This can be accounted for but there is no exact science behind him. The example given was somebody can have the best day at a particular exercise and do X amount of work before their back starts to hurt but then the next time they could have their worst day lifting because of the number of variables that go into that individual. Meaning their psychosocial variable can be influenced by sleep, fuel, or even a bad conversation leading up to the lift may make it more likely that that back pain can come on sooner due to the distractions.
There is no standard on the right amount of pain. Each person has a completely different background, family history, and how they perceive pain. A novice lifter will tend to shy away from training towards true failure whereas an experienced lifting will be more likely to reach true failure. Why is this? Because the experienced lifter has the confidence to know that they will be okay with the pain of failure and not injury. The experienced lifter also has the perception awareness of what the burn or fatigue means that the novice may not have experienced before.
When talking about ecological inactive, Dr. Jake explains that pain is a sense making experience. He goes on to talk about that if somebody hurts themselves deadlifting or something similar that the pain associated with those and like movements can be negative and inherently dangerous and will end in injury if they attempt those movements again. The experience doesn’t mean the movement is back but subconsciously there is recognition that there is a threat preserved whether it is real or not because there was an injury in the past correlated towards that movement.
Psychosocial variable examples:
-Fear avoidance- avoiding a movement due to perceived threat of injury.
-Pain catastrophizing- the movement has all negative outcomes.
-Hypervigilance- thinking about pain all day
-Pain self-efficacy- confidence in daily activities is affected by pain.
The ones that struggle with more psychosocial variables are more likely to deal with pain in a longer period. This can lead to being anxious and will go hand and hand with pain catastrophizing and fear avoidance.
Moving on to the affordance theory. This is the theory that one will walk into an environment and see what actions are available to them and what aren’t. If someone has had a back injury in the past, they may walk into the gym and see barbells or dumbbells and consider those off limits to them. The affordance piece is the mentality of thinking what action is available to me and what inaction is available. The more decreases of affordances can lead to a less meaning in life or less opportunity for meaningful opportunities because the pain threat is limiting the individual to perform outside of their comfort zone.
The last piece that coach Tom and Dr. Jake touched on is the difference between perfect biomechanical forms and allowing the spine to move in a “extreme” range. Dr. Jake mentions that nobody can squat or deadlift in a truly neutral spine based off research. When talking about a study where workers who have a lot of lifting tasks and looking at efficiency, and comparing a neutral spine comparing the spine to bend that the workers who allowed the bend had a decreased risk of injury and required less energy to expend overall resulting in being more metabolically efficient.
Logical vs evidence based:
Logical:
Perfect biomechanical position is never rounding back, never shrug shoulders, good/bad posture, only lift in a neutral spine, use knees not your back. In certain context this is correct, but the body is never black or white.
Evidence:
Limiting the ways you move is more dangerous than allowing yourself to be in a more adaptable and resilient in other positions.
In conclusion, this awesome podcast covers a ton of great information regarding what pain is, some of the factors that experiencing pain can influence and some of the less talked about ideologies about body positions. Overall, the body is an incredible system and learning how to work WITH it can be greatly beneficial in the long run.
LET’S GROW!!!!!!
To listen to the full podcast with Dr. Jake, click the link below!