At Central Athlete, clients come to us with a wide range of fitness goals. Some individuals want to lose weight, get stronger, or get out of pain. Generally, though, most of our clients simply want to live well and make health and fitness a consistent part of their lives. While adhering to a set of basic lifestyle guidelines can help someone live a long and healthy life, the people who work with us typically want more.
This is where a progressive resistance training program comes into play. Chances are they’ve experienced one bout or more of delayed onset muscle soreness (or DOMS) from a resistance training session. Coach Tyler dives deeply into the subject of DOMS and its effect in one's fitness journey in this previous article. But what happens when DOMS lasts for multiple days, increases in intensity in a specific area, or affects further training sessions? Is this considered an injury?
Injury occurs when the demand placed on any given tissue (bone, tendon, muscle, ligament, etc.) overcomes the capacity of that given tissue. Here are a few examples: Greg is playing in a soccer game for the first time in five years. Greg goes to cut hard off of his left leg, hears a pop in his knee, and collapses to the ground. He receives an MRI that confirms a torn ACL. The ACL was not accustomed to that specific stress in at least five years and was not properly prepared to withstand it. Since the demand placed on the ACL was greater than the capacity the ACL could tolerate, the ACL gave way. This is a simple explanation of how many tissues get injured.
Let's take another example of a fitness enthusiast named Jessica. Jessica has been back-squatting twice a week, every week, for the last year. Jessica is squatting at a comfortable weight when she suddenly feels a sharp pain in her low back and an immediate dull ache into her right glute. MRI confirms disc herniation at L5/S1 level. Following the MRI, Jessica’s physical therapist identifies a significant limitation in her right hip mobility. Her physical therapist also reviews her old squat videos and notices some significant movement in the low back and a lack of motion around her right hip. In this scenario, it is likely that the repetitive abnormal demand that was placed on the lumbar spine and specifically the L5/S1 intervertebral disc led to the disc giving way.
Two very different scenarios resulted in injury, but they both have one thing in common: The demand placed on the tissue was greater than the capacity of said tissue.
So how do we avoid ending up like Greg or Jessica? Well, ideally we move as perfectly as possible and build up appropriate tissue capacity to support the demands we intend to place on it. Injuries can always be avoided, but sometimes we weigh the pros and cons of performing certain activities to determine if it is worth rolling the dice. For example, Katherine’s friends call her to go axe-throwing on Saturday, but Katherine has not thrown anything since she played softball when she was 10. Katherine knows the tissue around her shoulder is not appropriately prepared to meet the demand of axe-throwing, but she understands that the tissue is incredibly resilient and will most likely be okay as long as she doesn’t throw as aggressively as possible the whole night. The next day Katherine’s shoulder is a little sore, but nothing feels serious and she had a blast with her friends. Every activity we perform has pros and cons with risk of injury. We can prevent injury by appropriately building up tissue capacity to meet the demands our lives place on those tissues.
Katherine was a little sore from her axe-throwing event, but how does she know she is not injured? Think of soreness and injury on a sliding scale. The body is constantly in a state of breaking down and repairing (and building up stronger). Katherine was most likely somewhere in between soreness and injury on that scale. Because the body is incredibly resilient, over the course of three to four days she moves from being closer to injured on the scale to being closer to sore. As an added bonus, her shoulder is now more prepared to meet the demand of throwing. There is no single deciding factor that dissociates soreness from injury (again, think of it as a scale). So before assuming the worst possible injury the next time you have an ache or pain, be calm and ask yourself some questions:
What is the severity of the injury or the severity of the pain?
- If the injury can be categorized as severe (such as a broken bone) or the cause of injury was something traumatic or out of the ordinary (falling off a motorcycle), it is wise to seek professional consultation. If the pain is remaining very high (>8/10) and is not decreasing, it is also wise to seek consultation from a professional.
How long has the pain been present?
- If the pain is moderate to high (5-8/10) for several days, and you have tried self-management techniques, it is time to seek professional consultation.
How much is this pain affecting my daily activities?
- If the pain is moderate to high (5-8/10) for several days and is significantly impacting the activities you perform on a daily basis, it is time to seek professional consultation.
What makes my pain worse? What makes my pain better?
- If there are specific movements that aggravate your pain, it is wise to avoid these movements. If there are specific movements that make the pain feel better, and do not make the pain feel worse later, it is wise to perform these movements. If the pain is constant and does not change any with different positions or movement, it is wise to seek consultation from a professional.
Soreness and injury are on the same scale and the body has the power to repair the injured or sore tissue. The body performs this ability naturally so it is important that the body is functioning as optimally as possible to allow for proper healing (think nutrition, sleep, hydration, mental health). In addition to improving your body’s natural ability to heal, schedule a FREE strategy session with one of our professional coaches and learn specific ways to speed up recovery, such as self-myofascial techniques, specific mobility drills, low-level aerobic work, etc., along with a personalized resistance training and nutrition plan.