When I started training like a powerlifter, I felt great. I was squatting and deadlifting multiple times per week and the resistance was going up by at least 5 pounds per week. This is known as “Newbie Gains” which is a magical time that lasts for the first 9-18 months of a beginner’s strength training program. The program I was following was ridiculously simple yet incredibly effective. I felt like I was beginning to hone in on what “good form” was.
However, my progress eventually began to stall. I was struggling to keep up with the blazing progress I had been making for months prior to. The smart thing to do at this point would have been to adjust the intensity of my planned training sessions. I did not do the smart thing. I decided to grind through this slump in progress. I kept adding weight, reps, and sets. My form and technique began to lose priority. The show must go on, I thought.
Well, the show came to a screeching halt.
It began with deadlifts. What should have been 85% of my 1 rep max was actually closer to 90% and what should have been 3-4 reps turned into 7 reps. That’s right, 90% of 1RM for 7 reps. That’s not being tough, that’s being dumb. After that set, I felt “something” off with my right low back in the vicinity of my SI joint. I wrote it off as a minor tweak and finished my deadlift sets. Little did I know this minor tweak would take me out of the game for almost a year. It was getting worse as the training session progressed. By the time I started squatting, it was like a hot knife in my back.
We can already gather a valuable lesson from this recollection of stupidity: if something feels tweaked or painful, STOP. Also, do not panic. The more you distress emotionally about back pain, the worse it will get.
Over the next few weeks, I wisely abstained from any movement that aggravated my back, which was virtually every lower body exercise I was doing. Actually, this abstinence wasn’t a product of wisdom as much as it was necessity. For better or worse, I am not one to let pain dictate my activity, but this injury literally stopped me in my tracks. It hurt to get out of bed, walk, sit, cough, or sneeze.
As someone who treats back pain, I was pretty convinced that within a month or two I would overcome this and be back on track. But after 4 months of core strengthening, glute activation, active range of motion and mobility work, I was struggling to shed this plaguing pain. I decided it was appropriate to pursue more invasive options. Upon initial consultation, the orthopedic surgeon, the radiologist, and myself were fairly confident in labeling my right SI joint as the pain generator. With that said, we scheduled a CT guided injection (corticosteroids and anesthetics) straight into my right SI joint.
The relief was immediate.
I was able to squat, deadlift, and sneeze pain free. But it was short lived. After the lidocaine wore off in the next 2-3 days, I was back to square one. The silver lining was that although the shot wasn’t therapeutic, it was diagnostic in the sense that we could rule out the SI joint as a pain generator. Fast forward 3 more months, a crazy amount of core stability and glute activation, chiropractic, and physical therapy, I still hadn’t recovered. Another injection was done; this time into the surrounding ligaments/muscle as opposed into the SI joint. I had the same results. As soon as the anesthetic wore off, I was back to square one. However, something profound had occurred to me after my second injection. Something that would lead to my eventual recovery.
Having two failed corticosteroid injections without an ounce of perpetrating evidence given from X-ray, CT, or MRI, I was at a total loss and very frustrated.
But then something dawned on me. It’s now been almost a year since the onset of injury. Nothing structurally can account for the pain (ruled out by imaging and examination). Nothing biochemically can account for the pain (ruled out by the bombardment of anti-inflammatory steroid injections). What’s left?
What’s left is the most important component to chronic pain. Confoundedly, I have always addressed this component with patients who have sought my care, yet somehow failed to adopt it under my own back pain experience.
The component is this: Pain is an experience in response to some kind of tissue damage. This experience is registered by your brain as a threat. This is an effective system the brain uses to deter a person from further aggravation and damage of the affected tissue. In most cases, the tissue heals and the threatening experience subsides. Sometimes, the tissue may heal, but the threatening experience remains where it becomes a self-reinforcing positive feedback loop. Before you know it, the damaged tissues will completely heal, but the experience of threat is just as strong, if not stronger, than when the tissue was originally damaged. This process is known as central sensitization. It literally builds neurological pain circuits that become ever-increasingly easier to trip.
The bad news is that this is a difficult cycle to stop. The good news is that this cycle can be stopped. In fact, the mere thought of overcoming pain is the first step toward its resolution. I will now share with you the techniques that I found helpful in overcoming my experience with central sensitization.
As mentioned above, breaking the chronic pain cycle begins by stepping outside of yourself, observing the cyclic pattern of threat that your body created, and realizing that how you’re thinking about pain could be amplifying the cycle. In other words, continued notions of perceived threat is making it worse. You can consciously choose to stop assigning the feeling of threat to that particular painful stimulus. This is as opposed to “ignoring” the pain; by ignoring the feeling of threat, the painful stimulus still occurs (in fact, you are letting the painful stimulus happen). That’s right, you are letting it happen, not the other way around. You are in control, not the pain. By doing this repetitively, you can learn to change the way you think about pain. The painful stimulus begins to dampen and inevitably goes away, not because you’re ignoring it, but because you are no longer assigning importance to it. Here are some specific examples I used:
Sitting in an office chair, I found that when I lean to the left, I would subconsciously hike my right hip as a protective measure to avoid a painful stimulus. I realized I was assigning threat to that particular movement. So I chose to repeat the movement while consciously relaxing my right hip as I leaned to the left. Sure enough, I received a painful stimulus, but instead of recoiling in a protective manner, I just let the pain happen and hang out in that position for about 15-20 seconds. I would then return to an upright position, and then repeat the left lean. As soon as the second repetition of this, the painful stimulus was decreased. Another 15-20 second hold, then back to an upright position. The more I repeated this, less pain occurred each time until it was virtually gone. I would wait 5-10 minutes before I leaned to the left again. When I repeated it after the 5-10 minute wait, pain did occur BUT to a much lesser degree than originally. I continued this for about a week, after which the painful stimulus was completely gone.
Another example was low back pain while driving. I noticed that I was slumping my low back into a flexed position to avoid pain. Now, we all know this is a bad position to begin with, but when you’re in pain, you don’t care. If I tried to sit up, it felt like a knife jab into my low back. However, with my newfound strategy to show pain who’s boss, I dumped my pelvis into an anterior tilt (i.e. extend my low back). It hurt as usual, but now I was letting the pain happen. After holding the position for 15-20 seconds, I let my pelvis slump back into a posterior tilt, and then again into an anterior tilt. As with the chair lean, the pain was less than the first repetition. I repeated the cycle several more times, waited 5-10 minutes, and retested. Sure enough, the pain was almost undetectable.
Here’s the template: find a movement that you find yourself guarding due to pain. Conduct that movement in a fluid, controlled manner despite the pain it causes. When you find a position within that movement that causes the most pain, hang out in that position for 15-20 seconds. Relax, and repeat. By doing so, you are rewiring your brain to no longer associate fear/threat to that movement even if the pain still occurs initially. It lets your brain know that the pain is not of concern. The registration of pain by your brain diminishes. With time and repetition, the movement that was once painful will become a fluid and controlled movement unaffected by threat or fear.
As you get better, don’t think of it as “The pain is decreasing, therefore I’m getting better.” Don’t give the pain that much respect. Instead, think of “getting better” as your ability to no longer tolerate the pain’s control over your thoughts and movement.
As always, if you have back pain, get evaluated by a licensed physician/therapist. Not every back condition should be addressed the same way. However, if you have back pain and it hasn’t resolved for months, and you have a diagnosis from your physician that wouldn’t contraindicate the above method, ask your physician if it’s right for you.
Don’t sacrifice your form in the gym for making progress in lifting more weight -use Physio F(x)® to ensure proper technique. But if you find yourself injured, and it becomes chronic pain, you need to evaluate how you’re thinking about your pain.