5/1/2024
The Crucial Role of Sleep in Weightlifting: Enhancing Recovery and Minimizing Aches and Pains
For weightlifters, sleep is more than just rest; it constitutes a fundamental component of their training regimen, crucial for facilitating physiological processes essential for muscle repair and growth...
Dr. Stephen Mayo, DPT
5/31/2024
Overcoming Injury
I want to stress that this is going to be general advice, and not a comprehensive recovery plan for any specific injury. If you cannot address your injury on your own, please speak to me on a 1-on-1 basis so that I can address your injury specifically. I will give some general advice on restructuring your training, but I will not (and cannot) advise on specifics and supplemental rehabilitation work. With that out of the way let’s talk recovery....
Dr. Stephen Mayo, DPT
11/8/2024
Runner's Knee: Patellofemoral Pain Syndrome
Runner’s knee is a common condition that describes pain behind or surrounding the patella, is isolated to the patella, and is non-traumatic. It is important to understand that not all knee pain around the patella is considered patellofemoral pain syndrome. Other conditions that could contribute to knee pain include IT band syndrome...
Dr. Jonathan Bailey, PT, DPT, OCS
11/15/2024
The Truth About Disc Herniations: Breaking Down Common Misconceptions for Lifters
Imagine you’re deadlifting, feeling strong, and then—suddenly—you feel that dreaded sharp pain in your lower back. Disc herniations are one of the most common back injuries, and they often come with a fair share of fear and confusion...
Dr. Stephen Mayo, PT, DPT
11/22/2024
The Brain Behind the Pain: Decoding Your Body’s Signals
Pain. Whether you’re young or old, active or sedentary, a runner or a CrossFitter, flexible or stiff, we’ve all experienced pain. It’s part of the human experience. You may have a specific event you can point to that caused your pain, and other times your pain seems to come from nowhere...
Dr. Stephen Mayo, PT, DPT
12/6/2024
Iliotibial Band Syndrome (ITBS): Understanding and Managing a Common Knee Condition
Iliotibial band syndrome (ITBS) is a common knee condition characterized by pain or tenderness over the lateral knee. It is frequently seen in runners and is the second most common knee pathology in this group. ITBS typically manifests as...
Dr. Jonathan Bailey, PT, DPT, OCS
12/20/2024
To Train or Not?
When to Push Through the Pain
As lifters, we all know the mantra: “No pain, no gain.” But when you’re nursing an injury or dealing with persistent discomfort, how do you decide whether to push through or take a step back?
Dr. Stephen Mayo, PT, DPT
The Crucial Role of Sleep in Weightlifting: Enhancing Recovery and Minimizing Aches and Pains
For weightlifters, sleep is more than just rest; it constitutes a fundamental component of their training regimen, crucial for facilitating physiological processes essential for muscle repair and growth. While the act of lifting weights stimulates muscle development, it is during the restorative phase of sleep that the body engages in significant repair and recovery mechanisms. Sleep should be an absolute priority if you want to maximize the results of the training that you perform in the gym. Let's do a quick dive into the rationale behind the importance of quality sleep for weightlifters and its efficacy in mitigating the discomfort associated with rigorous training sessions.Muscle Regeneration and Hypertrophy: Weightlifting induces microtrauma to muscle fibers, prompting the release of growth hormone during sleep. This hormone orchestrates the repair and hypertrophic growth of muscles. Adequate sleep duration and quality are pivotal for providing the requisite temporal window and metabolic resources necessary for optimal muscle recovery and growth.Connective Tissue Repair and Maintenance: Sleep not only benefits skeletal muscle but also contributes to the repair and regeneration of connective tissues including tendons, ligaments, and cartilage. These structures are integral for joint stability and function. Prioritizing sleep facilitates the restoration and upkeep of these vital tissues, thereby reducing the susceptibility to injuries and discomfort during training.Modulation of Inflammatory Responses: Intensive weightlifting can trigger inflammatory processes in response to tissue damage and stress. While acute inflammation is a part of the healing cascade, chronic inflammation can impede recovery and exacerbate pain. Quality sleep exerts anti-inflammatory effects, regulating the body's inflammatory response and alleviating exercise-induced discomfort.Sleep's Influence on Pain Perception:
Sleep plays a pivotal role in modulating pain perception and sensitivity. Inadequate sleep amplifies pain signaling pathways, thereby diminishing tolerance to discomfort during workouts. By ensuring sufficient sleep duration and quality, individuals can effectively manage pain and sustain training intensity.Hormonal Homeostasis:
Sleep is instrumental in regulating hormones implicated in pain modulation and recovery processes, such as cortisol and serotonin. Chronic sleep deprivation disrupts hormonal balance, culminating in heightened stress levels and compromised recovery. Prioritizing sleep fosters hormonal equilibrium, fostering optimal recovery and performance outcomes.Psychological and Cognitive Restoration:
Beyond its physiological benefits, sleep is indispensable for cognitive restoration and emotional resilience. A restorative sleep cycle enhances cognitive function, stabilizes mood, and fortifies mental resilience. This psychological rejuvenation equips weightlifters with the mental fortitude required to tackle arduous workouts and remain steadfast in pursuit of their objectives.In summation, sleep constitutes an indispensable facet of the weightlifting regimen, indispensable for optimizing recovery, attenuating discomfort, and augmenting performance. If you want to get the most out of the hard work you're putting in at the gym, or you deal with chronic aches and pains, take a look at your sleep habits. Improving these can be life-changing and should be a key priority in your recovery.
Overcoming Injury
I want to stress that this is going to be general advice, and not a comprehensive recovery plan for any specific injury. If you cannot address your injury on your own, please speak to me on a 1-on-1 basis so that I can address your injury specifically. I will give some general advice on restructuring your training, but I will not (and cannot) advise on specifics and supplemental rehabilitation work. With that out of the way let’s talk recovery.If I had to summarize the advice in one sentence it would be this: “Keep moving as much as you can and doing everything that does not hurt”. I am strongly against full rest outside of pretty extreme circumstances, most of which involve life threatening illness and very recent, highly invasive surgery. You need to use your body to make it heal. Complete rest leaves an area weak, with reduced mobility and strength. This is a recipe for recurrent injury. Movement also encourages consistent blood flow and pushes all the necessary components for repair to the affected area. Your body adapts to the demands made of it, so if you never give it any reason to return to full strength, range of motion, and integrity it is not going to use up the resources needed to do so. I am sure someone will pipe up and tell me that this is reckless and dangerous advice, as there is a huge amount of fear when it comes to human fragility, but they are wrong. I have worked through almost every injury I have ever sustained and have helped rehab dozens of clients. I do not think you will find a serious lifter that will advise you take a conservative approach to rehabilitation with lots of rest (granted aggressive and conservative are relative and subjective, so look at the actual recovery plans not just the words used).What does an aggressive, active recovery plan look like? Well, the easiest way to create one is to just take your normal routine and make the bare minimum number of concessions needed to avoid pain in the injured area. First, identify which movement patterns exacerbate the injury. This should not be that hard, you can probably guess what is going to cause pain pretty easily, but it is best to at least test everything with very mild weights to confirm, sometimes you can be surprised by things that don’t hurt when they should and things that do hurt when they shouldn’t.After that, begin the process of identifying the best replacements for, or alterations to, those movements. There are several routes you can take here. The first and easiest is simply reducing load until you can lift pain free. This is always a good option, as you maintain the full movement pattern exactly as it normally is, which helps put pressure on the injured area to return to a state where it can perform that movement. It does not really matter how light you have to go here, just moving is very beneficial and you can progressively overload as the injury heals. I will note that if a movement impacted by injury is the only one you are doing for a certain muscle group, I would supplement that lighter work with a variation or second movement you can perform more heavily, to maintain muscle mass and strength.A second, simple route is to reduce range of motion or substitute in a close variation. Sometimes a problem area can be avoided just by cutting a certain portion of the lift out, usually the bottom. This can also be progressed by slowly reintroducing range. Variant movements can also have the same effect for some movements. Some personal examples for this are box squats and trap bar deadlift. I find box squats a bit above parallel very tolerable when my knee is acting up, and trap bar deadlifts are easy enough on my back to lift heavy during most lower back/glute strains. This will again be a trial-and-error situation, but you will pretty quickly gather a good library of movements that play well with common injuries.The last option is total substitution, when you really cannot effectively do anything like a certain movement pattern. This is one place where machines really shine in my opinion. If you are fortunate enough to have a wide selection of machines to choose from you can often find one that works around almost any injury. While you should probably always include something close to your normal movement patterns for the sake of rehab, a substitution can be a great way to keep your surrounding muscles strong and prevent atrophy while you let something like a joint or supporting muscle heal.Your recovery plan does not need to strictly take one of these options, a combination of all the above is probably a good bet in most situations. Just remember your goal is to get back to where you were, so do not fall into the trap of never shifting back towards the movements that caused your problem at first, just because your new movements are ‘easier’ and more comfortable.You will also want to supplement this adapted training plan with supplemental rehab work in some situations. This can take a few forms. It can include specific isolation work to build up a small, injured muscle/other bit of soft tissue. Or it can be isolation work to build up the muscle and tissue around an injury, so that it can be better supported during the healing process. In some cases, an area that is incapable of properly healing, such as extensive damage to some connective tissues, can be completely circumvented by training redundant anatomy to pick up the slack. Supplemental work can also include stretching or mobility work to regain lost range of motion or allow the body to lift in ways that better leverages the weakened/injured area. This is something that can be just as important as ‘strength’ training, even when not injured, so do not forget to investigate what mobility work might help your specific injury.To go on a brief tangent, I want to really emphasize the potential for overcoming injuries that have not yet healed, or cannot heal on their own, by utilizing redundant anatomy. The human body is very resilient in most circumstances, and very few functions are exclusively carried out by a single muscle/piece of connective tissue. As an example, I have had my fair share of client’s where they have an anterior labrum that is almost completely torn. It will not heal on its own and cannot perform its function of stabilizing the shoulder joint. But with dedicated work to build up the other muscles, ligaments and bits of connective tissue that stabilize the shoulder, many people will be able to achieve full function without reconstructive surgery. This is something that many people do not think about, or even know about. Rehabilitation does not always mean healing the injured area, it just means returning to function. Sometimes that can be achieved without actual healing of the injured anatomy. This is something you will likely want to work with a qualified professional on, but it is a route to recovery that is available in some scenarios. Even if you can eventually heal an area, relying on redundant anatomy during the healing process can let you get back in the game sooner, so it’s worth exploring.Once you have your initial training program and rehab protocol sorted out, progression can also be determined by referring to the prime directive: Do everything that doesn’t hurt. As you heal and your injured area becomes stronger, you will find that more weight, more range, or different movements no longer hurt. That is your sign to push forward and keep on the edge of that pain. It is certainly a balancing act to do just short of ‘too much’, but pain is usually a very accessible assay for where the line of ‘too much’ is. If you are newer and don’t have tons of experience with rehabbing your injuries, I would err on the side of caution and be conservative in your jumps, it won’t delay your recovery too much. But as you get more injuries under your belt you will probably be surprised by how much an injured area can handle when you have a good handle of where just south of too much is. If you are pain free but people are still telling you to calm down and do less, so you don’t hurt yourself more you are probably right where you want to be.Finally, I want to address the mental baggage that can come with injury. It is very common to experience hesitancy with the lift that injured you. While it can seem that the injury is gone in your regular training, there can be reluctance to push that area to its limits for high intensity reps or sets. I have experienced this every time I have tweaked my hip, and it can be frustrating when the lifts impacted are among your favorites/best, like squatting is for me. The best way to get over this mental block, like almost everything else here, is experience. As you are exposed to more and more injuries, and more and more associated fear, the impact begins to blunt. The fear is proven to be baseless enough times that it becomes hard to take too seriously. There is still always a little niggling doubt in the back of my head, but it doesn’t stop me from doing much besides maybe blasting a true one rep max for a while after an injury.This advice is not particularly helpful for those experiencing one of their first injuries, so here are some practical options to combat the fear of re-injuring an area. Your first option is to work with the modified, variant, or substitute movements you used in your recovery. You can work with your regular movements for working sets but throw in some very high effort sets with the alternates. You should be less hesitant about these movements, as they didn’t even cause pain when you were injured, so they can be used to rebuild confidence in lifting heavy.A second option is to work with high rep sets to get intensity for a while, as opposed to high weight sets. High rep sets leave you room for an ‘out’ that high weight sets do not. You can, at any point, choose not to do the next rep and there will be no negative consequences. If you realize mid-set that you truly cannot handle 15 reps you can stop at 13. If you realize you cannot hit the weight you have chosen for your single heavy rep, you have no option but to fail the rep, which is much more likely to come with issues. High rep sets also come with a built-in confidence booster. You just hit the same weight 14 times and your previously injured area is fine, why would it suddenly break on the 15th rep? You can progress this by slowly tapering down the reps as your confidence rises, until you end up on the low rep, high weight ranges.Finally, you can incorporate extended warmups or ramping working sets. This works similarly to the confidence boost I mentioned in high rep sets. If you extend your warmup with more sets, the jump between sets is reduced. Why would your injury suddenly surface after just adding 20lbs, or even 10lbs, when the previous set was fine? This warmup may take a long while so you can also opt to work with ramping working sets instead of straight ones. This is to say that your first working set is the highest weight that you feel comfortable with, then all subsequent ones are just small jumps. You can have a set number of jumps in mind or just play it by ear, depending on how they feel and how easy they are.The theme here is rebuilding confidence in your injured area. And this is accomplished in much the same way that you healed physically; doing as much as you comfortably can, and increasing what you do when you can. It might be a slow process the first time you injure yourself, but much like the physical mending process the mental mending process will become faster with experience. I have very little hesitancy about using my injured areas even when they are still healing at this point. Experience has taught me what I can handle, and it is a lot more than I, and most everyone else, expects.
Dr. Stephen Mayo, DPT
Runner's Knee: Patellofemoral Pain Syndrome
Runner’s knee is a common condition that describes pain behind or surrounding the patella, is isolated to the patella, and is non-traumatic. It is important to understand that not all knee pain around the patella is considered patellofemoral pain syndrome. Other conditions that could contribute to knee pain include IT band syndrome, referral from the lumbar spine, or a specific pathology in tissue surrounding the knee. Runner’s knee is triggered by loading the knee during activities such as running, squatting, stair climbing, or sitting. The aim of this text is to outline why you get runners' knees and how to manage it.Why does it hurt?
Runner’s knee has a common onset of doing too much too soon. The activity doesn’t have to be running, it can be positional (like sitting), or a combination of multiple activities in one. This would be considered an overload injury and load should be altered or managed when pain arises.
The patella sits in a groove called the trochlear groove, and it is surrounded by a tendon. Above is our quad tendon and below is our patellar tendon. The trochlear groove is located on the bottom portion of our femur. When we move our knees the patella should glide and sit comfortably along the trochlear groove. So the quad itself can impact how forces are applied to the patella, but all other structures/tissue that control movement of the femur and tibia can impact what position the trochlear groove is in while we move.Use this analogy to better understand.The patella is a car, the quad is the driver, and the trochlear groove is the road. Traveling will require preparation. You can expect long traffic stops (prolonged sitting), high speed highways (running), twists and turns (pivoting), and various hills (stairs/squatting). The car and driver should be prepared with enough gas, snacks, good tires, and anything else to overcome what they encounter. If not prepared, or stuck on the road too long without breaks, the car or driver could experience problems.So how does this relate to the knee? If you have not been routinely exposed to a specific task, you may not be prepared for its demands. Whether that is long runs, fast runs, sitting for a long time, going up and down a lot of stairs, or some other task that is demanding of the knee. The best way we can reduce our risk of developing patellofemoral pain syndrome is being generally prepared for the various tasks we expect to be performing. This would include routinely performing the task in manageable blocked intervals, and becoming strong in those positions to better handle the task.How to manage it?
So say you felt prepared, but pain still wiggled its way into your knee. What should you do? First, identify the problem or trigger of your pain. Whether it is activity dependent like running, squatting, stair negotiation, or positional like sitting for a long time. Next, alter load by changing training volume or intensity to allow continued training without worsening pain. From there, supplement the reduced load with a rehab plan. This would include gradual exposure to the painful position, likely in a form of resistance training that is tolerable.
For example, if running is the painful trigger, then likely loading the knee while standing on one leg with the knee bent to ~40 degrees of knee flexion will likely be your trigger (common position of the knee while running, but not always the trigger). You could strengthen the quad above and below this position throughout a comfortable range of motion, and load the glute, calf, and hamstring in a single leg variation as well.Workout example: Split Squat working above the painful range, quad extension & hamstring curls machines working below the painful range, single leg RDL, side planks, and single leg calf raises with the knee bent just before the painful range. Perform 2-3x per week aiming for 6-8 sets per week, per exercise.Conclusion
So, pain around the patella could be runner’s knee, or something else. But if you have been exposed to more than you are used to and your kneecap is aching, then patellofemoral pain syndrome may be your issue. Identifying what activity irritates your knee, modifying desired activities to avoid worsening symptoms, and creating a rehab plan to return to what you want to do is your best option.
If you found this article helpful, feel free to sign up for our newsletter, follow us on social media, and reach out if you need help with your rehab journey.
Dr. Jonathan Bailey, PT, DPT, OCS
The Truth About Disc Herniations: Breaking Down Common Misconceptions for Lifters
IntroductionImagine you’re deadlifting, feeling strong, and then—suddenly—you feel that dreaded sharp pain in your lower back. Disc herniations are one of the most common back injuries, and they often come with a fair share of fear and confusion. But the reality is that many misconceptions about disc herniations can lead lifters to stop doing what they love or, even worse, make decisions that delay recovery.In this post, we’ll explore what disc herniations are, clear up some of the most common myths surrounding them, and share actionable advice to help you keep lifting safely.Section 1: What Is a Disc Herniation?A disc herniation occurs when the outer layer of a spinal disc tears, allowing the gel-like center to push out, which may put pressure on nearby nerves.Disc herniations can occur from excessive strain in which tearing can occur in the outer layer of the disc (known as the annulus fibrosis). When these tears occur the center of the intervertebral disc can push through these tears and place excess pressure on the nearby nerves, resulting in pain.As we age our discs lose water content and flexibility, which can increase the risk for disc bulges or herniations. However, many people have disc herniations and don’t experience any pain or symptoms. This systematic review found that approximately 19% of those in their 20s have disc herniations with zero reports of symptoms. This percentage increases with age. It’s possible to have a disc herniation that your body adapts to without any problems.For those who do experience symptoms from herniations, symptoms will typically resolve themselves with or without intervention within 2 months. Disc herniations can often heal with proper care and management, and many people return to full activity, including lifting, after injury.For symptomatic disc herniations it’s common to experience nerve pain into one of your lower extremities including numbness, tingling, burning and stabbing pain.Dispelling the Fear FactorDisc herniations can sound scary, but MOST herniations do not require surgery or even extended time off. Understanding the actual mechanics of the injury can help lifters stay confident in their recovery and make smart decisions.Section 2: Common Misconceptions About Disc HerniationsMisinformation about disc herniations can lead lifters to avoid training or engage in ineffective recovery methods. Let’s tackle some of the most common myths.Myth #1: “If you have a disc herniation, you must stop lifting.”While some rest may initially be beneficial, stopping all movement can actually delay recovery. Engaging in controlled, progressive exercises is often a better approach for long-term healing. Early movement has been shown to be the most beneficial treatment. These movements will likely be painful, but the more you move and perform exercises that you can tolerate, the more quickly you will be able to return to normal exercise.Myth #2: “Disc herniations are caused by lifting heavy or with poor form.”The general public's prevailing thought is that disc herniations result from lifting heavy weights or lifting with poor form. Perhaps there is some truth to this, but we must acknowledge the nuance rather than the face value of these statements.Firstly, everyone’s anatomy is slightly different. So while there are prevailing principles that generally work for most people, each person will lift differently. There is NO PERFECT form. Additionally, every person has a different level of experience when it comes to lifting weights. If you’re someone who routinely trains in the heavier compound movements, you’re probably better adapted to handle heavier weights than someone who the heaviest thing they lift is themselves off of the couch a few times a day.Herniations and low back injuries may occur during loaded spinal flexion, but this is no reason to avoid bending your back in your daily life. The phrase “use it or lose it” holds true here. The more capable you are to handle load in a bent position the less likely you are to hurt your lower back.Many times when someone hurts their back while lifting it’s from ego lifting or trying to lift a weight that they have not prepared their body to handle.Be smart, progress slowly, and if you haven’t deadlifted or squatted for a while maybe don’t try to max out on day 1.Myth #3: “A herniated disc means you’ll have chronic pain.”Chronic pain is a complex phenomenon and usually, a single event does not mean you will have chronic pain (outside of serious injury). Disc herniations don’t always lead to chronic issues, although they can. Chronic pain from an injury such as a disc herniation results from avoidance of activity out of fear of future injury. If you never return to normal activity out of fear, you only reduce your body’s capability to perform similar movements. The negative thoughts associated with this fear can actually lead to an increased perception of pain. That’s why it is imperative to normalize movement within your tolerance. In most cases lifters return to full strength and continue training without pain when they rehab with or without a structured rehab program.Section 3: How to Lift and Recover After a Disc HerniationOverview:Disc herniations don’t have to be the end of your lifting journey. With the right approach, many lifters return stronger and more resilient than before.Gradual Loading:Start with lower weights and gradually increase as your body allows. Controlled, slow progressions are essential.If you want to get back to deadlifting that might mean you have to start with just the bar or even a light kettlebell. THAT’S OK.Be conservative and practice normalizing your movement. Daily walks can be extremely beneficial as well.Listen to your symptomsIf your pain increases drastically during a movement, find a way to modify the movement.
decrease range of motion or load, or do a completely different movement altogether that still targets the muscles you’re trying to work.Slight pain & discomfort is normal during rehab, SEVERE pain is not. You should not have increased pain within a few minutes after performing an exercise, much less the next day.Focus on what you can do:You probably won’t be lifting “heavy” right away. That’s fine, you won’t lose as much strength as you might think, even after a few weeks. What is more important is building your tolerance for movement back to normal. If free weights are too aggravating, do machines. Your muscles don’t know the difference, they only understand stress & load.---Tips for Lifters Dealing with a Disc HerniationHere are some key strategies to keep in mind if you’re working through a disc herniation:1. Seek a Professional Assessment: A physical therapist can assess your range of motion, movement patterns, and develop a personalized rehab plan.2. Modify Your Routine: Focus on exercises that maintain strength without overloading the spine, such as single-leg work, belt squats, or trap-bar deadlifts while your symptoms reduce3. Prioritize Mobility and Flexibility: Include mobility work, especially for your hips and upper back, which can reduce lower back strain, and recovery strategies such as walking, prioritizing sleep & hydration, stress relieving activities4. Listen to Your Body: Pain can guide you in knowing what movements to limit or modify. If something feels wrong, consult a professional before pushing through it.---ConclusionDisc herniations can be intimidating, but they don’t have to put a permanent stop to your lifting goals. By understanding the injury, debunking myths, and implementing a thoughtful recovery plan, you can return to lifting with confidence.What Next?If you found this article helpful, consider following us on social media for more tips on lifting safely and rehabbing injuries. Need help creating a rehab plan? Reach out—we’re here to help you stay strong and pain-free in your lifting journey!
Dr. Stephen Mayo, PT, DPT
The Brain Behind the Pain: Decoding Your Body’s Signals
IntroductionPain. Whether you’re young or old, active or sedentary, a runner or a CrossFitter, flexible or stiff, we’ve all experienced pain. It’s part of the human experience. You may have a specific event you can point to that caused your pain, and other times your pain seems to come from nowhere. It can last a few minutes, days, weeks, or even years. As a Physical Therapist and Coach, I get asked about pain more than anything else. In the lifting world, we like to analyze our movements through a lens of mechanics & physics. We treat ourselves as robots because we assume we can manipulate a specific input and receive a particular outcome. As a result, you’ll often see people trying to move rigidly or look for a mal-alignment hoping to find a “bolt that’s too tight”, or to move in a way that keeps a “screw from coming loose”.Unfortunately (unlike barbell training), these rigid, black/white thought processes can leave you with more questions than answers to your pain or even undesirable results. This article attempts to simplify the very NOT simple concept of pain, and how to deal with it.Section 1: What Even Is Pain?In the traditional sense, pain is viewed through the postural-anatomical-biomechanical model. The idea goes like this:
1. Tissue injury and abnormalities irritate sensory nerves (nociceptors)
2. A signal is sent along “pain fibers” to your spinal cord. This allows for immediate reflexes to occur without thought (think of the automatic reaction you have when you pull your hand away from a hot stove).
3. The signal travels up your spinal cord to the pain processing centers of the subconscious and conscious parts of your brain
4. You perceive the intensity of the pain based on the irritating stimulus, where you attach a negative interpretation of the signal (you formulate knowledge that if you touch a hot stove, it will be hot so you know better to not touch it in the future).This process is simple and it makes sense, especially in the case of an acute injury. Such as when you step on a nail or break your arm from a fall. This explanation of pain has become so embedded in how we view pain that even without a clear and obvious event, it’s not uncommon for someone to get imaging, injections, or even surgery in the case of severe pain to find clear objective answers or evidence to why your pain exists. So how do we explain pain when there aren’t clear and obvious sources for your pain? Most injuries will heal themselves within 6-12 weeks, but many people still have pain long after these healing timelines have occurred. Pain that exists outside of these healing timelines usually represents a situation where the PAIN is the problem and the previously injured tissue is not the problem.Huh?This is where the traditional model for pain starts to erode, especially in the case of chronic pain that persists months or even years after an initial injury has occurred. It erodes even further as more evidence presents itself of people walking around with “abnormal” findings such as arthritis, disc bulges, structural differences such as leg length differences and joint degeneration WITHOUT experiencing significant pain. But what makes these people WITH abnormalities and no pain different from those who do have chronic pain?Section 2: Enter the Bio-Psychosocial ModelLet me introduce you to a better model of pain neurobiology known as the BIO-PSYCHOSIAL MODEL (the what?). It’s clear that pain is much more complex than the traditional model where the body is viewed as a series of levers, nuts, and bolts; assuming if there is an abnormality you can simply correct the abnormality to fix the pain. The reality is that our brain creates perceptions of pain based on learned experiences and information. In short, our body sends signals up to the brain for processing and the brain simultaneously sends signals downward which allows our nerve endings to fine-tune our interpretation of sensory signals.It does this largely in part to:1. Our Environment. Such as if you’re in imminent danger, sitting on the couch, depressed, anxious, confident, stressed, happy
2. How Long The Pain has been present. Seconds vs YearsIn this way the bio-psychosocial model for pain states that our pain is a culmination of psychological, social, and physical factors.In short, pain is a projection of what our brain tells us.Where the mechanical model views the body as a machine that can correct abnormalities for pain relief, the bio-psychosocial model views the body as a living organism that is largely affected by the environment in which the organism exists. This is why one person might barely notice the prick of a needle during a blood draw and another person will experience anxiety, 10 out of 10 pain, and scream in agony during the same blood draw despite the injury to the tissue being identical. Someone with chronic low back pain who experiences frequent “flare-ups” might become so afraid of making their pain worse that their brain may “learn” to hurt with less range of motion, and with a lower pain threshold. The brain can create associations with a particular movement that has been painful in the past and attach it to all movements that could potentially trigger that pain. These negative associations and fears typically intensify the longer that a person has been experiencing their pain. To the point where bending over to tie their shoes might become excruciatingly painful.Section 3: Repetition Builds Confidence, Avoidance Establishes FearOk, so we’ve talked about a bunch of woo-woo brain stuff and that’s all well and good but that’s not why you’re here. You're here because you have pain and want to know what you can do to address that. Unfortunately, we still haven’t quite figured this out in the medical community. You might be dealing with back pain and could hear a dozen different reasons why you’re hurting. A chiropractor might tell you that your spine is out of alignment, a PT might tell you you just need to squat more because you’re weak, a massage therapist might tell you that you have tight hamstrings and a surgeon might tell you that you have a degenerated disc that needs replaced. All of them could provide very educated, scientific, and sincere explanations of why you’re hurting and how they can fix it.There isn’t a single one-answer, and this is a topic that full books can (and are) written about. But, if we keep the bio-psychosocial model in mind, here are a few general steps that you can take to manage your pain.Disclaimer: this is outside of the presence of medical emergencies & (some) acute injuries
1. Managing stress, anxiety, and depression as much as possible (very difficult and much easier said than done).
2. Education about back pain that it is simply an output from your brain about a perceived danger, and does not typically indicate tissue damage.
3. SLEEP. Make sure you get adequate sleep (this will help step 1)
4. Avoid the use of NSAIDS, muscle relaxers and opiates as this will only mask the pain without ever addressing it (although they may be helpful in the very short term usage)
5. Exercising & training through previously perceived dangerous ranges of motion to build mental and physical resiliency to increase your body’s capacity and decrease any perceived fears of movement.
6. Continue participating in normal activities and AVOID IMMOBILITYThere’s nothing wrong with going to see a chiropractor, PT, massage therapist, or any other adjunct treatment, each one of them may help you. Just exercise caution if any one of them speaks in absolutes or that they know the SINGLE cause for your pain or worse if they try to sell you on a single process to fix your pain. Current evidence shows that any general exercise intervention will help decrease your pain (even just walking). My preference for treatment is to utilize resistance training along with pain education. There are clear benefits of resistance training such as maintaining lean muscle mass, bone density, and strength to perform activities in life with a more resilient body. Having a strong resilient body provides a level of confidence that you are capable of performing activities even in the presence of pain, which can be very beneficial for decreasing pain. If you have suffered an injury or are dealing with chronic pain the most beneficial thing you can do is to try to maintain as positive of an attitude as possible. Understand that pain and injuries are normal, and these things happen. If you play basketball long enough, you’ll likely sprain an ankle. The same thing can be said about any physical activity. Most injuries will heal themselves within 2 months regardless of what you do for treatment. Modify activities as needed, but don’t avoid activity altogether. Find ways to still remain active. Doing these will be extremely beneficial for returning to normal activity and decreasing any anxieties that you may have towards a specific movement. Confidence is built through repetition, fear is built through avoidance.ConclusionI’m a physical therapist and strength coach, and I just spent the last (a lot of words) saying that pain is likely not a result of mechanics and abnormalities, but that does not mean they do not matter. Biomechanics do matter, especially when moving under load. That is a topic for another article. Important take-aways from the article are1. Our brain creates perceptions of our pain based on our past experiences and perceptions which can intensify our pain sensation2. Understanding that pain is an output of our brain & does not always indicate tissue damage3. Avoiding immobility, fostering an environment of activity, and maintaining healthy life habits can help manage stress levels thus reducing the risk for developing chronic painCall to ActionIf you found this article helpful, feel free to sign up for our newsletter, follow us on social media, and reach out if you need help with your rehab journey.
Dr. Stephen Mayo, PT, DPT
Iliotibial Band Syndrome (ITBS): Understanding and Managing a Common Knee Condition
Iliotibial band syndrome (ITBS) is a common knee condition characterized by pain or tenderness over the lateral knee. It is frequently seen in runners and is the second most common knee pathology in this group. ITBS typically manifests as a sharp or burning sensation that worsens with repetitive knee-bending activities, such as running, cycling, or climbing stairs.Some individuals with ITBS may also experience clicking or popping at the lateral knee when bending or straightening it. While this clicking or popping isn’t always accompanied by pain, it can occur. However, not all cases of knee clicking or popping indicate ITBS; it’s just one potential symptom associated with the condition.Causes and Risk Factors
The exact cause of ITBS is unclear, particularly when examining biomechanical factors. However, we do know that activities involving high repetitions of knee bending and straightening, such as running or cycling, increase the risk of developing ITBS. Rapidly increasing intensity or volume, performing interval training, and weakness in the knee extensors, flexors, and hip abductors can further elevate this risk.Treatment and Management
When treating ITBS, I often recommend a combination of activity modification, pain modulation, and progressive strengthening. Here's a detailed outline:1. Activity Modification
This involves reducing or pausing irritating activities and incorporating cross-training to maintain fitness while minimizing symptoms. Short-term interventions like taping or orthotics may also be helpful.2. Pain Modulation: Soft Tissue Work and Stretching
The goal of soft tissue work and stretching is to reduce discomfort temporarily, creating a window of reduced pain that allows strength training to be more effective.
Soft tissue work: Foam roll the lateral glutes, lateral quads, and hamstrings for 1–2 minutes each.
Stretching: Stretch the glutes, quads, hamstring, hip flexors or any other muscle that feels tight for 1 minute each immediately after foam rolling. You don’t have to stretch all of them, and if you’re pressed for time just stretch your glutes.3. Strengthening Exercises
Strengthening is the most critical part of ITBS rehabilitation. Begin with exercises targeting the glutes, quads, and hamstrings:
Glute exercises: Side plank hip dips or banded lateral walks. For banded lateral walks, place the band around the midfoot and keep the knees slightly bent, just above or below symptom aggravation.
Quad exercises: Lateral step-downs (within a pain-free range), wall sits, or lengthened partials on a knee extension machine.
Hamstring exercises: Good mornings, single-leg Romanian deadlifts (RDLs), single-leg glute bridges, or hamstring curls in a shortened partial range.Rehab Program StructureFor the first two weeks, perform the following routine 2–3 times per week:
Foam roll lateral glutes, quads, and hamstrings (1–2 minutes each).
Stretch glutes and tight muscles (1 minute each).
Pick 1-2 exercises for each muscle group and perform each strengthening exercise for 2 sets of 6 reps.
Each training session, increase the reps by 2. When you reach 12 reps, add a third set and drop back to 6 reps per set, continuing until you can perform 3 sets of 12 reps for all exercises.4. Reintroducing Activity
Once strength levels have improved and symptoms are better controlled, begin reintroducing the activity that caused pain, such as running or cycling. Start with small, manageable bouts of activity and progressively increase intensity and volume. During this phase, reduce strengthening exercises to 2 times per week and incorporate plyometric movements 1-2 times per week to prepare for higher demands.Plyometric structure
Pick a set distance to perform all exercises (~50 meters). Perform each exercise down and back. Perform in a circuit style for 2-5 rounds depending on symptoms and how you feel. Pick an intensity that does not aggravate symptoms. You may need to start at a low intensity and build on that each week.
Circuit A: Warm Up
A - Skips
Quick High Knees
Butt Kicks
Circuit B: Workout
Forward Bounds
Lateral Bounds
Broad Jumps
Build up SprintsRealistic Expectations and Timeline
Rehabilitation timelines for ITBS can vary significantly. Research suggests that:
44% of individuals can return to their sport within 8 weeks with conservative treatment.
92% can return within 6 months.
These are general estimates, and individual recovery depends on factors like fitness level, symptom duration, and adherence to the rehab plan. It’s important not to bind recovery to a rigid timeline. Instead, approach rehab with patience and optimism, knowing that over 90% of people fully recover without significant medical intervention or surgery.Final Thoughts
ITBS can be a frustrating condition, but with the right combination of pain modulation, progressive strengthening, and gradual reintroduction of high-repetition activities, most individuals can make a full recovery. Focus on consistency, listen to your body, and allow yourself the time needed to get back to your sport without pain.
Dr. Jonathan Bailey, PT, DPT, OCS
To Train or Not?
When to Push Through the Pain
To Train or Not? When to Push Through the PainAs lifters, we all know the mantra: “No pain, no gain.” But when you’re nursing an injury or dealing with persistent discomfort, how do you decide whether to push through or take a step back? Navigating this fine line is crucial to your progress and long-term health. That’s where the “traffic light system” comes in—a simple framework to help you make smart decisions about your training.The Traffic Light System
When it comes to pain, not all sensations are created equal. The traffic light system is an easy way to evaluate whether it’s safe to continue training or time to modify your approach.Green Light: Keep GoingGreen represents little to no pain. You may feel a slight twinge or discomfort, but it doesn’t interfere with your performance. Importantly, any pain should return to baseline (or disappear entirely) once you finish the exercise. This is your body giving you the all-clear to proceed.Examples of green-light pain:- Mild tightness during warm-ups that eases as you move.
- A little soreness in previously injured areas that doesn’t worsen during the lift.Key takeaway: You’re good to go! Stick to your program and monitor how you feel.Yellow Light: Proceed but Pay AttentionYellow represents mild to moderate pain. You might notice some discomfort during a lift, but it’s manageable and doesn’t significantly alter your form. The key here is that your pain subsides shortly after your set—within a few minutes.Examples of yellow-light pain:- Shoulder discomfort during pressing movements that don’t worsen set by set.
- Some back stiffness during deadlifts that feels better with mobility drills afterward.Key takeaway: Be mindful. Adjust your intensity or modify the movement if needed, but you don’t have to stop training entirely.Red Light: Stop ImmediatelyRed represents significant pain. This is the kind of discomfort that forces you to compensate, changes your form, or persists long after your workout—possibly until the next day. Red-light pain is your body’s way of signaling that something isn’t right.Examples of red-light pain:
- Sharp, shooting pain during a squat that doesn’t ease up.
- A deep ache in your shoulder that lingers overnight after bench pressing.
- Pain during an exercise that results in a drastic change in form during the movement
- unable to perform the movement due to intense painKey takeaway: Stop the exercise, assess the issue, and if able, find an alternative movement to target the same muscles without aggravating the pain.Adjusting Your Training PlanDealing with pain doesn’t mean you have to abandon your goals. Often, you can still train the target muscle group with alternative exercises that are more tolerable.FOR EXAMPLE- Bench Press: If your shoulders hurt during a barbell bench press, try a neutral-grip dumbbell press or a floor press to limit the range of motion.
- Deadlift: If your back protests during conventional deadlifts, try Romanian deadlifts, trap bar deadlifts, or even single-leg variations. You can also always lighten the load to a tolerable weight
- Squat: If knee pain arises during back squats, consider front squats, goblet squats, or box squats to reduce strain.The goal is to stay active while respecting your body’s limits. Training around pain, rather than through it, allows you to maintain progress without making your injury worse.When to Seek Professional HelpIf you’re frequently encountering red-light pain or struggling to find tolerable alternatives, it’s time to consult a professional. As a physical therapist, I specialize in helping lifters rehab injuries and return to lifting heavy pain-free. Whether through targeted exercise programming, dry needling, or movement assessments, there’s always a path forward.Final Thoughts
Pain is a natural part of training, but understanding how to respond to it is critical for staying healthy and strong. The traffic light system is a simple yet effective tool to help you decide when to push, when to ease up, and when to stop. Remember: consistency is key, and the best way to stay consistent is to train smart.If you’re navigating pain and need guidance, don’t hesitate to reach out. Together, we can develop a plan to keep you moving forward.Stay strong,
Dr. Stephen Mayo, DPT
Dr. Jonathan Bailey, PT, DPT, OCS