Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
126: Are You a Pain Avoider or a Pain Endurer?
270 Plays2 hours ago
In this episode, Sarah looks at two broad pain patterns, people who tend to push through pain and people who tend to avoid it, and explains how each one can shape your relationship with exercise. Before getting into those categories, she lays out a key foundation of modern pain science: pain is not a simple one-to-one signal of tissue damage. Instead, pain is a subjective experience shaped by the brain’s interpretation of threat, context, past experiences, beliefs, and emotions. She also explains why the common zero-to-10 pain scale is often misunderstood, what it is useful for, and why phrases like “I have a high pain tolerance” or “my pain is a 10 out of 10” may not communicate what people think they do.
From there, the episode walks through the fear avoidance model, pain catastrophizing, and the avoidance-endurance model to explain why some people stop moving the moment something feels wrong while others ignore pain until it becomes a much bigger problem. Sarah breaks down the strengths and liabilities of both patterns, including how pain avoiders can become deconditioned by steering clear of normal exercise discomfort and how pain endurers can blow past clear warning signs and delay recovery. She also talks through how these patterns show up in real life, how to tell which direction you tend to lean, and how better pain literacy, gradual progression, and thoughtful exercise programming can help you recalibrate your response to pain without swinging all the way to the opposite extreme.
FOLLOW @themovementlogic on Instagram
FOLLOW @themovementlogic on YouTube
Sign up here for the Movement Logic Free Barbell Mini Course
RESOURCES
Recommended
Transcript
Introduction: Challenging Outdated Concepts
00:00:00
Speaker
I'm Laurel Biebersdorf, strength and conditioning coach. And I'm Dr. Sarah Court, physical therapist. With over 30 years of combined experience in fitness, movement, and physical therapy, we believe in strong opinions loosely held. Which means we're not here to hype outdated movement concepts.
00:00:15
Speaker
or to gatekeep or fearmonger strength training for women. For too long, women have been sidelined in strength training. Oh, you mean handed pink dumbbells and told to sculpt? Whatever that means, we're here to change that with tools, evidence, and ideas that center women's needs and voices. Let's dive in.
Understanding Pain Relationships
00:00:45
Speaker
Welcome to the Movement Logic Podcast. I'm Sarah Kort. I'm a physical therapist, and we are going to be talking about pain today. More specifically, we're going to be talking about your relationship to pain.
00:00:58
Speaker
And we're going to categorize that relationship broadly into two categories. people who endure pain and people who avoid pain. I have a feeling as soon as you heard those two options, you probably immediately knew which one you were in. But let's see, we're going to break it down a little further.
00:01:18
Speaker
But before we get into that, I just want to remind you that you can get our barbell mini course if you give us your email address. It's a pretty good deal. You give us your email, we give you an introduction to how to use barbells for your deadlift, for your squat, for your bench press. We break down all of the concepts.
00:01:38
Speaker
and parameters and things like that that you need to understand in order to be successfully lifting weights. We give you form instruction. We give you a lot. And in return, you give us your email. Now, you may feel like that's a lot to give to somebody, and sometimes it is, but we're not obnoxious. We don't send out a zillion emails all the time promoting products and nothing else. We send you really good, informative content, And you also hear about discounts and you hear about new courses. We have a new course coming up very soon.
00:02:13
Speaker
Don't you want to hear about it? I mean, you're listening to this podcast, so you're going to hear about it because we talk about our stuff. But if you want the discount for the course, you'll want to get on our mailing list, right? So I think it's a pretty good deal.
00:02:25
Speaker
Email address for Barbell Mini Course plus useful content plus discounts on future offerings. So go get it. The link is in the show notes, or if you follow us on social media, the link is in our bio where the link always is.
00:02:43
Speaker
All right,
Neuromatrix Theory of Pain
00:02:44
Speaker
let's get to it. So there are people out there who will run a marathon on a stress fracture. And there are people out there who will stop exercising the moment something feels even mildly uncomfortable.
00:02:59
Speaker
Whatever the reasoning is these two types of people are reacting to their pain in completely different ways. So we're going to talk about these two broad patterns. pain endures, which is so hard to say, and I'm going to have to say it so many times. It makes me think of rural drrr from 30 Rock.
00:03:18
Speaker
Pain endures and pain avoiders. And understanding your thought process behind which one of these you are is probably going to help you change if we need to.
00:03:32
Speaker
how you approach exercise. Before we talk about pain endures and pain avoiders, we need to step back for a moment and really clarify what pain is and especially what it isn't.
00:03:44
Speaker
Here's what pain isn't. Pain is not a direct correlation of tissue damage. There is no empirical scale that says this much tissue damage equals this much pain.
00:03:56
Speaker
And if that's something that you already knew and feel is maybe obvious, I literally just explained this to a client of mine last week and it blew her mind. She had no idea.
00:04:07
Speaker
Pain is a subjective experience, right? It is produced by the brain. It's influenced by the context in which it's happening. And it doesn't always match what's actually taking place in your body physically.
00:04:22
Speaker
So the short version of what happens when we feel pain. And if we're talking about acute pain, like an injury or a new trauma to a tissue, the process that happens is this. Your body sends a signal to your brain that something potentially harmful is happening.
00:04:39
Speaker
But that signal is not what we would call pain. The signal is basically a noxious input. It's saying something's not right. What do we think about this? And so your brain takes that information and it asks the questions, is this dangerous?
00:04:56
Speaker
Does this require some sort of protection? And are we going to call this pain? And this is how pain is described in what's called the neuromatrix theory of pain.
00:05:08
Speaker
Pain is an output from your brain, not an input So your brain integrates the signals it's getting about this noxious thing, and then it kind of holds it up to your past experiences, your beliefs around what pain means, your emotional context in that moment, your life context in that moment.
00:05:27
Speaker
And then it decides, okay, is this pain or is this not pain? So one of the things, I mean, there's so much, I could spend the whole hour just talking about this, but one of the things that's really interesting is the exact same physical stimulus can feel completely different depending on the situation.
Case Study: Neck Pain Triggered by Showering
00:05:43
Speaker
So for example, you're in a championship game and you get a cut on your finger. You're in this situation where you're really focused. You're not paying attention to the cut on your finger. You're completely distracted by what else is going on.
00:05:59
Speaker
But let's say you got that same cut while you were just sitting at home, scrolling on your phone. There's not a lot of distraction there. And so you're gonna be much more aware of that cut and how it feels.
00:06:11
Speaker
Let's say you're lifting a heavy weight and it feels like a lot of effort. What you might think of as like good pain that you're expecting. So you're okay with that. Your brain doesn't set off the alarm bells.
00:06:23
Speaker
But if you're doing the same movement and you get like a sudden sharp pain, that's an indication to your brain like, oh wait, no, something's wrong. So the the type of the pain you're experiencing can also change how you interpret it.
00:06:37
Speaker
A new injury, right, when you suddenly hurt yourself is a very scary thing probably high amount of pain. Let's say you, like I did one time, dropped your motorcycle on your ankle and felt it twist in real life in slow motion, because a lot of those things feel like they're happening in slow motion. That was very scary and it was very painful.
00:07:00
Speaker
But once I was in the sort of rehab process, I would get that same pain, but it wasn't so scary because i was managing it with my behavior and I was expecting it to hurt sometimes.
00:07:13
Speaker
So pain is is experienced and shaped by the meaning around it, not just by the mechanics of what took place. One of my teachers in PT school told us a story about a patient of his. And just as a warning, this is an extreme example of a very intense emotional experience. So he had a patient who would get pain in her neck, but only in the shower.
00:07:41
Speaker
And It was weird because he would be like, the why would the shower be the reason she got her pain? Was it because she moved her neck in a certain way? Was it because she was washing her hair and had to tilt her head back? No, no, no, no, no. none of There was no physical explanation. There was no mechanical explanation for why she was suddenly having this pain in the shower. She just did.
00:08:01
Speaker
And then he talked a little bit more with her about her medical history. And the reason she was seeing him was that she had been the driver in a car accident. And in that car accident, the passenger, who was her friend, had died, and she did not.
00:08:19
Speaker
And she had to sit in the car next to her friend while they used the jaws of life to get her out of the car. Really stressful, very traumatic, horrible experience for this woman.
00:08:32
Speaker
What he then learned from her was that she had a cut on her head, and the cut was dripping blood onto her neck, upper neck shoulder area.
00:08:44
Speaker
So while she's sitting there in this incredibly traumatic situation, she's feeling this dripping wet sensation on her neck. And that was why when she took a shower, her pain came back.
00:08:57
Speaker
Again, very extreme example, not something that you're going to run into typically, but I think a really good illustration of how much your brain's interpretation of what is going on determines the amount of pain that you are feeling.
00:09:13
Speaker
So you may be familiar with the pain scale, where you rate your pain from zero to 10, zero being no pain at all, and 10 being the worst pain you could possibly imagine.
Limitations of the Pain Scale
00:09:25
Speaker
But the situation with the pain scale is a lot of people don't like it. I don't love it. I don't use it very much. And the reason is a six for me or a six for you is not a six for someone else.
00:09:39
Speaker
Because pain is so subjective, it's not useful to try to compare my six out of 10 pain with your six out of 10 pain. There's no objective pain. Delineation, there can't be because pain is so subjective. The only thing it's actually useful for is comparing you to yourself over time. As in last week, it was a six out of 10. This week, it's a four out of 10, right? That way you can track, is it getting worse? Is it getting better? Is it staying the same? In my opinion, that's really the only use for the pain scale.
00:10:08
Speaker
And I've seen plenty of examples of people who don't understand the pain scale and kind of misappropriate purposefully or not.
00:10:20
Speaker
So if you are the kind of person who have said, or if you have said in the past, I have a high pain tolerance or the flip, my pain is a 10 out of 10. Neither one is actually communicating what you want to communicate probably.
00:10:36
Speaker
If you've ever said, i have a high pain tolerance, and I include myself in this, I used to be like, I have high pain tolerance. The people who say that, we tend to romanticize it or carry it around like it's some sort of badge of honor. right You're so brave that you can tolerate that much pain, but that's not really what comes across. People who I've encountered in the PT world where they tell me i have they have a high pain tolerance, to me, that's just an indication that I'm going to probably have to tell this person not to overdo it.
00:11:03
Speaker
It tells me that you are good at ignoring things and pushing through things. it's It's unlikely that you're not experiencing pain. You're just very good at ignoring it when you feel it.
00:11:15
Speaker
The opposite, my pain is a 10 out of 10. In the medical world, that can be read as drug-seeking behavior. because it suggests that your crappy drug, right, your Tylenol or whatever that you were going to give me is not going to cut it because my pain is a 10 out of 10 and I need harder drugs. So that's that's something that you may want to stop saying if you've ever said it. The people who come into the PT clinic or come see me for physical therapy and tell me their pain is a 10 out of 10, what that tells me is they actually don't understand the pain scale and we need to recalibrate it. But that also might be an indication of someone who is very afraid of pain. And so as a result, everything's a 10 out of 10. Typically, I would say something like, oh, well, so a 10 out of 10 is the equivalent of a rusty fork being stabbed in your eye.
00:12:08
Speaker
Is that what you're feeling? And then often people are like, oh, well, no, it's more like a 7. This is a total aside, but I have to go to CPR training courses regularly. And one time, I don't know why this guy got into this. I think he was just excited. I was the only person in the class.
00:12:24
Speaker
And he told me, so I'm going to tell you. Speaking of getting stabbed in the eye with a rusty fork, if you ever come across someone who's got something stabbed in their eye, you know, as as you do, the first thing you want to do is actually tape over their other eye because you don't want them looking around because they're going to look around with both eyes, including the one that's got something stabbed in it. So just a little tidbit for the day. There's your important life information that you're definitely going to need somewhere down the
Fear Avoidance Model
00:12:55
Speaker
line.
00:12:55
Speaker
One thing I want to say as well, just sort of as a caveat to this conversation is that chronic pain is kind of its own category. These concepts of pain avoidance and pain endurance definitely do apply to chronic pain, but it is a it is a much more complicated psychological issue that requires a lot of reframing and can, for that reason, can be very hard to treat. Some of the people that's been the most challenging for me to work with have been people with chronic pain. Because rather than just avoiding or enduring, it's now, yeah there's so many different levels of so many complicated things going on.
00:13:34
Speaker
So this conversation may not apply to someone who's going through a chronic pain situation. Okay, if pain was just this completely objective experience, we wouldn't be having this conversation.
00:13:47
Speaker
But because pain is subjective, some people interpret it as a signal to stop immediately. Other people interpret it as a something to just push through. And that's why we get these pain avoiders and pain endures. They're not just behaving differently, they're experiencing and interpreting the same signals differently.
00:14:08
Speaker
Now there is science behind these patterns. People have tried to come up with models to explain these patterns. So let's talk about a few of these models that exist. The first one we're going to talk about is something called the fear avoidance model of pain.
00:14:24
Speaker
The fear avoidance model of pain is a psychological framework, and it explains how individuals may develop and maintain chronic pain through maladaptive fear-based responses.
00:14:36
Speaker
So this is one category where we can talk about chronic pain. It was introduced by Latham et al. in 1983, and it was elaborated on by Villehen and Linton in 2000. I'll include those in the show notes.
00:14:51
Speaker
The basic concept of the model is that individuals interpret pain either as non-threatening, no big deal, or catastrophic. The people who catastrophize pain, they see it as a sign of severe harm.
00:15:05
Speaker
They experience an increase in fear and anxiety. And this increase in fear and anxiety leads to avoidance of the movement or activities that are perceived as painful.
00:15:17
Speaker
This in turn is going to then cause physical deconditioning, potentially social withdrawal, right? So you're not exercising because it hurts. You are getting more decondition in your body. You may be not saying yes to going out with your friends because you're afraid of moving, right? And so this cycle just becomes this like Ouroboros, right? The snake eating its own tail is just reinforced in this circle of you had the pain, your interpretation of the pain was that it was negative.
00:15:51
Speaker
It's giving you anxiety. You're creating a lot of fear and catastrophizing thoughts. Therefore, you avoid the pain. Therefore, it causes more physical disability. Therefore, that in itself gives you more pain and it just goes on and on.
00:16:05
Speaker
So in essence, the fear avoidance model underscores how your psychological interpretation of pain will shape how long it persists for and how impactful it is on your life.
00:16:17
Speaker
So this then guides our understanding of people who are going through this and then creating evidence-based pain management. There's a lot of cognitive behavior approaches, graded exposure therapy, things like that.
00:16:31
Speaker
And it's not to say that as a movement professional, you can't help with this, but because so much of it is psychological, unless you you yourself are also a psychotherapist or a psychologist, a lot of the treatment for this is going to be out of your scope of practice. It is within the scope of practice of physical therapists, because we are allowed to work on physical conditions with the intent of improving psychological conditions. but I'm not going to have a patient come in and i'm have them sit down and we're going to talk our way through your pain. I am using PT interventions, but understanding their implications psychologically.
00:17:09
Speaker
Some people don't like this model. They argue that it oversimplifies how pain is multidimensional and it underemphasizes the biological and social factors. And there are revised models that incorporate more contextual factors, which then align more with broader biopsychosocial frameworks of pain.
00:17:28
Speaker
But the idea essentially is that when people interpret pain as dangerous, they begin avoiding movement. And this avoidance leads to reduced activity, deconditioning, increased disability, and sometimes more pain from that reduced activity, which creates this self-reinforcing cycle.
00:17:48
Speaker
Now, Part of that behavior is pain catastrophizing. Pain catastrophizing is a psychological construct describing a maladaptive pattern of thinking and feeling in response to pain.
00:18:01
Speaker
It involves an exaggerated negative mindset where pain is interpreted as overwhelmingly threatening or uncontrollable, which then heightens your emotional distress and your perceived pain intensity.
00:18:13
Speaker
This was developed in cognitive behavioral pain research from the early 90s. There is an assessment tool, and I'll include that. It's called the pain catastrophizing scale.
00:18:26
Speaker
So when you are catastrophizing about pain, there's three essential cognitive emotional processes that you're going through. One is rumination, which is like persistent focus on the pain and its implications, right? You kind of get stuck in your head just thinking about it.
00:18:43
Speaker
One is magnification, which is the overestimation of the threat of this pain. And the last is helplessness. There's a perceived lack of control over your pain outcomes.
00:18:55
Speaker
And these patterns amplify these emotional and psychological pain responses. And it, again, just maintains this cycle of pain. So the pain catastrophizing scale is a 13 item questionnaire that quantifies catastrophizing across these three sub domains of rumination, magnification and helplessness.
00:19:15
Speaker
If you have a higher score, it correlates with greater activity in the brain regions associated with emotional pain processing, like the anterior cingulate cortex and the insula.
00:19:26
Speaker
So this suggests that there is a neurocognitive basis for how this maladaptive appraisal intensifies the perception of pain.
00:19:38
Speaker
And again, the main intervention approaches are psychological, like cognitive behavioral therapy. There's another type called acceptance and commitment therapy.
00:19:49
Speaker
And there's also mindfulness-based stress reduction. And all of these methods teach reframing more awareness of the present moment and more adaptive coping strategies that help to reduce that emotional reactivity to pain.
00:20:06
Speaker
So the takeaway from the behavior of catastrophizing is that the more threatening someone perceives the pain to be, the more disabling it tends to become because people get stuck in this loop.
00:20:18
Speaker
So the fear avoidance model, the first one I spoke about, explains why some people stop moving when they have pain. The avoidance endurance model explains why other people do the exact opposite and keep pushing.
00:20:32
Speaker
Both can lead to poor outcomes, but just on different ends of the spectrum. The avoidance endurance model is a psychological framework that explains how people respond behaviorally and emotionally to
Avoidance Endurance Model
00:20:45
Speaker
pain.
00:20:45
Speaker
And it emphasizes a different kind of maladaptive coping pattern. in particularly these avoidance or endurance behaviors, as your pain develops long-term.
00:20:57
Speaker
It was conceived by Vlayan and colleagues between 1995 and 2002. And again, I'll link to that in the show notes. And it extends the fear avoidance model of pain by incorporating both the avoidance and the endurance response.
00:21:12
Speaker
So this framework says avoidance behavior arises when individuals fear pain and limit activity to prevent it. potentially leading to deconditioning and heightened pain sensitivity. Endurance behavior, in contrast, involves persisting through pain or ignoring it.
00:21:29
Speaker
It's driven by optimism, a sense of duty, or a suppression of their distress. which can also prolong pain and hinder recovery.
00:21:41
Speaker
Now, researchers have identified two major endurance subsets or subtypes. One is called distress endurance, which is persisting through pain while suppressing negative emotions.
00:21:54
Speaker
which can often be then linked to depression. You're just sitting on the bad feelings. You're not letting them out. There's also something called eustress endurance, which is that persistence that that's motivated by what seem like positive beliefs, like no pain, no gain.
00:22:11
Speaker
which may appear to be a good adaptation short-term, but actually can worsen symptoms over time. Again, cognitive behavioral therapy, graded exposure, activity pacing are all tools that are used to modify these behaviors.
00:22:27
Speaker
And there's also something called the avoidance endurance questionnaire, which then measures your coping profile. And I'll stick that in the show notes as well. So people who are pain endures typically ignore symptoms, they push through pain, or they persist with what they're doing despite the pain getting worse.
00:22:47
Speaker
And this can lead to cycles of pain flare-ups, which can also lead to a longer and delayed recovery and just a worsening of what you're doing to your body actually on a physical level.
00:23:03
Speaker
So we've identified pain avoiders and pain endurers. There's an important clarification, which is most people are not just one or the other. The pattern might show up differently depending on the context.
00:23:16
Speaker
You might avoid running because you know that it bothers your knee, but you might be on a machine at the gym doing a seated row and something feels painful in your shoulder, but you just keep going, right? So while you are probably closer to one end of the scale than the other, you're not a monolith of you only endure your pain or you only avoid your pain. Context is going to depend.
00:23:46
Speaker
Let's take a look at those pain endures and break down some of the typical traits and and real life examples of what that looks like. So it's the kind of, I i mean, this is talk about painful. This is me describing myself.
00:23:59
Speaker
I am very much a push through it's fine kind of a person. Has it come around and slapped me in the ass? Yes, more than once. I'm trying to get better at it. I'm actually currently in the middle of actually not just enduring some pain, but listening to it and changing my behavior, my exercise to see what we can come up with, me and my body together, as opposed to me ignoring what's going on and just willpowering my way through it.
00:24:34
Speaker
So there's a sort of it's fine mentality. Everything's always fine. It's okay. It's fine. I say that a lot. There's a tendency to downplay your symptoms.
00:24:44
Speaker
There's a little bit of that pride in your toughness, right? It's that same, oh, I have a high pain tolerance kind of thing. And there's a tendency to just continue whatever you're doing despite the pain you're feeling. That might be the runner who keeps training through worsening shin splints.
00:24:59
Speaker
Or the weightlifter who's like, oh, it's just ah it's just a little tweak. Or the person who just keeps putting off seeing the doctor about something for months and months and months. Common beliefs can be things like if you admit that you have pain, it's a weakness, a psychological weakness.
00:25:16
Speaker
That if you stop, it means you failed. And that, you know, tough people push through. And there's phrases out there that are sort of pro-pain, right? Not pro-pain, but pro-pain.
00:25:33
Speaker
For example, the one I hear from people all the time, no pain, no gain. Or pain is weakness leaving the body. Pain is temporary. Pride is forever.
00:25:43
Speaker
Pain is the price of progress. If it doesn't hurt, it doesn't work. These are common ways that people say, that people tell themselves, it's fine to push through this. And the thing is, depending, sometimes it actually is fine to push through something. But what I'm talking about is the people who push through everything and especially push through signals of ah like a higher intensity or a quality of pain that suggests that something very wrong is happening.
00:26:12
Speaker
There are actually advantages of being a pain endurer. you typically have a higher tolerance for what we would call discomfort, right? Being a little bit uncomfortable with things.
00:26:26
Speaker
Broadly, you might have a higher tolerance for being in a room where the air conditioning isn't working. You might have a higher tolerance for sitting on an uncomfortable bus for long hours, right? Those are things that we would consider, you know, uncomfortable, but not pain, right?
00:26:46
Speaker
You may have better adherence to a training program because you understand that the effort of exercise does not qualify as pain. These are different things.
00:26:57
Speaker
Typically, pain endures are very willing to work very hard. And you might also have that as a point of pride that you are a hard worker. I certainly do. I work very hard. Does my bank account reflect it? Not especially, but I do.
00:27:13
Speaker
And that people who endure pain can actually handle things like effort and fatigue really well. So in the context of exercising, this looks like someone who's really consistent, someone who is able to push closer to that muscular failure of a heavy lift.
00:27:33
Speaker
It's someone who doesn't quit just because the workout feels hard or intense. So these are really helpful traits for building strength and fitness. With that said, there are also cons of being a pain endurer. Sometimes it backfires if you are ignoring signals that you've injured something.
00:27:53
Speaker
Like you're running, you get this sharp tweak in your foot, all of a sudden it hurts a lot, you just keep running, right? That's not necessarily a good strategy.
00:28:04
Speaker
It backfires if you're someone who delays getting help for something. And what can end up happening is that it might take something that was really a minor issue, but because you didn't want to do anything about it, it eventually turned into a major issue.
00:28:19
Speaker
So something like training through a tendinopathy until it becomes a much more severe problem or continuing a high impact exercise, like a dance routine while you have like a stress fracture or or thinking of pain as something to beat.
Olympic Gymnast Carrie Strug's Story
00:28:38
Speaker
So in other words, pain endures sometimes stay in the game too long. And if you're my age, if you're in your 50s or forty s roughly, you will probably remember very well.
00:28:49
Speaker
Carrie Strug was an Olympic gymnast at the Atlanta Olympics in 1996. And she injured herself during the competition badly. You could tell that she injured herself badly.
00:29:03
Speaker
She then went ahead and did a vault. The vault is the one where they run tight. like as fast as they can at it and then do like a billion flips off of it and land and in theory land and don't move. It's a very high impact, high intensity movement. So she's in this like high stress context.
00:29:23
Speaker
My understanding that there was some pressure from her coach to do it. This is not a conversation around that, but she put the pain somewhere in her brain and she performed a second vault.
00:29:37
Speaker
After which she immediately collapsed. I believe she won the gold. And then they had to carry her off and they had to put her leg in a cast. Immediately following this, she retired from gymnastics and she never competed again.
00:29:52
Speaker
Again, it's an extreme example, but that's the kind of situation where a pain endurer, which she clearly was, because if you train it to an Olympic level, you're going to put up with a lot of discomfort and probably some pain and injuries along the way.
00:30:06
Speaker
That was a situation where she decided in that context, do the second vault. She won the gold, but she really screwed up her foot and never competed again. So was that worth it for her?
00:30:21
Speaker
Possibly, I don't know. And that's not what this podcast is about, but that's just an example of of someone enduring their pain. So if we then switch and talk about pain avoiders and what they look like, a typical trait would be very quick to modify or stop an activity as soon as they feel something.
00:30:39
Speaker
They're extremely attentive to their body signals and are very concerned about damaging themselves or injuring themselves, and they prefer to stay in a zone that feels to them safe. They're not comfortable stepping outside of a specific sort of zone of whether it's a type of activity or an intensity of activity. They don't want to push beyond that.
00:31:02
Speaker
So an example might be like, you're doing some squats, your knee feels a bit weird, so you just completely stop. You avoid impact exercise because you're worried it's going to hurt your joints.
00:31:13
Speaker
It might include avoidance behavior just based on the possibility of pain, not even a pain experience. Or they might quit a workout when they feel like their breathing has become uncomfortable. They're concerned about how much they're breathing.
00:31:29
Speaker
The common beliefs are that pain means tissue damage. Discomfort means something is wrong and exercise should not feel bad. There's again, just like there is for the endures, there are phrases that are anti-pain, right? Like listen to your body, let pain be your guide.
00:31:51
Speaker
Don't push into pain. Pain is a warning sign. Respect your limits. Pain means something is wrong. Being a pain avoider does have some advantages.
00:32:04
Speaker
These folks often catch problems early. They are good at protecting injuries. They tend to follow their rehab instructions very clearly and not overdo it.
00:32:17
Speaker
And because of that, they tend to avoid more severe overuse injuries. So they will seek help sooner and they will be very cautious about progressing.
00:32:30
Speaker
They're good at respecting these warning signals, but this very often turns into a limiting pattern because the avoidance of the discomfort of exercise might mean that they don't exercise.
00:32:46
Speaker
Very often, these are folks who interpret the discomfort of effort as a dangerous signal And they end up being deconditioned due to inactivity, right? So avoiding strength training because you get that burning feeling in your muscles.
00:33:02
Speaker
Or stopping any activity when you have the slightest amount of pain. Or having fear of movement after you've injured yourself where you stop moving. This can lead to things like lower fitness levels, reduced physical capacity, and increased pain sensitivity over time.
Misinterpretation of Exercise Sensations
00:33:18
Speaker
While our pain endures, sometimes they stay in the game too long, pain avoiders sometimes leave the game too early. Now, a key confusion that happens for pain avoiders is this misinterpretation of normal exercise sensations as pain.
00:33:37
Speaker
So things like muscle burning, heavy breathing, fatigue, a sense of effort, These are not injury signals. These are physiological responses to exertion. They're completely normal.
00:33:50
Speaker
Your body's responding to the stressor that you're putting on it, but it's a good stressor. So for these folks, it's really important to be able to distinguish these different sensations of effort versus pain. I have a friend who was not a habitual exerciser.
00:34:07
Speaker
And I remember talking with her about this, where for her, any physical discomfort was categorized in her brain as pain. So the physical discomfort of effort meant something was wrong.
00:34:20
Speaker
And so that really got in the way of her committing to any type of exercising that overloaded her even slightly beyond something like walking.
00:34:30
Speaker
So that's that's important to understand that for a lot of people who avoid pain, it's very difficult to categorize the difference between physical exertion, physical effort, and exercise.
00:34:42
Speaker
pain, but then also on that sort of pain continuum to be able to interpret different types of pain differently. If I've been sitting for a long time and I stand up and my lower back is tight and achy, I'm not especially worried about that because i so i walk around a little bit and it goes away.
00:35:00
Speaker
Someone else might interpret that as something's really wrong with my back because I should be able to stand up and not feel that sensation. And in the words of the Princess Bride, life is pain, Highness.
00:35:15
Speaker
Anyone who tells you different is selling you something. And I say that jokingly, but ultimately, we do want to understand that pain is not something that you're going to be able to avoid for your entire life, nor is it something that you should push through when it's severe, but it is something that is going to help you calibrate what you're doing with your body if you're able to negotiate the different symptoms and as well the different levels of pain so that you then make choices for your movement that are thoughtful and are not based too much on your habit of either enduring or avoiding.
00:35:59
Speaker
So how do you know which one you are if it's not clear to you? you might want to ask yourself some of the following questions. Do you frequently push through pain?
00:36:11
Speaker
Have you ever said it'll go away about an injury? Do people tell you that you ignore symptoms? Or do you stop exercise quickly when something hurts?
00:36:24
Speaker
Do you worry that discomfort means damage? And do you avoid certain movements because they might cause pain? Most people lean to one side or the other. Few people sit completely in the middle.
00:36:37
Speaker
The other thing to understand about pain with movement is that sometimes it's actually warranted as part of your rehab. Rehab used to be very much a help them get back to healthy without experiencing their pain.
00:36:54
Speaker
But now we understand that actually in some instances, a little bit of pain is not wrong. And it actually allows us to create enough load to help promote that rehabilitation of the tissue, especially in situations that include tendons, for example.
00:37:14
Speaker
Some people will use the pain scale as a way to help people calibrate if what they're doing is appropriate rehab pain or not. And they might say something like, if your pain is under a four out of 10, keep going.
00:37:30
Speaker
That's something that you have to use, obviously, with caution, making sure that people really understand what the pain scale actually represents. I typically say as well, if there's some dull, achy pain, we're okay.
00:37:43
Speaker
If it feels like something very sharp is suddenly happening, let's pause and reassess what's going on. So the goal of understanding these tendencies is not to suddenly switch sides, completely change your personality, become an avoider when you are an endurer,
00:38:00
Speaker
That's very unlikely to happen. But instead, if you're an avoider, it's useful to learn when discomfort is actually safe and productive. And if you're an endurer, it's useful to learn when is appropriate to actually listen to the pain that you're feeling and maybe change what you're doing.
00:38:20
Speaker
Both groups benefit from better pain literacy, better understanding the nuance of different sensations and knowing what is okay and what is a red flag.
Adjusting Exercise Approaches
00:38:31
Speaker
If we apply this to exercise specifically, if you're a pain endurer, you want to pay maybe a little bit more attention to monitoring your symptoms and then making adjustments when pain is escalating.
00:38:44
Speaker
So maybe you're like, all right, and my knee's been feeling a little funny, but I'm still going to go on this run. While you're on your run, you notice that actually your knee starts hurting more. What might have been a three out of 10 is now a seven out of 10.
00:38:56
Speaker
And that might be a good indication to stop what you're doing. It sounds crazy, kind of, when you say it out loud like that, but I am fully guilty of this behavior, as is your friend Laurel, by the way.
00:39:10
Speaker
just going to totally out her. And though also you want to focus on respecting that your body may need more recovery than you are willing to give it for some reason.
00:39:22
Speaker
So you're going to ask yourself, is this pain getting worse? Is my function decreasing? Am I no longer able to do the exercise the way that I previously was because of this?
00:39:34
Speaker
Am I ignoring signs that are giving me really clear warnings? My example right now is I finished chemotherapy. I'm still on immunotherapy.
00:39:45
Speaker
The immunotherapy is very inflammatory to my body, to everybody's body who's on it. And the specific issue with that is because i've had a significant amount of bone damage specifically to my sacrum and to my right hip those areas that are already sensitized are hypersensitized now coupled with my scoliosis and what's causing a bit of leg length discrepancy it's not straightforward it's complicated but Last week, I tried to do my typical week of exercise where I weight train twice a week and I engage in cardio exercise two or three times a week.
00:40:27
Speaker
And by the end of the week, my sacrum was in an incredible amount of pain. Did I pay attention to that during the week? Not especially. Did I just become meaner to a few people instead of recognizing that I should be recognizing my pain and maybe addressing it? Yes, I did.
00:40:44
Speaker
I don't feel good about that. This week I'm taking off of exercise. And I've also now been put on some pain medication, which is helpful. But I can already tell the visible swelling and inflammation around my sacrum has gone down.
00:40:59
Speaker
It is not painful to touch. And so I am currently having to recalibrate my brain around who I am because I see myself as someone who lifts weights twice a week and does the appropriate amount of cardio as recommended by the WHO and the CDC.
00:41:17
Speaker
And I'm in the middle of having to contend with the fact that that may not be realistic right now. And I don't like that idea. I would much rather ignore that idea.
00:41:30
Speaker
But when I ignored it, it slapped me in the ass, literally. So this is a challenging thing to go through. And you may be resonating with this on some level, not the specifics of my situation, but the frustration with what feels like having to almost change who I am.
00:41:53
Speaker
I don't just engage in exercise because it's good for me. I am a physical therapist. I think about movement and exercise all the time. It's very uncomfortable to be so immersed in this world and yet to not be able to engage in it to the amount that I want.
00:42:14
Speaker
And I'm probably just going to have to get a little more comfortable with that. Now, if you are the opposite, you're a pain avoider, How this applies to exercise means, and you may need help with this. You may need professional assistance from some kind of therapist for this, where you start to tolerate the sense of exercise discomfort.
00:42:38
Speaker
which might mean a sort of gradual exposure to that effort. It might mean adding in 30 seconds of jogging into your walks and just starting to include this slightly higher level of effort, getting accustomed to that sensation, those signals and rewiring essentially your brain, not to interpret that as pain or a reason to stop.
00:43:04
Speaker
Right? So that you can actually start to expand what those safe movement ranges are for yourself. It's going to allow you to engage much more in the kind of exercise that's going to be good for you, like lifting weights, right? That's going to feel like effort.
00:43:24
Speaker
I was teaching at a retreat for cancer survivors a couple of weekends ago, and we were doing some work with dumbbells. And one of the participants was saying, oh, my gosh, my heart is beating really fast.
00:43:35
Speaker
And I said, uh-huh. Yeah, well, you're you are efforting. And as long as your heart rate decreases, once you stop efforting within a reasonable timeframe, you're fine.
00:43:46
Speaker
That's not a signal of anything bad happening. So getting accustomed to all these different sensations that we that we go through when we exercise. And so you might ah ask yourself questions like, is this sensation actually harmful?
00:44:03
Speaker
And it's actually really good to kind of stop and and talk back to your thoughts like that, that sensation of effort while you're having it, it's good to look at it and and say to yourself, okay, I'm panting, my heart rate's up, my muscles are feeling tired, but none of this is actually harming me.
00:44:21
Speaker
Ask yourself, am I avoiding effort rather than injury? Is this discomfort just normal training stress? To start to talk back to what your brain has been telling you about your pain and what your pain means is a very good approach both for pain endurers and also pain avoiders.
00:44:40
Speaker
One of the things that good exercise programming can help with is that it provides a gradual progression. If it's done well, you will progressively overload the weights that you're using, for example. You might progressively add more running time to your walks.
00:44:59
Speaker
It helps with things like clear intensity targets, So understanding something called RPE, the rate of perceived exertion. It's a scale that goes from one to 10. One is minimal effort, 10 is maximal effort. And understanding how to grade what you're doing to hit a certain point on that scale to achieve exercise and movement goals.
00:45:22
Speaker
And it also gives you very clear boundaries around what pain is, right? So that if you are exercising and you have a ah brief sense in your knee that something's funny, but as soon as you stop doing the squat, let's say it feels fine, that's giving you information that this is not something on the pain scale that we need to pay attention to.
00:45:45
Speaker
So really good exercise programming gives you a very structured way to interpret the sensations coming in and to better understand what the appropriate behavior would be, whether it is to endure it a little bit more whether it is to stop doing that activity or change the amount or the intensity of that activity.
Conclusion: Recalibrating Pain Understanding
00:46:11
Speaker
What I hope you take from this is that pain is information, but it's not always a clear signal of what exactly is taking place. There is no one-to-one correlation of pain level to tissue damage.
00:46:26
Speaker
There are people who ignore it too easily. There are people who listen to it too closely. And so the skill that we're trying to acquire is learning when pain matters and when it doesn't.
00:46:41
Speaker
And that might completely change your relationship with exercise in a way that's probably going to feel uncomfortable at first because it might be undoing decades of beliefs, potentially beliefs handed down to you in your family about what pain is and what pain isn't, what you should do in the face of pain.
00:47:05
Speaker
So it's probably not going to feel that comfortable trying to change this as I am experiencing right now. But if you know that you are really too far in one direction or the other, or in certain situations, certain contexts, too far in one direction or the other, it's absolutely worth recalibrating your understanding of the signals that your body is giving you.
00:47:30
Speaker
This might be something that you work with a psychotherapist with. This might be something that you work with a trainer or a physical therapist with. But if it seems like something that you need help with that you're like, I'm not sure I understand how to do that on my own.
00:47:47
Speaker
Please definitely reach out to a professional who will be able to help you with that. All right. That's it for today's episode. Thank you so much for listening. Please rate review. We've had some fun reviews recently.
00:48:01
Speaker
One super not positive, which is always entertaining, but we love your reviews. We love to read them. So if you have a moment, please leave us a review. Please subscribe.
Season Eight Teaser and Promotions
00:48:11
Speaker
We are also on YouTube now. So if you're a YouTuber, our channel is at The Movement Logic. All of our podcast episodes are up as are a lot of our video content from Instagram. If you are not a Instagram user, but you want to see what we've been up to on Instagram, head on over to YouTube.
00:48:31
Speaker
Sign up for the Barbell Mini Course at the link in bio. You won't regret it. It's free. And we will see you for the beginning of season eight, which we know you have been waiting for with bated breath, which is going to start in two weeks on April 15th.
00:48:50
Speaker
We will see you then.