Why Your Athletes MIGHT be in Pain (from training)

What is in this Blog: 

1. How training too much or too little can influence pain and injury.

2. How a loss of movement variability can contribute to pain and injury.

3. How the concept of allostatic load contributes to pain and injury.

Background

Almost everyone you work with will experience pain or injury from training. There is no way to fully prevent this from happening, except potentially to do the bare minimum in the most controlled of environments. There are no exercises, “bulletproofing”, or periodization structures that can stop pain and injury from occurring. Pain and injury are simply a byproduct of pushing the limits of your athlete’s capabilities. If your clients want to achieve their highest level of sport, then they have to be okay with encountering some level of pain and discomfort.

This is not to say that there are not more intelligent ways to structure training that can mitigate these risk factors. In fact, using progressive models that account for the client’s current capabilities, life stressors, and target goals can help reduce the occurrence of succumbing to injury. Unfortunately, even the most perfectly designed program will fall short if the marker for success is to completely avoid pain and injury while striving for sports performance. It is an unrealistic endeavor.

While it may seem obvious that pushing your clients too hard and too often can lead to injury, the opposite is also true. Under-preparing people can also set them up for failure. You may be able to navigate training cycles while avoiding injuries, tweaks, niggles, but you are most likely not going to see them realize their goals. By chance they do make it to their respective level of competition, they will probably be shocked by the intensity of competition.

When working with individuals, you have to keep in mind that they have hired you for a purpose. If you fail to move them closer to their goals, then you will likely struggle to retain clients. You have to take calculated risks in order to continue to drive people towards their performance goals. In finding this balance of safe training and performance results, we as coaches should accept that pain will be a part of the training process.

The rest of this blog will explore some of the reasons that individuals will experience pain from training.

(Some of) The Reasons

Mismanagement of Load

Load management encapsulates different concepts. Three common ways athletes mismanage load are ‘Competing in Training Too Much’, ‘Under Preparation’, and ‘Specific Joint Overload’. Below you will find these concepts in more detail. 

Competing in Training Too Much

Being unprepared for the task is one of the main reasons individuals will experience pain. This can be seen as a mismanagement of load, intensity, volume, density, or frequency of a movement relative to an individual's capacity. In practice, how fast you can push someone will depend on their age, experience, and physical capacity. What this normally comes down to is the too much, too soon issue where a client pushes their boundaries too often and too quickly. An athlete can turn each piece of a training session into a competition or a reason to attempt to reach a new PR. This type of mindset can be okay for a short period of time, but this aggression often leads to injury or chronic pain as people fatigue. The timeline in which this will happen will depend on the person, but it will catch up to everyone who operates in this manner.

Under Preparation

In the realm of CrossFit, coaches who try to control every variable of training often under-prepare their athletes for competition. A conservative approach that relies on submaximal efforts to keep a client healthy will likely lower the risk of injury but fail to prepare them for the chaos of competition. If the individual’s goal is to compete at the highest level of sport possible, then the training needs to reflect that at different points in their season. You need to strike a balance of hard training with easy sessions to continue to make progress.

Specific Joint Overload

The mismanagement of training stress can come from athletes who are unwilling to accept failure. These athletes often deviate from the training plan by adding large amounts of extra reps because they are dissatisfied with misses and poor movement quality. So instead of making peace with a poor session, they continue to try more reps to tweak positions and ultimately do better. There are plenty of examples of this, I see this often with athletes trying to refine their snatch or hit heavier snatch lifts. They’ll say “one more” while taking much more than one extra lift. This can turn into rotator cuff or wrist injuries as reps get sloppy and fatigue increases. In order to meet this type of athlete in the middle, it will require communication about when and where it’s open to add extra reps in. And where they just need to shut their brain off and follow the program.

Loss of Movement Options

Specific training will lead to specific adaptations. If you train the back squat, you get better at back squatting. There will be some transference to other squatting movements, but if you train the back squat expecting to get better at throwing, the adaptations are likely negligible. A majority of movements performed in the gym are all done within the sagittal plane. Rarely will your clients experience movements that are more biased towards the frontal and transverse planes. This bias towards sagittal plane movements can make your clients stiff and unathletic. 

This lack of variability in your client’s training will decrease their movement options. If your only goal is to improve 1RM absolute strength, then this approach might be okay. However, it is less okay if you want your athletes to smoothly share load across joints in athletic, high-speed, and high-frequency situations. You can think about it like this, if your client only has one squat stance, then they do every squatting variation, snatch, clean, front squat, back squat, overhead squat, wall ball, thruster, etc, from one position at all different types of loading. This is constant stress on specific structures which could lead to overuse injuries. If you allow your clients to spend time developing further ranges of motion that they can actually coordinate to create movement, then you allow them to share load across a joint differently as needed. While specificity is needed for sports performance, variability is needed for long term health.

Increases in Allostatic Load

Allostatic load is a concept that comes from the idea of allostasis, which is achieving stability through change in regards to stress adaptation. The allostatic load refers to the accumulated stress from life events that someone is exposed to beyond their training stressors. This is all of the stress that cannot be accounted for but inevitably affects the individual when they step into the gym. For example, consider a client who has just had their dog die, got into a fight with their significant other, or lost their job, these types of stressors are the types of things that will increase someone’s allostatic load. These things are the intangibles that a training plan cannot account for but needs to be appreciative of. It is hard to quantify these stressors and how they will affect an individual. You can use a subjective feedback scoring system to ensure you’re not overloading an individual with further training stress relative to their life stress. 

If life stress is high and training stress is high, it is a sure fire way to set someone up for developing an injury or experiencing pain. There is no exact method for balancing allostatic load and training load. It is a constant conversation with the athlete to help them understand how to develop autonomy in situations where they need to adjust training due to life circumstances. It is a common athletic mindset where high level athletes want to complete the training regardless of how they are feeling. Communication about playing the long game, aligning their choices and decisions with their end goal, and how too much stress can take a negative toll on the body is imperative. Pushing past thresholds too often will eventually lead to pain.

Conclusion

As a coach, it is your responsibility to ensure the progress of your client towards their goals. Throughout that process, you will most likely encounter periods of time where they are injured or experiencing some level of pain. You need to have an awareness of what situations may bring about these periods of time and how you can navigate issues as they arise. This could be developing better communication skills to ensure athletes understand when it’s okay to push in training and when it’s necessary to back off. Another way could be structuring training in a way that stops someone from doing too much too soon while still allowing them to feel challenged. There is no perfect formula for this, it will come with trial and error. Things that work for one client will most likely not work for another. Beginning to understand some of the reasons that pain can occur is the first step in helping your clients. The next is starting to learn strategies for getting them out of pain and back to training.