Pain vs. Discomfort

Everyone and anyone who’s been in a gym has heard the phrase “No pain, no gain.” What does that phrase really mean? Do we want our clients exercising in pain? What should effective exercise feel like?

In my experience, clients often interpret “No pain, no gain,” as “Pain is inevitable and it should be ignored.” I believe that for the good of our clients’ health, trainers should examine this misunderstood statement with their clients. This is a vital conversation, especially with clients who are new to training.

Pain & discomfort defined

I don’t recall if it was in a seminar or an article, but someone smarter than I once discussed pain vs discomfort. I’ve stolen the idea and used it ever since. (If you made this description and you’re reading this then thank you! It’s been highly valuable to me and my clients.)

My clients should understand that in order for exercise to do the things we want it to do — if we want to create favorable adaptations to exercise — then a client must exercise to the point of exertion and fatigue. The client must work hard. He or she might sweat, grunt, groan, and work to the point of fatigue and discomfort. A description of the D-word:

Discomfort:

Often a burning in a working muscle or muscles.
Comes with a feeling of fatigue.
Doesn’t alter the way you move (compared to a limp, for instance)
Is usually symmetrical if for instance you’re squatting, swinging a kettlebell, doing pushups, running or cycling.

Discomfort is a sign that we’re working near your accustomed limits. That’s a good thing, and that’s how you get in better shape.

I also tell my clients about pain. We don’t want pain. (Some minor, intermittent pain may be OK. More on that in a moment.) Some characteristics of the P-word

Pain:

Often felt in a joint, not a muscle
Sharp or electric
May not accompany fatigue
Severe pain alters your movement: Knee pain causing a limp or low-back pain altering how you bend down and pick up something
It’s often asymmetrical: Knee pain in one knee when squatting, shoulder pain in one shoulder during pushups or bench press, low-back pain on one side of the low back

If a client feels pain then we stop and we evaluate. Persistent, serious pain should not be a part of our day-in-day-out experience at the gym. Pain is not something to be ignored or masked with pain pills. Pain is a signal from the brain that something isn’t operating as well as it should be.

Color-coded pain

In another case of I-forgot-where-I-read-it disease, I read about a physical therapist’s color-coded, traffic-light guide to pain. I’ve adopted it and it helps guide me as to when to when or if I need to alter an exercise for a client due to pain. It goes like this:

GREEN: Everything feels fine; no discomfort anywhere. Client is ready to rock ‘n’ roll!

YELLOW: Minor, sporadic, or short-lived pain during the exercise but it’s not bad enough to stop or alter the movement pattern. We keep going as long as it doesn’t get worse.

RED: It hurts. We stop.

If pain becomes more intense, and/or more frequent, and/or lasts for more than a week then it’s probably time to seek medical care of some sort. Trainers should have a physical therapist, chiropractor, or some other licensed medical professional to whom he or she can refer clients.

I like this code system in that it’s rare that everyone is going to feel 100% perfect all the time. It’s not uncommon for us to feel something that is less than optimal but not so bad that we need to stop entirely. With the yellow reading, we can keep going through some minor pain, and we can avoid catastrophising around pain. If a client can experience a little bit of pain yet continue working then I think we can build resiliency in the client and protect against what’s known as fear-avoidance of certain movements. If we get to red then we can always stop and change things.

The fear-avoidance model. You don't want to be caught up in it.

Fear-Avoidance Model. Avoid it.

Unfamiliarity: Is it pain or discomfort?

Exercise newcomers may have no idea what it feels like to work hard. Their experience with muscular discomfort may be sporadic and in the distant past. Unfortunately, many people experience all uncomfortable feelings the same whether it’s joint pain or the normal sensation of hard work. They are different and our clients should learn the difference.

A classic example is low-back pain/discomfort. The epidemic of low-back pain is a unique pain in our culture. It is widespread and debilitating for many thousands of people. For those who suffer low-back pain there can be tremendous fear of recurrence. At the same time, exercise is an effective antidote for many forms of pain in older people, and for chronic (but not acute) back pain.

Numerous muscles attach in and around the low back. The glutes, erector spinae, lats, obliques, and other spinal muscles live and work all around the low-back area. Just like any other muscle, if you work these muscles hard then you’ll feel it. Exercises such as squats, deadlifts, kettlebell swings, and bent over rowing can cause serious — and totally normal — discomfort in the low back. Yet for many clients, any sense of low-back discomfort can be bad and scary. Thus it’s very helpful and reassuring to a client if a trainer can discuss the issue of pain vs. discomfort.

The spirit of “No pain, no gain”

The knowledge behind that phrase is well-informed and comes with good intentions. Plus, it rhymes! It sounds good. But clearly it can be misunderstood. (If I ruled the world, I’d change the phrase to “No discomfort, no pain.”) The truth is, no one will increase his or her physical capacity by sitting comfortably. Anyone who wants to get in better shape must work hard. At the same time, pain, as I described above, isn’t a normal part of working out. Pay attention to it. Get help if it doesn’t go away.

Here are a few of the points on the scale that are used to determine if you have a food addiction. Does any of this sound familiar? If it does, you may be an “industrial food addict.”

Food Addiction

We’ve got several interesting fitness-related things in the news recently. First, from the Huffington Post comes Food Addiction: Could it Explain Why 79 Percent of Americans Are Obese? Here the food industry and its products are compared to the tobacco industry and their products. Turns out our junk food is skillfully crafted and manipulated by the food industry to make it highly palatable possibly to the point of being addictive. Key to the discussion is the following information from the article:

Researchers from Yale’s Rudd Center for Food Policy and Obesity validated a “food addiction” scale.(i) Here are a few of the points on the scale that are used to determine if you have a food addiction. Does any of this sound familiar? If it does, you may be an “industrial food addict.”

I find that when I start eating certain foods, I end up eating much more than I had planned. Not eating certain types of food or cutting down on certain types of food is something I worry about.

I spend a lot of time feeling sluggish or lethargic from overeating.
There have been times when I consumed certain foods so often or in such large quantities that I spent time dealing with negative feelings from overeating instead of working, spending time with my family or friends, or engaging in other important activities or recreational activities that I enjoy.
I kept consuming the same types of food or the same amount of food even though I was having emotional and/or physical problems.
Over time, I have found that I need to eat more and more to get the feeling I want, such as reduced negative emotions or increased pleasure.
I have had withdrawal symptoms when I cut down or stopped eating certain foods, including physical symptoms, agitation, or anxiety. (Please do not include withdrawal symptoms caused by cutting down on caffeinated beverages such as soda pop, coffee, tea, energy drinks, etc.)
My behavior with respect to food and eating causes significant distress.
I experience significant problems in my ability to function effectively (daily routine, job/school, social activities, family activities, health difficulties) because of food and eating.

Based on these criteria and others, many of us, including most obese children, are “addicted” to industrial food.

Here are some of the scientific findings confirming that food can, indeed, be addictive(ii):

Sugar stimulates the brain’s reward centers through the neurotransmitter dopamine, exactly like other addictive drugs.
Brain imagining (PET scans) shows that high-sugar and high-fat foods work just like heroin, opium, or morphine in the brain.(iii)Brain imaging (PET scans) shows that obese people and drug addicts have lower numbers of dopamine receptors, making them more likely to crave things that boost dopamine.
Foods high in fat and sweets stimulate the release of the body’s own opioids (chemicals like morphine) in the brain.
Drugs we use to block the brain’s receptors for heroin and morphine (naltrexone) also reduce the consumption and preference for sweet, high-fat foods in both normal weight and obese binge eaters.
People (and rats) develop a tolerance to sugar — they need more and more of the substance to satisfy themselves — just like they do for drugs of abuse like alcohol or heroin.
Obese individuals continue to eat large amounts of unhealthy foods despite severe social and personal negative consequences, just like addicts or alcoholics.
Animals and humans experience “withdrawal” when suddenly cut off from sugar, just like addicts detoxifying from drugs.
Just like drugs, after an initial period of “enjoyment” of the food, the user no longer consumes them to get high but to feel normal.

Exercise & the Common Cold

“The most powerful weapon someone has during cold season “is to go out on a near-daily basis, and put in at least a 30-minute brisk walk.”
– Dr. David Nieman, director of the Human Performance Laboratory at Appalachian State University in North Carolina,

It’s always nice to see research that backs up something that we think is true. In this case, researchers at Appalachian St. University have evidence that exercise is possibly the best way to avoid colds. Read more in Regular Workouts Ward Off the Common Cold from MSNBC. The results of this study are in line with other studies discussed in the article.

There are all sorts of products out there such as Airborne, echinacea and zinc losenges that claim to shorten or prevent colds. The evidence on that stuff is spotty. The evidence on exercise and its preventative powers is far more solid. Exercise!

Rocker Shoes

An article from MSNBC, Do those funky shoes really promote fitness? discusses rocker or toning shoes, the increasingly popular shoes with a curved bottom. The claim by these shoe manufactures (Sketchers, Reebok, MBT) is that wearers will burn more calories when they walk around in these things.

A study by the American Council on Exercise suggests that these shoes do nothing of the sort. (Hard to believe? A magic shoe actually doesn’t lead to weight loss??) Participants walked all of five minutes on a treadmill while researchers monitored their heart rate, oxygen consumption and muscle usage (abdominals, butt, quadriceps, hamstrings and calves). (I don’t know that five minutes is an adequate amount of time in these things. Seems like participants should be monitored over the course of days or weeks). The article goes on to discuss the possible injurious effects of wearing these weird shoes as well as a a lawsuit brought by a woman who didn’t lose any weight wearing them. On the topic of the biomechanics and rocker shoes, this article by Denver-area chiropractor and gait specialist Dr. Ivo Waerlop, goes into deep detail as to why these shoes are a bad idea.

I see these shoes as the latest fitness fad pushed on people who are hoping and praying for a fitness magic bullet. (I love the fact that people are looking at their shoes and thinking about their calories! How about looking at your food???) This type of thing comes up frequently and the results of such stuff rarely lives up to the hype. I’ll be interested to see what happens to medium- and long-term wearers of these shoes. I think they’ll a) be disappointed in the weight they don’t lose and, b) possibly beset by chronic pain. If nothing else, they’ll be embarrassed that they ever put on those big clunky Frankenstein clodhoppers.

Beating Obesity

The latest edition of the Atlantic features an excellent article on our nation’s struggle with obesity. Beating Obesity is written by Marc Ambinder and it’s a thoughtful, in-depth look at the political and social ramifications of this seemingly losing battle. We learn about the major players including First Lady Michelle Obama, the food industry and the insurance companies. (Ambinder himself struggled with obesity and eventually underwent bariatric surgery as a solution.) Ambinder does a very good job in discussing the issues of individual responsibility and the environmental challenges we face such as food at every checkout line (not just at the grocery store), ever growing portion sizes, and junk food that is cheaper than fresh fruits and vegetables.

Most importantly he examines the moral and demographic issues of obesity. He notes the following:

“Black children are more at peril of becoming obese than white children; black women are more than 50 percent more likely to be obese than white women. ‘At the current rate of increase,’ epidemiologists noted in a recent article in Obesity, ‘it will take less than 30 years for all black women to become overweight or obese.’ Obesity rates are above average among Mexican American boys, as they are among Hispanics generally. Obesity rates among young American Indians tend to be nearly twice the national average.

Please check out the article. It’s an excellent piece.

Drinkers More Physically Active Than Abstainers

Who’da thunk it?? Science Daily reports on a study in the September/October issue of the American Journal of Health Promotion indicates that drinkers exercised more than abstainers–and those who drank more exercised more!

“Among women, those currently using alcohol exercised 7.2 minutes more per week than those who abstained. Relative to abstainers, the more alcohol used, the longer the person exercised. Specifically, light, moderate and heavy drinkers exercised 5.7, 10.1 and 19.9 minutes more per week. Overall, drinking was associated with a 10.1 percent increase in the probability of engaging in vigorous physical activity. The results for men were similar.”

That outcome might be surprising to a lot of people. However, it’s interesting to note that for 2008 Colorado was the leanest state in the nation with an obesity rate of 18.4% yet a recent Men’s Health survey listed Denver as the most dangerously drunk city in the nation.

What does all this mean? It seems we might see parallels between alcohol and medicine. Too much of either will sicken and/or kill us but the right amount might be healthy. It certainly seems clear that some degree of alcohol consumption works well for a lot of people.

In my experience the drinking culture here in the Denver area is one that is strongly balanced with vigorous exercise. Hiking, skiing, kayaking, mountain biking, and/or running is often followed by a loosely reasonable amount of the region’s superb beer. Combine these habits and you get a fairly healthy and happy population.

Why do you exercise?

Do you have physique goals? Is sporting performance important to you? Do you exercise for the purpose of disease prevention? Maybe it’s all or some of the above.

For whatever reason, some of us simply enjoy picking up heavy steel objects and running/biking/climbing/jumping around to the point of exhaustion. We derive pleasure from discomfort: burning, aching muscles; lungs on fire; sweat in the eyes… What we do isn’t always fun like a birthday party but deeply fulfilling.

The fascinating thing to me about exercise is that it is clearly very simple in most regards. Pick up something heavy several times. Move fast enough and/or long enough to sweat and pant. That’s exercise for the most part. It ain’t Greek philosophy, trigonometry or neurosurgery. Yet look at how many smart, highly accomplished people simply cannot find a way to do something so simple—even though we recognize how vital exercise is to a long, healthy life. Think of a time when you’ve pushed yourself—or have been pushed—to extreme physical exertion. It doesn’t take complex mental skills but we all know these kinds of efforts take tremendous mental fortitude.

Exercise is Medicine

Exercise is medicine. Jake “Body by Jake” Steinfeld writing for the Huffington Post offers three points of advice to help improve the health of the nation. His advice goes to the point that above and beyond anything else, our personal choices have the greatest impact on our health. More than doctor visits, cutting edge disease treatments or the latest medicine we have the greatest power to either stay healthy or get sick. We decide what food to eat. We decide whether or not to exercise, and we decide whether or not to smoke. Those are the big three and that’s where health care begins.

Michael Pollan, author of the Omnivore’s Dilemma and In Defense of Food puts it very well in his op-ed piece for the NY Times:

“But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America’s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet. To put it more bluntly, the government is putting itself in the uncomfortable position of subsidizing both the costs of treating Type 2 diabetes and the consumption of high-fructose corn syrup.”

So there it is. We’re using tax dollars to subsidize a food industry that poisons us, while at the same time we’re looking to send our tax dollars to treat the resulting illnesses. Might it make sense to cut food subsidies so that we then can reduce spending on health care? And to the point of personal responsibility, if through our own actions we can avoid illnesses such as diabetes altogether–and thus never treat them at all–then isn’t that the best version of health care available?

(BTW, if you haven’t read Pollan’s In Defense of Food then you should go get it right now and start reading. As well, he was interviewed by Bill Moyers interviewed Pollan a few months ago. Go to PBS to watch it.)

Politicians very rarely suggest that we bear the most responsibility for our health. To do so would point out that we as a nation are failing miserably at controlling ourselves.

Denver Fitness Journal

All Things Health and Fitness by Kyle Norman, MS, CSCS, FMS, RRCA Running Coach

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