Do You Suffer From Chronic Pain?

As a strength coach and nutritionist for over 10 years now, I have seen quite a few people that are always in pain. Our current lifestyle is easy to blame for this. We are stuck in some awful positions for prolonged periods of time. We sit in the car on the way to work, sit at work, sit in the car on the way home, sit on the couch watching TV, and all of the time in between is spent hunched over looking at our cell phones.

McGill, the granddaddy of spinal researchers, showed that being stuck in a poor position for 20 minutes has lasting effects to tissue that requires twice as long to correct (1). Most of are stuck in a car for longer than 20 minutes just to get to work, not to mention all of the other time we spend sitting. Most people are not even members of a gym, and the ones who are tend to just “wing it” in the gym or follow the hottest trend of internet workouts without ever a thought of how to best counteract these poor positions.

Due to this, the latest study presented by the National Institute of Health does not come as a shock. The NIH reported that 11.2% of Americans suffer from chronic pain. That turns out to be roughly 25 million people. That is a lot of people that suffer from pain on a daily basis (2). This number is unacceptable. The annual cost of orthopedic injuries in the United States is over $200 billion annually. A cost that we cannot afford that continues to climb each year.

I am on the side of the fence with people such as Shirley Sahrmann that theorize that movement impairments cause pain over time. Shirley Sahrmann breaks all of this down in her textbook “Diagnosis and Treatment of Movement Impairment Syndromes.” If you are a coach or an aspiring coach I highly recommend this text.

According to Sahrmann there are 4 key elements to this model. They are the base which is our muscular and skeletal system, the modulator being our nervous system, biomechanical being the static and dynamic components of movement, and the support systems being our lungs and heart.

The human body is an amazingly adaptive machine. We go through our typical day of sitting in the car, at the desk, texting, and so on and we develop impairments in the communication and function of the previously stated elements. From not using specific muscles we develop weaknesses. Our body senses that these muscles are weak and other muscles nearby pick up the slack. The problem with this is that the muscles picking up the slack are not located in the exact same spot as the weak muscles. Therefore, they organize our joints and skeletal structures in a less that optimum way. This negatively effects the communication by our nervous system and our static and dynamic movement components become altered. In this example it is easy to see how one component can affect the others.

When our static and dynamic postures and movements become altered it sets the stage for pain and/or injury. Movements performed at high frequencies and movements that require extremely high or low tension can cause changes in muscle strength, length, and stiffness. This includes sustained faulty postures.

Even elite level athletes display weaknesses when manual muscle testing is performed by physical therapists. Non-contact injuries are a common occurrence in sport. The football player that tears his ACL when no one is around may look strong, but I will almost guarantee that upon manual muscle testing he had muscle weaknesses somewhere. According to Sahrmann’s theory, these muscle weaknesses led to a breakdown in the system that impaired movement quality and led to the injury.

This does not mean we all need manual muscle testing to correct weaknesses and reduce our pain or risk of injury. In fact, just isolating a weak muscle and strengthening it does not mean that it will be strong when it is integrated into actual movement. The goal is to relearn proper positioning and then become stronger in those positions.

Proper positioning starts from the center out. We need to stabilize our spine and pelvis first, before we stabilize our shoulders and hips as spinal alignment directly effects positioning of both of those joints. For example, if we have a kyphotic curve of the spine, our shoulders will roll forward and internally rotate. We can perform all of the shoulder external rotation exercises we want in an attempt to make them stronger, but without clearing the t-spine issue we will never rectify the issue.

To stabilize the spine and pelvis we can just squeeze our glutes, and the cue that I use for the abs is to “drop your bottom rib into your belt buckle.” Keeping that rib down, stick your chest up and tuck your chin into your neck making a double chin. Once our spine is set we want to externally rotate our shoulders and hips to put them into an optimal alignment. For the hips think of screwing your feet into the ground without the feet actually moving and for the shoulders think of spreading your collarbone apart.

The idea is to maintain this alignment with everything we do. For example, let us look at the barbell squat. We set the spine and pelvis the exact same way as we do with our bodyweight. We bend the bar on our back to create external rotation of the shoulders. If you pitch forward in the squat this may be a likely issue. From there we take a big breath into our belly to increase intra-abdominal pressure which minimizes shear force placed on the spine. We continue to screw our feet into the ground on the way up and down with the weight.

This is how proper strength training can help us reverse some of our bad positions and help decrease the number of people that suffer from chronic pain. When performed properly, exercise such as the squat and the deadlift are corrective. Muscle weakness is a common culprit of pain and many injuries. Teaching the body how to move as one unit and getting stronger in those positions can only help. Being lazy is much worse for your back and knees than deadlifts and squats.