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Chronic pain is frustrating to live with, especially for athletes and runners. Unlike the healing process of an acute injury, chronic pain last long after your body has restored itself. It’s kind of like a car alarm that goes off for no reason; but fortunately you can learn how to properly manage it and start running again.
Pain science reveals several important points regarding chronic pain. Most important is that pain rarely equals harm or damage. You can be hurt and strong at the same time or have damage without pain—ever find a bruise but have no memory of how it got there? Chronic pain is the result of a sensitized nervous system known as central sensitization. You feel pain when the accumulation of stress exceeds your brain’s perceived ability to cope.
Contributors to sensitization include:
- Belief that you’re broken and further activity will break you more
- Lifestyle factors such as job stress, relationship stress, lack of sleep, poor diet, lack of exercise
- Coping strategies like avoiding running out of fear, which drives you deeper into despair and further sensitization
- Emotions: catastrophizing, fear, anxiety, anger, rumination.
- Tissue stress: This can definitely contribute to pain, but damage is typically a minor contributor to sensitization.
Tackling Chronic Pain
There are two ways to tackle pain: one way is to decrease the stress that contributes to it, the other is to increase your resilience and get stronger.
You can lower nervous system sensitization in several ways:
- General physical activity
- Talk with a counselor
- Various therapeutic techniques: massage, foam rolling, manual therapy, hot, cold
- Consistent sleep schedule
- Improve your diet
- Load and strengthen the place that hurts
- Resume running
You may not know it, but your bones, connective tissue, joints and muscles are very strong and respond well to loading. If you’ve been guarding and resting part of your body then it gets weaker. Structures like the Achilles and patellar tendons need strength, not more rest. Physiotherapist, chiropractor and pain expert Greg Lehman considers gradual strengthening as one of the best ways to reduce pain.
Loading strengthens muscles and connective tissue, providing an analgesic effect. Physical activity boosts your mood and builds self-efficacy. By engaging in exercise, you break the fear-avoidance cycle. Here are several exercises to help with a variety conditions.
Isometrics work well to calm pain. Contract and hold with no motion for 30-60 seconds. Perform isometrics frequently throughout the day.
- Heel raise loaded with a kettle bell for Achilles and plantar fascia pain. Use a bent or straight knee.
- Wall sit for patellar pain. Progress from two to one leg.
- Straight-leg bridge for glute/hamstring pain. Progress from two to one leg.
Heavy-Slow Resistance Training
Exercises should be exhausting in 5-10 slow, deliberate reps. Most of these can also be done as isometrics too. Start with bodyweight then add weight via barbells, dumbbells, kettlebells, weight vests, machines or rubber tubing/bands. Persist into pain no higher than a 4 on a 1-10 scale.
- Heel raises for Achilles tendonitis can be done with a straight or bent knee
- Load the knee and hip to reduce knee pain
- Band knee & hip extension
- Band walks
- Side bridges target abs and hip
- Band leg press
- IT band exercises
- 1 leg squat
- 1 leg bridge
- Band leg press (A squat can be done in a similar way)
Exercise is medicine. If you’ve avoided running for a while then it’s time to run to help calm your nervous system. Use the process of graded exposure—add work gradually, keep pain at a minimum and you’ll increase your capacity for activity.
Try a run/walk protocol:
- Week 1: 1 min. run/3 min. walk, repeat 10x
- Week 2: 2 min. run/2 min. walk, repeat 10x
- Week 3: 3 min. run/1 min. walk, repeat 10x
- Week 4: 40 min. run
Perform each workout twice per week on non-consecutive days. Pain should be no higher than a 4 on a 10-scale (with a 10 being very painful), and it should not alter your running form. Note: Be sure not to push through severe pain.
It’s not uncommon for pain to flare up after activity. Don’t be alarmed. You haven’t done more damage, you’ve pushed a boundary which has caused your nervous system to overreact. Reduce your activity level a little next time you exercise.
If you need more information, a physical therapist or other medical professional can help guide you through chronic pain management. Injuries such as stress fractures definitely need to be unloaded and rested. If your pain gets worse with activity then seek medical care.