Why You’re in Pain and What You Can Do About it
by Dave Thomas
“Your physical condition merely reflects the specific adaptation of your body to your everyday life. In other words, you are trained for whatever activity you have been practicing, and no more”. -Bruce Lee
Recovery, myofascial work, changing up our movement patterns, hydration, stretching and a healthy diet are among the most important things we can do to keep ourselves in the game long term. Unfortunately, they are not sexy. They fall into the boring category of maintenance.
Maintenance is never something I gave too many shits about up until six months ago when I started to feel the mileage of playing competitive sports into my twenties and continuing to train hard now into my early, almost mid thirties.
I was always the type that knew I should spend time on the roller, that knew I should stretch more, and that knew I should rest but I never actually did it with any consistency. As a result, my years of largely ignoring soft tissue work caught up with me and over the past six months, I’ve worked like hell to unwind it.
I believe this to be the most important article I’ve written in years.
What you’ll read today represents hours of research, experimentation and reading on the topic of soft tissue recovery.
I will never claim to be an expert on human biology, and I will definitely not claim to be an expert on the subject matter today. The study of trigger point science is so unclear to this point, some in the field have gone so far as to labeled “pseudo-pseudoevidence based medicine” (1) and “an appallingly high percentage of doctors and other practitioners are still pretty much out of the loop regarding trigger points“.
To say the waters are murky and opinions differ would be accurate. I want to make clear that this article is one of science-based opinion, not fact. Today I’ve leaned on folks who’ve made studying fascia and soft tissue their entire life’s work, so most of what you’ll read today is a gathering of others work.
It’s like a recovery gumbo.
Before we get stated, I understand this article may run a little tedious as it’s purposefully in-depth. I really urge you hang in there and finish but if at any point you are over it and just want the takeaway, you can scroll down to the “In Conclusion” section.
Let’s fucking do this.
What Happens When We Train?
The human body can handle a lot and positively adapt. That’s the entire point of training and the reason we do it. What the body cannot handle are years of accumulated intense rigors without any care towards its recovery. The body will fail.
Let’s take a quick look at what happens to your body when you train.
- Micro Muscle Tears – When you weight train, target muscles undergo micro tears in the fiber. Our body heals itself through a complex system involving the addition of actin and myosin, the contractile proteins that are located within the muscle that are responsible for movement (remember these two). The new actin and myosin are added to the muscle fiber and the result is an increase in its diameter and contraction capability.
- Scar Tissue/Adhesions – Scar tissue and adhesions are our body’s response to try and heal itself. Scar tissue is a gluey collagen that tends to bundle our muscle structures together and make them immobile, losing their ability to effortlessly glide over top one another.
- Knots/Trigger Points – Muscle “knots” are highly acidic trigger points that create problems in your movement and training, and the painful bastards you feel on a daily basis (2). Repetitive use of Type II muscle fibers in the eccentric phase of a movement patterns have been tied to the forming of trigger points. This would be the heavy lowering phase of movements like a hang clean, squat, deadlift or any other movement that engages the fast twitch fibers.
- Fascia Disruption – Intense training has the ability to disrupt fascia’s hydrated, flowing nature as we’ll explain in this article. Uh, what the hell is fascia, right? Fascia is a spider web like structure that literally covers our entire body, head-to-toe in one uninterrupted structure. As fascia forefather Tom Myers explains, it’s like a sweater for our muscle, tendons and ligaments that saran warps everything together. Think of a Spider-Man suite.
By nature, all of these phenomena are created by our bodies to help us heal, protect cells and create stability. However, when left alone for too long and able to fester, these adhesions, scar tissue and knots can begin to effect our movement, decrease our performance, cause pain and lead to injury.
So, how to do manage them?
Door #1: You Don’t Do Shit
We’ve written many times about the concept of withdrawals and deposits as it pertains to your training. It’s a concept of “training accounting” I first read about through Rob MacDonald and I fell in love with it from the get go. It’s very simple. When you train hard, you are making withdrawals from your body. You’re taking out. When you choose recovery implements, you make deposits. You’re putting back in. The ultimate goal being a balanced checkbook. If all you do is make withdrawal after withdrawal, you’re going bankrupt and the game’s over.
In door number one where you don’t recover, you’re whole training cycle is like nerdy Phil from HR in the Spearmint Rhino for the first time. Withdrawal. Withdrawal. Large withdrawal. Really large withdrawal. You’re bankrupt. And sad.
What Is a Knot?
Actin and myosin are filaments that comprise every muscle. Their existence is very harmonious tango and what is responsible for muscle movement, or contraction. The muscle contracts through actin and myosin effortlessly sliding across one another, like a kid sliding down a water slide.
As we’ll explain, over-stimulus of training, repetition of the same movement patterns over and over again, and under-recovery have the tendency to create a state for our fascia and muscle that is oxygen-less, dehydrated and inflamed. In this state, actin and myosin lose their harmonious tango of effortless gliding and instead bind together, become stuck and stagnate, resulting in a “knot”.
Think of it like the water slide without any water. Movement ain’t so good in it.
A patch of polluted tissue that is highly acidic and inflamed, and an accumulation of metabolic waste products.
Most professionals out there seem to agree that if you repeatedly target the same areas in your training, do not stretch, recover, foam roll or spend little to no time performing soft tissue work, the likely result will be the dehydration of the the fascia, the allowance of these acidic areas to build up, and knots to form.
What Causes Knots?
If you are more of a visual or auditory learning, I’ve created a five minute video that does a fairly decent job of summarizing a knot within the muscle.
Let’s say that you lift heavy four times per week for six months and you don’t do much to recover. Ultimately, you form a knot in your trapezious (a common area for knots). You keep training because frankly, you can, only each time you hit the gym you continue to agitate and irritate that triggered areas.
This constant agitation results in what’s known as the “poisnous feedback loop”, a fucked up type of painful purgatory. As the muscle continues to hold its contraction and “seize up”, the polluted area of build up is quite literally strangled off from blood flow (think of an ambulance trying to get to a flipped over car but can’t do to traffic). This blood flow is what would deliver the oxygen that commands the mysosin and actin to unbind and release from one another, as well as fresh blood nutrients to help clean up the acidic area. So, because the knot has restricted its blood supply, this of course irritates the knot further, and then it seizes up again, and more solidified.
Hence, the “poisonous feedback loop” and why they may be so challenging to get rid of once they form.
The Problem of Compensatory Patterns
Your body is very aware, particularly in the fascia. It can sense what is going on and like an interconnected super highway, it creates brand new “compensation pattern”s of movement to avoid pain in areas that are knotted. Over time, your body’s kinetic “line of action” becomes altered and you’re now moving under load in a pattern you weren’t biomechanically designed to do, or used to doing. This can ultimately lead to a state of “overcompensation” and injury, without you even realize your body is doing it.
Not to mention knots can lead to tightness which can pull on surrounding joints. A knot in your IT band could pull on your glute which can then pull on your low back, and then bam, you strain your low back thinking that you were “doing a movement wrong or too heavy” when that’s very, very rarely the case. It’s often tightness and triggers built up elsewhere.
From Paul Ingraham, “Even the clearest localization of pain in area may, in fact, be originating from a distant area”(4).
As we learned in the intro section of this article, through our fascia everything is connected. As Brooke Thomas plainly puts, “our calf becomes the achilles which becomes the calcaneus bone“, or like Tom Myers puts, “there are no oceans in the world. There is one large ocean”.
In other words, everything is connected. Literally. Muscle becomes tendon which becomes bone. Understanding this, we’re able to realize that there is no such thing as an isolated point of trauma because everything in our body is tied to and works together.
It’s like a game of Jenga. You can’t just pull out three pieces in the bottom and expect the middle and top to still be stable, right?
Maybe not now, maybe not in a year. But local (one spot) will become global (everywhere) if unaddressed.
The best treatment is to create an environment that allows for blood flow, oxygen delivery, nutrient circulation and the ability for our body to flush out the pesky bastards before they begin to plant roots. If it’s too late for that (and it probably already is for you), the good news is these kinds of conditions can be reversed.
You just have to walk through a different door.
Door #2: You Choose to Recover
Once we learn we have to start making some deposits to go along with those strip club level withdrawals, we start to reclaim our healthy movement pattern and we start to realize the fountain of youth really just lies in what we do outside of the gym.
Self Myofascial Work
Before we get into which kind you should implement it’s important that we understand why foam rolling is so important.
Myo, meaning “muscle”, fascia meaning “fascial”. Muscle fascia work. In this instance, we’re primarily concerned with fascia, the web like cocoon from earlier that surrounds our entire body in one uninterrupted ocean.
Under healthy, hydrated conditions, fascia is relaxed and wavy. It stretches and moves without much restriction. The hydrated fascia creates an environment where our muscles, joints and tendons have mobility, integrity and resilience (5). Everything moves in harmony and movement pattern is productive and painless.
In an inflamed state, dehydrated fascia takes on an entirely new structure. It goes from hydrated and pliable to stiff and brittle. Brooke Thomas makes the great analogy of a sponge. When a sponge is hydrated it is dynamic and pliable and able to absorb shock and trauma, but when it is dried up it becomes hard, brittle and easy to break. Dehydrated, inflamed fascia is a source of painful tension and it restricts our flexibility, stability and range of motion.
So, how do we keep fascia hydrated and healthy?
Enter self myofascial work.
A main reason fascia become dehydrated, brittle and knotted is repeating the same movement pattern over and over again. This repetition continuously pushes the water away from our muscles and fascia. The analogy that is used for this is one of the more brilliant analogies I’ve read in quite some time, and it comes from Tom Meyers.
“When you do heavy exercise you are driving the water out of the tissue in the same way that if you step on a wet beach you push the water out of the sand, and when you pick up your foot the water seeps back into that sand. You’re doing the same thing with tissues, when you’re really working out you are driving the water out of the tissue while you are working”.
Once knotted, the fascia gets clogged up and cut off from water and becomes dehydrated, making water chugging a useless endeavor since it can’t receive it(6). It’s like trying to water a flower with someone pinching the hose.
So we gotta unclog it.
Once we do, not only do we begin to break up and dilute the cesspool of toxins that allow oxygen into the trouble spots that make up a trigger point, but we also open up the waterways for water to reach fascia and begin the process of re-hydrating it back to its healthy, optimized state.
How do we unclog?
- Rumble and/or Foam Roller – How you use it is very important in determining the results to receive from it. For the bigger muscle complexes like the IT bands and quadriceps, make sure you move very slow, find the trigger points and apply pressure to them rather than roll quickly. Spend one to three minutes lying there, trigger hunting.
The slow pressure from the roller on the fascia acts to “blanch” out the trigger point by forcing out stagnant tissue fluids (7), resulting in blood flow and oxygen delivery to acidic knots. Remember, oxygen essentially commands the knot to unbind the actin and myosin, but it cannot get there through highways filled with traffic accidents.
Oscillating can be a very helpful technique, as well. When lying on top of a roller, rotate or twist your body from side to side in a lateral movement rather than a vertical roll up and down. This will apply pressure across the striation of the soft tissue, which will help break up knots, adhesions and scar tissue.
(There’s a lot of research out there that says not to roll the IT band. I don’t agree with it, but you should know about it the other side of the opinion. I roll my IT band very, VERY slowly and focus more on applying pressure than rolling. My IT band was a shit show and slow rolling it has been incredibly beneficial. If yours is healthy, you may not need to roll it.)
- Yoga Tune Up Ball – I am not a big fan of lacrosse balls. I have noticed that every time I used them, I was in such discomfort that my breathe would shorten and my body would seize. When you go too deep into the musculature, your body may perceive it as a threat and the muscles will begin to contract and protect rather than relax and release. You shouldn’t be in agony when performing myofascial work (though you may be at first if you’ve waited a few years to address it).
So, what are Yoga Tune Up Balls and why them? The YTU Balls carry the same benefit of the lacrosse ball in that the surface is area is much smaller than a foam roller, so you’re able to target more specifically. However, what it possesses over the lacrosse ball is that it is softer and more pliable, and as this article points out, “studies have shown that softer implements impacted the connective tissue about twice as effectively as the harder implements” (8). You’ll get a lot of the benefit without your body’s defense contraction kicking in.
I prefer these on my glutes.
The result of daily self myofascial work will be far less pain (if not total removal) from areas of your body that contain built up trigger points.
Release of Lower Back Pain
Often we think we have “bad backs” because they get sore and injured from exercise when in reality, the back is just where a lot of symptoms happen to reveal themselves. It’s at the core of our body and is connected to both the lower and upper body, so it’s very easy to irritate it. Most issues in your body will ultimately make their way into your lower back through the mere fact that everything is connected, especially to your core region.
In fact, what a lot of people think of as sciatica, the irritation of the sciatic nerve, may actually be a trigger in your piriformis that needs to be released.
Remember, through fascia it’s all connected.
Clean up your fascia work and you will likely see a very large improvement in how your back feels.
Other Very Important Tools
The following should also be a part of your daily and weekly routines.
- Diversify Your Movement Patterns – This is a big one. As we learned, constant repetition of the same movement in the same form causes knots, so change up your movement and prevent the constant patterning that causes them. If you constantly move at the same plane, metabolic temperature and movement pattern (aka you cherry pick your lifts and workouts) you’re more likely to dehydrate the fascia, making it the brittle more easily destructible kind (8). Remember the Tom Myers foot in the wet sand analogy.
And from Michael Rosengart of PreHabExercises.com”
“Knots occur when individual muscle fibers are either biochemically over-stimulated or biomechanically overused or overloaded in specific movement patterns…Maintaining the same position or repeating the same movement for prolonged periods of time will create knots in the soft tissue. (9)”
This is easily avoidable. Simply stop cherry picking.
Our body favors what we do most. If we sit and type at the keyboard all day, we’re going to internally rotate our shoulders, right (10)? If back squatting dominates our routine then we’re likely going to favor external hip rotation. Both of these local issues may ultimately have a global impact if overdone.
Unless you are competing in strongman, weightlifting or powerlifting, there’s zero reason to be exclusive with them as an every day person who wants to be strong and fit (and behind the scenes, off of Instagram, those athletes spend a considerable amount time on their body maintenance and dedication to their sport. Much more than you’re likely prepared to do). Mix it up, include bodyweight work, flows, kettlebells, yoga, circuits and other workouts that aren’t so repetitive. Vary your intensity, volume and pace. In a given week attempt to perform as many movements as possible, and always hit days that present opportunity to do things not often performed. I know this is counter to the ever popular, lift heavy all the damn time philosophy, but it’s the far smarter way I believe.
- Rest – Repeat after me. I. Will. Stop. Going. To. The. Gym. Every. Day. Seeing your progress stall or can’t get discomfort to go away? The money is on lack of rest because gains, sir, do not occur without time for them to settle in. Rest is how our tissues re-hydrate, heal their microtrauma and how our nervous system returns to homeostasis and in a position to exert strength. Regardless of your goal, it will not be accomplished by powering through it on days you should be healing and progressing.
- Static Stretching – Regular stretching is good prevention against sticky fascial adhesions from forming, but it does little to release deep, embedded knots as their tentacles are in too deep to be broken up by stretching alone. It must be paired with myofascial work. If you do not address myofascial work to go along with stretching, you could be making your triggers worse by over stretching the muscles that aren’t knotted up. Think about tying a knot in a rubber band. Pulling on both ends of it is not going to undue the knot, but may in fact tighten the knot and create laxity in the band where there shouldn’t be. This is why stretching should be a complimentary strategy in unison with self myofascial work and if you’re super jacked up, begin with a focus on rolling.
- Yoga – The flexibility of yoga is nice but what I’m after are the multi-plane flows. There are three planes of movement; saggital, frontal and transverse and weightlifting is saggital dominant, meaning our body gets very used to moving in one anatomical plane. I go once per week and the multi-plane flows and contorting of my body has been highly beneficial. Further, the demand to hold positions for a longer period of time in poses I would never challenge myself to do on my own has not only helped to normalize my joints and soft tissue, but it’s added an isometric strength element to my training that I’ve enjoyed. Because fascia stretches more slowly than muscle (12), it’s also important to take the body through held positions of static stretching for prolonged periods of time, as well, making a restorative yoga setting a good idea, as well.
- Drink More Water – Think of a water slide that stops receiving water flow. Not fun, right? That would be your muscle attempting to move under heavy load. Hydration is of the utmost importance to prevention and removal of trigger points. Without it, we don’t get better.
- Avoid Stagnation – If you sit at a desk all day, get up every thirty minutes to an aware and do some weird movements. Hip circles and rotations, lateral side bends, just move around and put your body in positions it doesn’t get into. Max Shank is big into this with his 5 Minute Flow. Grace from Marketing may ask what the fuck you’re doing but to hell with Grace.
- Consume a More Alkalizing Diet – Considering the evidence that knots are highly acidic, it would stand to reason that consuming foods that are alkalizing by nature would benefit our ability to rid them, wouldn’t it? I don’t have any evidence to support this, it’s just a cause and effect theory, but because excessive presence of acidity in the muscle will support the actin and myosin to remain bonded together (11) and the knot to persist, it stands to reason that less acidic blood arriving to highly acidic trigger points can only have a positive effect if any, right? Foods that would help with this are leafy greens, beets, cinnamon and ginger to name a few. Avoid unnecessarily high levels of meat, dairy, grains and alcohol.
In case you skipped to the bottom, here’s a recap of what we have learned.
Disruptive structures can form in our body from muscles being overstimulated or overused and/or the same movements repeated too many times, in combination with a lack of recovery and lack of water.
Once formed, the nature of knots cutting off their own healing through their acidic build up and inflammatory “poisonous feedback loop” continues to support their existence and becomes problematic for movement health.
Preventive measures include varying your movement patterns, dedicated foam rolling, ball therapy, rest, hydration, stretching and diet every single day.
To ensure diversified movement pattern and results, recommended training frequency is two anaerobic strength days, two aerobic circuit days, one to two yoga classes, one to two days of complete inactivity.
By paying attention to our movement and recovery, we have the ability to train incident free and see amazing, uninterrupted results.
-Bring a Yoga Tune Up Ball or lacrosse ball (not preferred) and roll your feet around it for 10 minutes a day.
-A Theracane can be a good tool to work triggers in your back while at your desk.
-Do not sit for more than an hour stretch. Take little break to do some dynamic shakes, rattles and rolls.
-Don’t eat garbage.
-Ten minutes on the roller while watching TV. Every day.
-Ten minutes of stretching in silence (great opportunity to use Coach Juliane’s Night Moves series here). Every day.
In the Gym:
-Don’t cherry pick. Train with diversity of pace, movements, load and intensity.
-Four days on, three days off (with yoga on one or two of the off days).
-Focus on establishing healthy movement pattern.
-Spend five to ten minutes on the roller on areas that will be targeted in that workout.
-If you are really tight a little light stretching is not a bad idea. Don’t overdo or stretch if you don’t feel tight.
-Spend five to ten minutes static stretching the muscles targeted in the workout. Hold the positions for thirty seconds to one minute.
-Foam roll for five minutes on the targeted muscles.
If Extremely Sore:
-Rest until it subsides. Do not train on top of it.
The condition of our soft tissue has great influence over our movement pattern, and subsequently, our healthy, active abilities. It is absolutely critical to the process that we include a variety of tools to help ensure our soft tissue is in a healthy state.
I would say this article represents a small tip of the information that is out there, but hopefully it’s a jump off point to starting the conversation proper recovery and a push in the right direction towards understanding your movement choices and the importance of recovery.
My guess is most of you will read this, be a little more educated and ultimately ignore the advice. You’ll walk through door number one each day, like I did for three years. The smart people will take the longer, more demanding road of door number two and enjoy years of uninterrupted training success.
Remember Bruce Lee’s quote. We are the sum of our movement decisions.
Are you receptive or stubborn? Unfortunately in this game, you can’t be both.
PS. If you enjoyed this article, please share it.
Dave Thomas is owner and head coach at Performance360. Dave has studied fitness and nutrition for over ten years and has been overseeing gym programming and client results at Performance360 since 2010.
Professional Acknowledgements: Tom Myers, Paul Ingraham, Dr. John Barnes, Brooke Thomas, Michael Rosengart
References for this article:
(1), (4) Ingraham, Paul. “Toxic Trigger Points.” Www.PainScience.com. Paul Ingraham, 19 Jan. 2014. Web. 1 Mar. 2016.
(2) Shah, JP, JV Danoff, and MJ Desai. “Result Filters.” National Center for Biotechnology Information. U.S. National Library of Medicine, 1 Jan. 2008. Web. 01 Mar. 2016.
(3), (7) Ingraham, Paul. “Trigger Point Doubts.” www.PainScience.com. Paul Ingraham, 8 Jan. 2008. Web. Mar. 2016
(5), (6), (8) Thomas, Brooke. “Top 5 Ways Fascia Matters to Athletes”. www.breakingmuscle.com. Date Unknown. Web. 1 Mar 2016.
(10) Thomas, Brooke. “The Thing You Do Everyday That is Setting You Up For Shoulder Injury”. www.breakingmuscle.com. Date Unknown. Web. 1 Mar 2016.
(11), (9) Rosengart, Michael. “Soft Tissue Therapy”. www.prehabexercises.com. 17 Feb. 2015. Web. 1 Mar. 2016
(12) Myers, Tom. “Staying Fit All Life Long: 10 Tips for Fascial Fitness”. www.embody-work.com.