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  • Mitchell Rothbardt

Ways to Deal With Chronic Pain

Let’s face it. We live in a society that is growing more and more sedentary all the time. We all sit in front of a computer for a very large part of our day and it is absolutely destroying our bodies. Everyone who is familiar with the Fitbit knows about the 10,000 steps per day goal. Well, it’s not uncommon at all to see that someone’s step total is accrued almost completely from walking from their house to their car to their office chair and back. You’d probably be lucky to get 3000 steps from that.

I’m not going to get into all the hows and whys this is so damaging in this article but suffice to say that this is absolutely destroying how we move. When you add in the stress we feel from being super-busy all the time it’s no wonder so many people’s posture suffers so badly.

I know this isn’t nearly as sexy a topic as how to lose weight but I can’t stress how much more important it really is than that. All day I see people who have knee pain, shoulder pain, back pain, hip pain. They’re all looking for the one thing that gave them that pain and I do my best to explain that just one thing didn’t do it. It’s the end result of hours and days and even years of poor posture and poor movement.

Let me repeat that in a little different way.

Unless someone took a baseball bat to you, that chronic pain you’re feeling is most likely the end result of hours, days and years of poor posture and poor movement.

I could repeat that statement from now until Saint Smithen’s day and it would ring just as true each time I said it.

There are a number of different ways to deal with this kind of pain and I’m going to talk about that here. I like to classify the treatments for these things as being either active or passive.

Passive treatment would be something like going to the chiropractor or getting a massage. In other words something where you go and have something done to you.

Active treatments would include exercising or stretching. In other words something you do to yourself. (Get your mind out of the gutter!)

What I want to do in this article is explain what I’ve found with these different treatments, both the positives and the negatives. I’ll keep it quick because I think there are some basic principles that apply, no matter what. (It’s funny how simple some of this stuff is when you really think about it.)

First let me say this as an over-riding principle: Passive treatments put you in a position to be better able to correct your issues through some kind of active treatment. In my opinion, passive treatments can be very valuable but are not an end unto themselves.

Let me explain what I mean by this. What passive treatments do for the most part is relieve some sort of tissue restriction. Now here is the important part.

They do not address the underlying issue of how that restriction got there in the first place.

Let’s get a little specific to explain what I mean.

By far the biggest single issue I see is shoulder pain. I see shoulder pain way more than back pain. I’d even say shoulder pain is at least 3 or 4 times more common. The reason for most of the shoulder I see is closely related to three reasons:

  1. People’s tendency to elevate and hunch their shoulders when typing.

  2. People’s tendency to elevate and hunch their shoulders when stressed.

  3. People’s tendency to jut their head forward while typing, driving, watching TV, or looking at their computer. This head position will force an elevated and hunched shoulder position.

The elevated and hunched position over time leads to a pretty common shoulder issue known as impingement. It’s a pretty wide-ranging term but some version of it is the most common cause of shoulder pain that I see.

The most important thing that someone can do to alleviate this kind of shoulder pain is to work on his or her overall shoulder and head position. To be specific, making sure that your shoulders are back and down and your head is not jutted forward, particularly while under stress or in front of a computer. While working on this you should also be working on shoulder movement, specifically the tendency to use your upper traps and neck instead of your shoulder blades for much of your shoulder and arm movement. This is what contributes so much to stress and tension.

After years of improper movement and posture there will be lots of movement restrictions that have built up in the form of scar tissue and other things. Due to this it may be very difficult to move properly or hold good posture. This is where passive treatments can be valuable. A good massage therapist, for example, will be able to manually break down some of these restrictions, which will temporarily give you greater range of motion and the ability to move better. I say temporarily because if you don’t work on these things after your massage, old habits and positions will put you right back where you started.

Let me talk a little about more specific types of treatments and the positives and negatives of them. We’ll start with passive treatments.

Massage – Everyone loves a good massage. A good massage therapist will be able to find tight muscles and restrictions and either break them up or start that process if you have a lot of these issues. There are a few ways that you can do some self-massage work (we’ll talk about these in a minute) but there is nothing like having someone who knows what they’re doing get in there.

The negatives are that, as I’ve mentioned many times already, if you don’t take advantage of your improved range of motion and work on your movement, you’re going to find yourself right back where you started pretty soon.

Chiropractic – Chiropractic work can be a little controversial. There are some who swear by it and others who consider it a sham. I’m on board with it and have seen its value. Having said that, I know way too many people who rely on it way too much.

Consider the overarching theory of chiropractic work. In a nutshell it says that the body, if put in the right positions, has the ability to heal itself. I certainly believe that. The key here is that you must put your body in the right positions. A good chiropractor will set you up to do that, but ultimately the responsibility is up to you.

If you’ve been going to a chiropractor every week for years to work on the same issue, you’re doing something wrong.

Ultimately passive treatments can be very helpful but the main issue with them is they don’t work directly on movement or posture.

Let’s talk about some more active treatments.

Foam Rolling – This kind of bridges the gap between passive and active treatments. It’s active because you do it yourself but it is pretty similar to a massage. It can be great at getting rid of some restrictions and giving your muscles the ability to relax. This alone can increase their range of motion and reduce pain. We always foam roll prior to exercise and sometimes after, as well. It is like any passive treatment, though, in that it can remove restrictions but doesn’t work on movement itself.

Stretching – Stretching for the sake of stretching may be the biggest waste of time there is to relieve pain. There are a few reasons for this.

  1. It doesn’t work on movement

  2. People frequently stretch in a fashion that actually tightens the muscle instead of loosening it making the problem worse

  3. People stretch the muscles that feel tight not realizing that they feel tight due to restrictions somewhere else which, again, makes the problem worse (if you spend lots of time stretching your low back and hamstrings this statement applies to you)

  4. People stretch in a way that forces them into bad posture which, again, can make their problem worse

That being said, targeted and proper stretching of specific muscle groups can be helpful in getting certain muscles to relax. The key is using proper techniques for the right muscles.

Mobility Work – This can be a little hard to define because some people’s mobility work is some people’s exercise and vice versa. There is a little gray area here but a good general definition is that mobility work is a lower level exercise that focuses purely on the mobility and/or movement of a specific joint. The key here is that it’s a lower level (usually meaning relatively easy) movement.

We generally use mobility work as part of a warm-up. We use it there because it’s usual purpose is to get the body ready for more difficult movements that will test the movement pattern. Think of it like practice. The gray area comes when some people learning a specific movement pattern may find it so difficult that they are not yet able to make it more difficult.

If you don’t know what I mean lets think of it like driving a car. For an experienced driver, driving at 10 miles per hour would be kind of like mobility work whereas for someone just learning that may be full on loaded exercise. I hope that makes sense.

The positive aspects of mobility work are that you are working on your movement. One thing to keep in mind here is that there is no excuse not to perform mobility work with 100% good technique. If you can’t, then it needs to be regressed to the point where you can. If you don’t, it’s like driving into a parked car at 10 mph only to hop right back in the car to go 25mph.

The negative aspects are that you can’t stop here. Once you can perform your mobility work at 100% you must systematically make movements more difficult in order to teach the body the proper movement patterns under stress. That is the only way to make good movement a habit.

Strength Training – This is the ultimate active treatment. Not only does proper strength training improve muscle function, it improves proper movement due to the muscles in questions simply being stronger. How does this happen?

A stronger muscle can withstand more stress while still moving well and holding positions properly. Doesn’t that make sense?

The disadvantage is that improper strength training can cement poor movement patterns and force compensations.

I hope that this gives you a better idea of ways you can go about recovering from chronic pain. I assure you I know how discouraging and uncomfortable chronic pain can be. Like everyone I’ve had my share of dings and tweaks. Not too many people know that over the last several months I’ve suffered through some pretty uncomfortable left knee pain. Having said that, I squatted 463 pounds and deadlifted 480 pounds pain-free at a powerlifting meet a few weeks ago. I did it using a combination of the treatments described above and following these guidelines as written by Max Shank, an excellent trainer from the San Diego area:

“I’m convinced the fast track is as much non-painful movement as possible. Maintain range of motion and prevent excessive scar tissue. Need to lay off movements that hurt, though.

I have found that total rest is actually worse because then people develop a sense of fragility, which impedes long-term improvement.”

I know this is a complicated subject. I hope I could shed a little light on it. Please let me know if you have any questions or if I can help you in any way.

As always, thanks for reading!

Mitch Rothbardt, CPT, PN Lean Eating Coach Level 2, FMS

510-754-7113

MitchRFitness@gmail.com

2861 Grove Way in Castro Valley

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