Pain is a complicated topic. It is important for sport coaches, strength & conditioning coaches, physical therapists, and other sports medicine personnel to possess a sound understanding of pain since they typically deal with athletes, clients, and patients who are in pain.
I’ve delved into pain science, but my knowledge is far inferior to the folks who make pain science their primary research focus. Therefore, I invited pain expert Jason Silvernail (DPT, DSc, CSCS, FAAOMPT) to conduct an interview on pain.
I hope you gain some valuable knowledge listening to this interview – I know I did!
Click Play to Listen
Below are the questions I had written prior to the interview. While I didn’t stick to the questions “to a T,” I tried the best I could.
- First things first. Please state your credentials. Why should people listen to you?
- Before we delve into things, let’s define some terms. Please explain:
- The PSB model
- Cartesian model of pain
- Bottom-up approach
- The BPS model
- The neuromatrix
- Altered action patterns
- Would you agree that there is a sound link between anatomy/structure and injury. For example, sacral inclination and L5/S1 disc degeneration, tibial plateau slope and ACL injury, increased Q-angle and patellofemoral pain, and anterior pelvic tilt and hamstring strains.
- Would you agree that there is a sound link between posture and tissue stress/deformation. Those in anterior pelvic tilt and lumbar hyperlordosis, for example, will place more stress on the posterior elements of the spine, and those in posterior pelvic tilt and lumbar hypolordosis, for example, will place more stress on the posterior side of the discs.
- Would you agree that there is a sound link between biomechanics/form and tissue stress/deformation. For example, those who jump and land in knee valgus will exhibit more stress on the knee, and those who round their back excessively when stoop lifting will exhibit more stress on the spinal ligaments and intervertebral discs.
- So if the PSB model dictates how tissue stresses are allocated throughout life, then it’s logical to assume that the PSB model is linked to pain, right?
- So what’s the problem? Does research support the PSB model and pain? Should “injury” be directly associated with “pain”?
- You’re telling me that things like excessive anterior pelvic tilt, spinal instability, gluteal amnesia, and knee valgus aren’t well correlated with pain?
- Does every individual have enough “dysfunction” to warrant pain?
- What factors contribute to the likelihood of an individual experiencing pain?
- I have an identical twin brother. I can squat pain free week in and week out, but last year he informed me that his knees hurt when he squat. I investigated his form, and lo and behold he was caving in at the knees. Isn’t this a clear cut example of the link between biomechanics and pain – we have the same genetics, but my form is better than his, which leads to different outcomes. Moreover, I showed my brother how to squat with his knees out and his pain during squatting vanished. Better mechanics equals less tissue stress equals less pain. Biomechanics therefore cures pain. In S&C, we work with individuals who experience pain during exercise. Often we alter their biomechanics and voila – the pain goes away. Can we assume that we simply decreased the “mechanical insults” to their tissues by having them move better? What’s wrong with my thinking?
- Usually people hurt in areas that receive high concentrations of stress – the knee, the lumbar spine, the SI joint, and the shoulder, to name a few. And when people experience injury, for example an ACL tear, a hamstring tear, or a herniated disc, it’s almost always accompanied by pain, right? Doesn’t this indicate a clear link between biomechanics and pain? Are there any scenarios in sports medicine where “tissue deformation” or injury almost guarantees pain?
- You’re telling me that someone can herniate discs or tear tendons, labrums, and menisci and not experience any pain at any point in time?
- Should personal trainers, strength coaches, and physical therapists study movement and try to learn the best ways to move so that tissue stress is minimized (for example, joint centration)?
- Should personal trainers, strength coaches, and physical therapists be concerned with fixing posture?
- How do you structure your physical therapy sessions?
- Do acute pain situations require different strategies compared to chronic pain situations?
- What are your thoughts on myofascial release, ART, foam rollers and the like? Are they the panacea for pain, or are they mostly effective through the placebo effect?
- Is there such thing as good movement versus bad movement? Do we just wait for people to hurt and then teach them something different? Should we actively try to avoid injury and excessive tissue stress/deformation, and why are some movements more notorious for creating pain?
- Should treatment be based client’s beliefs? What if their bias/preferential treatment was geared toward accupunture or even crazy things like wigi boards? Should we do that instead of movement?
- We see evidence of decreasing threats in our daily lives as guys who exercise. For example, the pain induced when first putting the bar on the body during back squats, front squats, Zercher squats, hip thrusts, or hook grip deadlifts eventually subsides. DOMS goes away with frequent bouts of the same exercise. However, pain isn’t always predictable. Many people tend to have trigger points that never seem to go away. DOMS in the low back always tends to occur with deadlifting. A hot Jacuzzi session “hurts” night in and night out. Why does some pain vanish while other pain resides or reoccurs?
- Who are the top pain researchers and experts?
Links, Pics & Vids
Lorimer Moseley (Body in Mind)
David Butler (NOI Group)