BODY

Pain… The Good and the Bad!

Pain is a daily occurrence in some form or fashion all over the world. Have you ever heard this saying?

“There’s good pain and there’s bad pain.”

As a physical therapy specialist, I see people who have pain, which makes them unable to do something meaningful for them. I see jiu-jitsu fighters who have been hurt continue to train through the pain and inevitably it gets worse, requiring them to later seek longer duration professional help. And why you might ask? This is because there are different types of pain experiences, and we are always hopeful that it will just go away. If you ignore it, it can get worse and do so with vengeance. Pain is also an individual experience. So, no one can feel your pain, which can make it challenging for you to sometimes personally manage. Is that pain “good” or “bad”? This article will discuss the types of pain experiences commonly seen in sports regarding jiu-jitsu.

Mechanism of Pain

Before we discuss the different types of pain, it is important to understand how pain is created. Pain is defined as an unpleasant sensory or emotional experience associated with actual or potential tissue damage. That is a powerful definition! It starts with a stimulus somewhere in your body. If the stimulus is strong enough to invoke an action potential (electrical impulse) in your nervous system, that impulse is then sent to your spinal cord, up to your brain, which then gets interpreted. The brain then has to decide if this stimulus is going to be read as “DANGER” or “IGNORE” it. This information is constantly fed to your brain, and it is also constantly filtering the impulses every second of every day. If you are sitting reading this article, your butt may be telling you to move around because your butt tissues are being compressed from sitting. This stimulus you will either ignore, or you will shift around to avoid more intense “pain.”

Personal Experience of Pain

Your brain has a “pain map” that is created from your own life’s experiences. This makes everyone’s map unique. This map can be related to any one of the following: physical, psychological or emotional pain. If you are having physical pain (let’s say elbow pain from an armbar) and then experience emotional / psychological pain at the same time (missing the podium because of that armbar you saw coming but didn’t react fast enough), then the pain can be magnified. This will, in turn, leave an imprint on your brain, so if you ever experience similar circumstances in the future, the pain may actually be worse than the previous time because the pain previously wasn’t bad enough the first time around.

Let me give you another example: if you have played sports growing up, your tolerance to pain may be higher than others who didn’t. Why you ask? This is because you have been knocked around, pushed and pulled in every direction, likely experiencing some form of pain (both good and bad). And realizing that the little bumps and knocks did not kill you or threaten your life,  your tolerance or sensitivity to this pain is better than others who may not have experienced it.

Actual vs. Potential Tissue Damage

What does this mean? It means the mind is very powerful… You don’t even need to physically experience pain to be able to feel pain (which is in your brain). The thought of having pain can actually cause you to feel pain. Let’s explain this further.

Have you ever seen someone get hit in the groin or punched in the face? Both of these situations will cause an experience that is nothing short of pain free. Both of them hurt! Did you ever watch this happen and you started jumping around, maybe even held that part of your body, knowing how bad that hurt? Now you experience that pit in your stomach from either situation even though you didn’t get actually get hit. But maybe you know that situation. It still hurts!

Good Pain

It hurts so good… When we say good pain, we mean pain that we know our brains interpret as not being dangerous. That’s why we say it’s good, but this is left to your own personal interpretation.

Muscle pain – This is the pain that can occur from either stretching or using your muscles. You may experience this after you push the limits of your muscular system. Whether it is after a hard jiu-jitsu training session, strength training session, or stretching session, you likely know this pain. It’s the most common type of good pain we experience. This can happen while training and up to several days following, especially if you are ramping things up. Initially, this pain is due to fatigue in the muscles and then the pain felt in the subsequent days is from a buildup of lactic acid in your muscles. This is totally normal when you increase either the intensity or frequency of your training. This pain or soreness is known as DOMS (Delayed Onset Muscle Soreness). The muscles have been broken down microscopically and then have had to rebuild themselves, making those muscles stronger. This pain usually takes 2-3 days to subside.

This type of muscle pain can also be experienced following a really good deep tissue massage or stretching session, as the health professional breaks down restrictions and increases the mobility of your stiff tissues. Maybe you have foam rolled yourself and thought that really didn’t feel good, but yet you still did it. And you may also experience DOMS afterwards (as described previously). So be prepared. Most importantly, this pain is very short-lived.

Joint stiffness – This type of pain isn’t necessarily pain, but something that you may experience if you have been training really hard for an event. Some will describe this as soreness, but often this goes away with activity. The key to this type is stay mobile. This is where stretching, walking, or light activity is extremely helpful.

Bad Pain

Bad pain is described as a type of pain that either takes a long time to recover from or indicates a more severe

injury. Your brain has interpreted this pain as “DANGEROUS.”

Referred pain – This type of pain occurs in response to an actual problem going on somewhere else. A common example in jiu-jitsu is having pain that shoots down your arm, but the source is the nerves coming from your neck. Maybe you got stacked on top and felt something initially into your neck and then sometime later felt it go into your arm/hand.

Muscle pain – This type of pain can be bad too. It usually comes from either a forceful muscle contraction or elongation. This causes tearing of the muscle fibers and is often heard by the individual. This pain is usually described as being sharp. Following this type of injury, there is pain into the muscle belly (center portion) that hurts to contract or lengthen. If the damage is severe enough, you can feel a gap in the muscle.

Tendon pain – This type of pain is usually described as achy, but does get sharp when the tendon/muscle complex is stressed by contraction or lengthening. This is commonly known as tendinopathy. This pain is tender over the tendon and feels better when you don’t put too much stress on it. When you add stress to the tendon, the pain will likely increase. This type of pain can take a long time to heal if you wait too long to take care of it.

Ligament pain – This type of pain is usually described as sharp when there is stress placed onto the ligament. As an example, if you play De La Riva guard, your outside hook leg is vulnerable to LCL (lateral collateral ligament) damage if your opponent pushes down on the inside part of your knee. This can stretch the ligament

out, giving you the sense of movement or instability as you do activities.

Chronic pain – This type of pain occurs from initially sustaining an injury, and then failing to allow the healing to complete. According to a study conducted by the National Institute of Health in 2012, it was estimated that nearly 23.5 million Americans suffer from chronic pain

(daily pain for >3 months). This accounts for about 10% of the population. If you continue to train when you have an injury, you risk constantly re-damaging the injury site, which delays your ability to fully return. As hard as it is for some to put a halt on training, it can be detrimental to your recovery. This makes the injury worse and impacts your long-term prognosis.

These types of injuries need to be followed up by a healthcare professional such as a medical doctor, physical therapy specialist, or chiropractor who understands these injuries well. They need to be familiar with the proper management strategies for these types of injuries.

When to Seek Professional Help

As a general rule of thumb, if any pain lasts longer than 7-10 days, there is a really good chance you need it be looked at by a professional. Why? If you do not get it looked at carefully, your body will do amazing things to compensate for what is going on. This will alter the way you function, from walking to sitting to training. These compensations will lead to bigger problems down the road, so we always say early intervention is the best intervention.

Remember that your brain has a map, and longer you deviate from the course on that map, the longer the recovery can be. This is where a team of health professionals in your corner are an asset to give you longevity in the sport of jiu-jitsu or anything else you participate in.

General Management Strategies of Injuries / Pain

1. Control the pain and inflammation

This usually takes 2-3 days. Training should be halted here or significantly modified until these are under control. This can be achieved simply by applying ice to the area. Inflammation control is important because it creates muscle inhibition (makes muscles harder to function appropriately). Although inflammation is a necessary role for the body to heal correctly, excessive amounts are thought to prolong the recovery time. So, early intervention is the best intervention here! Apply ice to the injured area for 15-20 minutes only. Any longer than that and you risk making the inflammation worse. If the injury is severe enough, using a sling or brace may be necessary for a short time to remove additional stresses to the injured area thus reducing the pain and inflammation.

2. Restore range of motion and increase muscle activation

This usually takes 1-2 weeks. Training should still be halted or significantly modified here. You need to go to class to support your training partners and watch carefully. You can still learn! Range of motion can be achieved by

simple range of motion movements. You do want to work within your comfort zone and go slow! Don’t cause more pain. As your range of motion improves, then train the new range by using a light hand weight or light resistance band to perform the same motions.

3. Increase your strength and endurance 

This is the longest phase (6-8 weeks and sometimes even longer) and now training can start here… but still be careful with who you train with. The injured area needs to function appropriately to provide muscular stability and control. If there is still inflammation, this can inhibit muscles from working, and then they must be retrained. Strengthening is the most important part here and can be achieved by progressing the

resistance bands and weights to improve strength and endurance. Remember, never sacrifice QUALITY of movement for quantity. We often will recommend repeated movements for time rather than a number of reps. This way the focus is on the quality.

4. Increase your functional performance 

This phase and phase 3 blend together now up to 3 months. At this point, you should be feeling great and have already been back to rolling and training. The light is at the end of the tunnel, but you are not quite there yet! This stage is the longest and the easiest for people to stop because they are feeling much better. You need to continue to address overall strength with complex movement activities, like plyometrics and yoga.

A delay in treatment often leads to extended healing times and lost time with training and rolling. Improper management of your injury will increase your risk of future injury. Finding a specialist to tend to your injury is very important in the long run. The specialist will be able to work with you and guide you toward the best outcome to match your goals.

Conclusion

When it comes to pain, it is part of our everyday lives. Everyone has varying levels of pain tolerance, which you can divide into “good” and “bad” pain. Realizing that pain is a signal or warning system to the brain, which it filters as dangerous or something that can handled, some people have the ability to sink into higher level of thinking to block the pain well after the actual injury happened. We see this in jiu-jitsu quite frequently in tournaments when the stakes are on the line. The bottom line is this: understand pain and that it isn’t always bad. And if the pain persists, seek out help to get you back on the right track, so you can return to what is meaningful for you.

Stay healthy and see you on the mats!!!

 

For more information check out: Level 4 Physio-Wellness-Performance

dr.ingstad@level4pt.com

 

 

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