Episode 230 Show Notes
Grant and Heavey are joined today by Charlie Merrill, from MPerformance.com and Lin Health, as they chat about pain. Is it real? Or just in your head? The brain may have a very powerful role in this so listen in to find out more!
[01:50] Listener’s Question:
Joe is asking about flys where he heard from YouTube not to do dumbbell flys on a bench because you’re too likely to extend too far. And you could put yourself at risk of tearing your chest muscle. What flys would Charlie recommend instead? Is the pec fly machine recommended? Or what other alternative exercises will let you achieve a horizontal abduction in your chest?
[03:18] Setting Your Intention
Basically, it depends on what you’re training for. Are you training for a sport where you need that horizontal abduction where you need to be strong in that position? You don’t have to limit your movement if it’s a normal healthy movement.
Charlie sees movements not being performed the way they should optimally be performed such as when you’re not training for a full range of motion. For instance, you’re doing a lot of leg lifts without the intention of using your abdominals. Or your back is extending when it should be flexing. It’s mostly technique faults that get people into trouble more than any particular movement. This is the main reason Charlie doesn’t want to scare people away from movement because 99% of the time they are healthy and good for you when done properly. If you’re not using the proper intention during your movement and not focusing on proper form, then you’d be running into some trouble. We need to keep on moving more often, not less. But, it must be with proper mechanics.
Especially when it’s heavy and fast is the time you need to be really focused. 80% of your movement should be pretty solid.
[08:15] Basic Movements
Back on Episode 225, Rippetoe talked about focusing on three movements – squat, bench press, and deadlift – and that’s it! Charlie thinks that if you’re just starting out, it’s nice not to have so many things to focus on so you can just master those things. You can hone in on form and intensity for the squat, bench press, and deadlift. But if you’re looking to go for a more well-rounded health, wellness, and fitness, then you’re going to miss a ton by just doing three movements. Although it could be a good starting point, there could be three other movements that can be just as good, depending on what the athlete needs.
[09:40] What is Pain?
Pain is an expression by our brain that is manifested in our body. It’s universal. The experience is unique to every person. But we all have it. Pain serves as a danger alarm system, warning us that something is not right. It’s there to get your attention and to help you change your behavior.
9 out of 10 of Charlie’s clients in the past year had no obvious mechanism for their injury. They had no trauma. There was no indication that overtraining was the cause of pain. Some people may have gotten an injury five years ago and they still could be in pain until now even if the soft tissue have long since been healed. So what’s the explanation for this?
[12:40] Blame It on the Brain
The brain is in charge of all of our pain. Understanding how that plays out in the real world is really interesting. Charlie talks about interesting stories of people who have injuries but felt no pain. On the other hand, there are also some who do not have any injury at all, but they have massive pain. All that being said, the brain weighs out all the information that comes to it and makes a decision on what signals to send.
[15:05] The Brain’s Representation of Our Body Parts
In Grant’s case, he has a toe injury and the pain he feels limits the movements he’s doing. So if for instance, he only does half-squats instead of squatting to full depth because of the pain. Pain is going to change our behavior significantly. It’s going to prevent us from doing certain things. But Charlie questions whether how much of that range of motion is just adaptive since you haven’t been using that body part?
It’s possible that it’s because of the representation of your brain for your toes. There are actually representations of what our body parts look like in our brain. It’s represented by massive hands, feet, and tongue and lips while the rest of the body is relatively tiny. This shows that the brain dedicates a lot of sensory and motor information on each body part. The brain’s representation of that toe might have adapted to a point where now the toes feel painful all the time even though if they’re not structurally damaged.
[17:50] All Pain is Real
All pain is real. So there is actually pain in Grant’s toe. His brain has been conditioned that the toe is now in danger. And somehow, it needs to be protected. So Grant’s behavior is trapped with that and the brain thinks it really needs to be protected. The pain dial is turned up for years and years because the belief system concerning his toes is being bad and stiff.
The first step in the process is to rule out structural problems. Then you can move on to the next step of developing a treatment plan for that body part. Charlie mentions an Australian study where there observed 3,200 people with back pain. They went through the primary doctor and less than 1% of them had a scary structural problem that needed some type of attention. The prevalence of structural problems is really low. That being said, it’s still important to rule it out.
[19:40] Back Treatment for Peripheral Body Parts
Charlie sees mostly spinal-related problems. He stresses that any time he treats a peripheral body part like a hip, knee, or ankle, he always treats the lower back. The lower back is how the information goes up and comes back down. The signal has to pass through the lower back to get there. There’s almost always some effects on dysfunction on the lower back that’s affecting the limb. If it’s the wrist, limb, or shoulder, he always treats the neck and usually the upper back in order to help the person move on. Treating the painful body part is usually not a great solution.
There’s an upstream-downstream phenomenon where you have an injury in the foot and there’s some upstream thing causing that downstream pain. This is because the nervous system is all connected – it’s one piece of tissue through the whole body – unlike the muscles which are discrete from side to side. The nervous system creates more complexity in that we have to consider the whole system including the brain and the spine.
80% of people have low back pain at some point. This is attributed to things like posture, sitting, and environmental factors such as your work station. But that’s old school thinking as those things don’t correlate well. Mostly, it’s caused by psychosocial factors. We used to think that heavy backpacks were bad for kids and that really isn’t supported well in the literature at this point.
[22:35] Psychosocial Factors that Lead to Low Back Pain
Looking at pain in a biopsychosocial model means we consider the body, the psychology, and the social implications. For instance, what other people tell you, who you spend time with, who your parents are, the places you hang out, etc. So there’s definitely a social contagion aspect of pain and this is backed by a lot of interesting studies.
So you think of those three factors now rather than just the biomechanics. If you think that driving your car is going to hurt your back, it probably will. If you think your mattress is hurting your back, it probably will.
Back on a episode 224, a study was actually mentioned where housekeepers have a pretty active job and half of the group of housekeepers in the study were told that their physical activity from their job qualified and met the recommended exercise standards. As a result, their biomarkers started improving, whereas the other group didn’t with the same amount of activity.
So psychology is plays a role here. Our brain is getting feedback from our body, from psychology, social inputs – and makes a decision on what to do about it. Pain is just one really effective output to get people’s attention, especially athletes.
Athletes are especially vulnerable since they define themselves by what they can and can’t do.
[25:55] How Do You Move Forward?
A joint doesn’t have to be totally clean to be considered normal. There can be degenerative change or wear and tear. There could be disc bulges or disc herniations in the back that show up on the MRI. But those things don’t predict pain well. There’s a poor correlation between MRI findings and the pain we see. There are a lot of people that have wear and tear in their bodies that don’t necessarily need to be in pain.
The term commonly used now is “curing” pain rather than coping. Coping is the psychology word where you just accept the fact that you have pain and you have to live a life with pain. But now we know that pain is a helpful message. The more we help people receive what that message is, the more they can heal and get past it.
[28:10] Two Types of Pain
There are two different types of pain – the one you choose and the other you’re don’t choose. The former type of pain is scary. A lot of athletes can normalize the first type of pain. They get used to it and can tolerate it really well. Their brain is less sensitive to it and it doesn’t have the same fear response that another athlete might have. They’re able to tolerate better.
The other type of pain is scary because you don’t know what’s happening. It’s out of your control. You can’t just stop training to make it go away. It’s there with you all the time and maybe it’s affecting your relationship. It’s affecting much more of your life than just that hour of exercise. This kind of pain lights up the brain in a different way. With functional MRI, we see that more and more where the chronic pain lights up the brain in a very specific way. It’s tied deeply to emotion and some brain centers that are not just dedicated to the body.
[30:45] Is Pain Just in People’s Head?
In someone with fibromyalgia, the pain is very real. They have muscle tension in their body as well as fascial restriction. Those are changes are very real but you have to understand those changes are being driven by the brain. The trigger now tends to be more psychosocial-mediated. The physicians and professionals are now treating fibromyalgia with much more success.
Moreover, all symptoms in the body can be produced by the brain but it can also be potentially produced by body problems. Hence, you want to rule this out. Once we have pain, the current stressors of a person’s life are important. These get accumulated over the years. Part of the process may include unpacking these things. Manual therapy techniques from PTs and chiropractors use change the brain as much or more than they change the body. As a result, the body changes. Charlie also teaches his patients some rules of how pain works to make it less scary for most people.
[36:38] What is Manual Physical Therapy?
Manual physical therapy is a niche where using specific body techniques such as manipulation, trigger point needling, fascia release, and corrective exercise. You’re working with your hands to change the way people’s brains and bodies perform.
As to assess whether it’s the muscle or the fascia is affected, you need to assess based on watching them move, hearing their story, and putting your hands on them. Charlie usually works in multiple systems because it’s usually not just one structure that needs to be worked on. For example, the joint has to be manipulated. The fascia has to be released. The joint may have to undergo stability work.
[40:52] Dry Needling
Dry needling is the way to tap into the nervous system to create change. It interrupts the status quo. So if your brain has this outsized representation of your big toe, dry needling can help interrupt and change that.
Links
SS 224 – Using Your Mind To Improve Your Fitness
SS 225 – Getting Strong is Simple w/ Mark Rippetoe
Healing Back Pain by John Sarno
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