Pain & Injuries In Barbell Training | Part 2 - Do You Need an MRI?

In Part 2 of the pain & injury series, Drs. Rori Alter and Alyssa Haveson explore the three components involved in the experience of pain, the biopsychosocial model of pain, and why people experience pain differently.

Pain is a complex physical and emotional response, that sometimes -- but not always! -- occurs in response to injury or physical trauma.

It's tempting to trace pain and injury to a specific event, or a problematic joint or muscle, but this is often difficult to do.

While MRIs are a useful tool, they don't tell the whole story about pain either.

When barbell strength trainees or powerlifters get injured there is often fear of the unknown.

What does this injury mean for your participation in barbell lifting in the immediate future and down the line? Sometimes pain and fear hold you back from maintaining your strength through the healing and athlete recovery process.

On the other hand, you may ignore your aches, pains, and injuries only addressing the issue when your training, performance, or life starts to suffer.

You may be wondering:

“What should I do for X?”

“How long will this take to heal?”

“Do I need an MRI?”

“Can I continue lifting?”

“Should I stop lifting?”

“When will I get better?”

“What stretch or mobility exercise should I do?

“Is X torn?”

“What’s damaged?”

The medical and exercise narratives often lead us to fear certain movements and hyperfocus on specific tissues, bones, or joints that are the “one” thing causing your injuries.

But the truth of the matter is:

Pain does not always mean damage and damage doesn’t always mean pain
The cause of injuries are multifactorial and there is never just “one thing” in or outside of your body that causes an injury

In this episode of the PRS Podcast we are going to help you understand why it’s important to continue to barbell train through injuries and as the injury rehab process.

We cover:

The medical-model narratives around barbell training, injuries, and pain that lead people to fear lifting. [00:08:59]
Understanding the pain experience through the lens of the Bio-Psycho-Social model of pain and why everyone responds to pain and injury differently. [00:23:56]
What tissue damage means for pain and dysfunction and what pain or dysfunction means about tissue damage. [00:25:38]
The importance of MRI findings in the injury diagnosis process. [00:35:12]

Dr. Rori Alter, PT, PRSCC, SSC: [00:00:24] Welcome back to the Progressive Rehab & Strength podcast. I'm your host. Dr. Rori Alter, head clinical coach here at Progressive Rehab & Strength, with my lovely co-host today. Again, as always, Dr. Alyssa Haveson, also a PRS clinical coach, and we are in part two of our Pain and Injury series. So in our last episode of this series, we talked about what barbell training injuries are, the difference between acute and chronic injuries, and why acute injuries are almost easier to wrap your head around. And the multitude of factors that lead to injuries, such as tissue capacity, training load, and technique. But there's more that we're going to talk about today. So if you haven't listened to Episode five, which is part one of this pain and injury series, we highly suggest listening to that and then coming back to this one as a follow-up to it and then listening to our next episode, episode seven, which is part three and the final part of the Pain and Injury series.

Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:01:38] So in this episode, part two of the Pain and Injury Series, we're going to discuss a very important topic, the pain experience and if and when we need imaging for our injuries in pain. So, Rori, why do these topics get their own episode?

Dr. Rori Alter, PT, PRSCC, SSC: [00:01:54] Oh, boy, it's a big question. That is the big question. Why are we talking about pain and imaging in this episode? So in the medical and insurance-based world, there is a very, very large emphasis on pain and how much pain you have and how frequently you experience pain. And does this cause you pain and blah, blah, blah, blah, blah. You're always asked about pain on all your intake forms and in every treatment session or in a physical therapy treatment session. Or, if you're seeing the orthopedist, you're asked about pain. If you're seeing the chiropractor, you're asked about pain. It's like pain is almost one of the first questions asked, and it's the only question that is always asked, right? So if you don't have pain, you might not even get any more treatment sessions from your insurance company. So pain is a very emphasized question or experience in the medical world. And that's what it is, though. It's an experience. So not everybody experiences pain in the same way. How much pain, what that pain signifies to someone, and what they believe about pain all play into their experience and how they function with pain or even without pain. So we have the medical narrative that plays into pain in barbell training. So we're talking specifically about barbell training. We're going to look at the medical narrative and the exercise specialist and rehab clinician narrative, kind of like the old view. I would say we have a more global or wholesome approach to pain and the pain experience that has been coming to light in the last decade.

Dr. Rori Alter, PT, PRSCC, SSC: [00:03:45] So we're going to go over the medical narrative and some of the exercise specialists and rehab clinician narratives that play into people's beliefs about pain and barbell training. So like I said, doctors and clinicians frequently ask for a pain level. So they're like "on a scale from 0 to 10...," and we do this too because I think pain is important. We do have to ask, and I think it's important to get a rating from a person because it can give us how they perceive the intensity of their pain relative to what we might experience. So the relative intensity of the pain is more what we're looking at, not really like a ten out of ten is not the same ten for everyone and a five out of ten is not the same five for everyone. It's five on their scale and ten on their scale. But in the medical world, that's not it's one scale. And so, it's not a relative scale in the medical world. So doctors and clinicians frequently ask about pain. So that's one huge component of it. And like I said, this information is helpful, and we do need to know about it. But reporting pain too frequently and directing your focus on pain instead of all the symptoms, where those symptoms are coming from, why we have those symptoms, and what is contributing to them is where the medical model falls short.

Dr. Rori Alter, PT, PRSCC, SSC: [00:05:17] And there's also a common narrative that pain is bad and means damage. And if we have pain, we should stop. And if we don't have pain, we can do things right. So I think that instills a belief in people that pain means stop and no pain means go. And because also most clinicians, medical doctors, even physical therapists, and chiropractors don't know enough about barbell training, specifically programming and technique. And they make assumptions that you're just training at high intensities all the time and that if you're training at high intensities all the time, obviously you're going to hurt yourself, which is not the case. And they don't understand how to adapt programming and adapt technique to help you continue to train through injury. So the medical world says, Oh, squats and deadlifts are bad for your back and your knees, and you're going to hurt yourself. So if you're in pain, don't do them at all. Right? So we have this whole narrative from the doctor that you might be seeing for pain or injury that automatically says, pain, stop. So if we fall into this category where we're just going to listen to our doctor and we haven't seen other people get through injuries and continue to train with injuries and experience pain, but still train and come out of their injuries. On the other side, we might develop fear, right? Anything you want to add to that, Alyssa.

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