Article written by Josh Mac
I own a shirt that reads “Train through the pain” across the front of it. That’s some real tough guy sh!t, let me tell you. I bought it before I knew what pain was and what pain, specifically nerve pain, was capable of doing to me. Now I wear it ironically because the message that it sends, although Neanderthal in thought process, still rings nonetheless true for me.
18 months after a 4 disc herniation, I have reoccurring pain due to nerve damage which manifests itself as sciatica in both legs and a degradation of peripheral feeling in my right quad. These sensory problems are the remnants of the damage done when disc material and blood ejected and pressed against my nerve roots as a result of a lifting related injury. Although the acute injury has since healed, pains more evil side reared its ugly head in the form of lasting chronic nerve pain.
Many of us have sustained injuries as a direct result of training, but when is it ok to train through the pain and when isn’t it? What is nerve pain and what is it a symptom of? Is pain and the experience of having pain cumulative in nature, or can it cease without leaving a physical trace of its presence? Let’s tackle the shit out of this topic as hard and as painfully as humanly possible.
What is Pain?
Pain at its core is a feeling that occurs when nerves indicate that something may be wrong in our bodies. I refrained from calling the feeling unpleasant because some people are sick f#cks and actually enjoy it. Generally speaking, pain can be a sign of damage, disease, degeneration or just the symptom of being in Ric Flair’s figure four leg lock. Pain is classified in two general classifications: Acute and Chronic.
Acute pain is a sudden onset from a clear cause, like me punching a hipster in the face. Pain that has a direct known causation, intensity and duration is known as being acute. Things that can cause acute pain include but aren’t limited to:
- Getting kicked in the balls
- Getting kicked in the ribs
- Getting kicked in the teeth
- Getting curb stomped
- Being in Brett the hitman Hart’s sharp shooter
Acute pain is generally treated by treating the injury or condition that is the cause of the pain. Once that heals, the pain should stop and usually does. You don’t still feel your circumcision, do you?
Chronic pain on the other hand is pain that may start as an acute pain but its duration and/or intensity extends beyond the scope normally associated with the injury or condition. It is characterized by a person’s distress rather than their pain level alone. Chronic pain is treated directly with the most emphasis on long term pain reduction. An example of chronic pain could be if Brett Hart’s sharp shooter fucked up your back for the foreseeable forever.
Both Acute and Chronic pain may manifest themselves in several different ways. They can be local, widespread, referred, radiated, or spontaneous. Pain can be a simple headache or a crippling migraine. It can be a tummy ache, or a gut wrenching gas bubble as you pray in a cold sweat to your God of choice for relief on the toilet at Chili’s.
For the avid lifter, pain can be simple delayed onset muscle soreness causing you to walk like Jon Wayne for a few days or it could be a sign that something is going wrong and needs to be addressed. Knowing the difference is vital if continuing to train is something you’re interested in.
Is Pain cumulative?
Yes and no.
If the question is if pain resulting from acute injury physically causes itself in normal, healthy tissue, then no. If you cut your finger and feel pain, the pain itself should subside as the injury heals if all goes well. Pain may persist or return due to many factors including improper healing, scar tissue, nerve damage, infection, or lack of mobility but pain shouldn’t reoccur solely because pain itself physically once existed there. Pain alone as a byproduct of acute injury may not be cumulative, but the correlating trauma might be. An example would be an employee who repeatedly strains their back lifting boxes. Repeating high risk lifting practices causing the initial injury followed by repeated injury of the same muscles would be a cumulative trauma, possibly resulting in cumulative pain as a symptom. Likewise, repeatedly training with less than stellar form may have a cumulative effect leading up to an injury.
However, pain itself can become cumulative psychologically as pain tends to be memorable, especially the severe kind. Perceived level of pain and tolerance can be affected for sufferers of chronic pain, disease, depression or mental disorders. Ask anyone who has suffered chronic pain for months or years. Pain lasting that long can break a person down mentally and make the pain feel multitudes worse. Part of what makes pain tolerable is the assumption that it’s going to end at some point.
Common causes of pain in trained lifters
Common complaints from those engaged in strength training are shoulder, wrist, forearm, bicep, hip, back and knee pain. Although prehab will help avoid most injuries, conditions such as supraspinatus tendinitis, lateral epicondylitis, medial epicondylitis, tenosynovitis/tenovaginitis, patellar tendonitis, carpal tunnel syndrome, and Nickelback music are common and can make lifting intolerable throughout their duration. Unfortunately, it’s not unusual for lifters and strength athletes to experience any of the following throughout their career:
- Tears: Muscle and ligament tears such as bicep, quadriceps, and pectoral are often the result of acute injury and are accompanied by immediate pain.
- Inflammation: Swelling of joints, ligaments, or tissue causing stress, decreased range of motion and pain such as bursitis or tendonitis
- Joint degeneration: arthritis, overuse, loss of cartilage due to age, painful at use or rest.
- Ear discomfort: from Nickelback music
While many of those are acute and treatable for lifters, some pain is not as simple as we’ll cover now.
When is it time to worry about nerve pain?
It should always be a concern. As strength athletes, we’re constantly pushing our bodies to and through our perceived limits. We should always practice good form and listen to the feedback that our bodies give while training. Let’s take a look at where it all starts, the CNS:
Central Nervous System
People on the web and in the gym talk endlessly about the CNS, CNS burnout, CNS fatigue, CNS this and CNS that. You’re not supposed to lift heavy too often because your CNS will light on fire. In reality the Central nervous system is made up of the brain and the spinal cord. This system keeps your self-propelled meat machine from just being a useless corpse.
The brain contains 5 pairs of cranial nerves for motor function, 3 pairs for sensory and 4 pairs for motor AND sensory. They control important functions like your vision, sense of taste and smell, facial movement and balance. These nerves are part of the peripheral nervous system. I’m using these now to write this.
- Spinal Cord
The spinal cord houses 31 pairs of nerves: 8 pair of cervical nerves, 12 pair of thoracic, 5 pair of lumbar, 5 pair of sacral and 1 pair of coccyx nerves. The spinal cord extends from the base of the brain to the L1 vertebrae. From there down to the coccyx, the spinal cord fans out like a horse’s tail and becomes the Cauda Equina and also part of the peripheral nervous system. Nerves pass out from the spinal canal in pairs through the intervertebral foramen. From there, the pair splits into anteriorly (motor) and posteriorly (sensory). The anterior side supplies the front of the spine including the limbs. The posterior side goes to the muscles behind the spine. Moral of the story: “Protect ya neck.”
Beyond the CNS, the PNS
Connecting the CNS to the outside world is the Peripheral Nervous System (PNS.) This is the part of the nervous system outside of the brain and spinal cord. This system of nerves carries information from your body to the central nervous system and vice versa. The PNS is responsible for everything from maintaining a healthy heart rhythm to having ticklish armpits to maintaining bowel control. If the CNS is a tree trunk, the PNS are the branches.
There are two types of cells in the PNS, Sensory nervous cells and motor nervous cells. The sensory nervous cells carry information to the CNS and the motor nervous cells carry information from the CNS. Basically, the sensory nervous cells tell your brain that someone is tickling your armpit, and your motor nervous cells are telling your heart to keep beating. Boy, let’s not let those two messages get confused. For further information on the PNS, enroll in college.
Nerve damage can occur from many different factors such as autoimmune disease, cancer, diabetes, drug abuse, infectious disease, nutritional deficiencies and compression due to trauma.
Symptoms of nerve damage can manifest in several different ways such as electrical sensations, burning, cold feeling, pins and needles, dull aching or a sharp stabbing pain or even cause problems with positional awareness. It can also be felt elsewhere in the body from the cause. This is known as referred pain. Beyond pain, nerve damage can cause problems with motor skills and decreased peripheral feeling on the skins surface. Because we’re focusing on strength athletes, let’s focus on nerve pain caused by compression and trauma.
Nerve pain associated with disc radiculopathy
Common causes of nerve damage resulting in nerve pain in athletes and non-athletes alike are disc bulge and disc herniation. According to The Mayo Clinic, approximately 3 million cases of disk herniation are reported each year in the US alone.
In either condition, disk or disk material extends beyond the normal boundary of the vertebrae and put pressure on the nerves of the spinal cord.
- Disc bulge
A disc bulge is an out pouching of the disc exterior beyond the boundary of the vertebrae. If the disc extends far enough beyond its boundary it may come into contact and irritate the nerves of the spinal cord. The disc is still intact and with treatment or in some cases surgery, can return to within its boundary limits.
- Disc herniation
In a disc herniation, the soft center of the disc pushes through a break in the tough exterior disc casing. This soft jelly like disc material can irritate nearby nerves and cause weakness, numbness and/or pain. Some individuals experience no symptoms or a herniation, and many others do not require surgery to correct the problem. However, every case is different and should be reviewed by a medical professional for imaging and proper diagnosis.
For example, damage or compression to nerves can cause pain, weakness or loss in sensation or control in different parts of the body (see table below.)
Nerve pain not associated with disc radiculopathy
One condition that can compress the sciatic nerve and mimic the pain and sensation of a disc bulge or herniation is piriformis syndrome. This muscle, the musculus piriformis (from Latin piriformis means “pear shaped”) resides in your buttocks. LOL! It originates inside the pelvis, passing over the sciatic nerve on its way to the femur.
The piriformis muscle is especially important for strength athletes as it stabilizes the hip, enables the thigh to lift and rotate away from the body, enables weight shift from foot to foot and helps maintain balance. Squats, Yoke and Stones come to mind immediately.
Piriformis syndrome occurs when the piriformis muscle compresses the sciatic nerve. Several factors can cause this to occur, such as: injury, overuse, and poor mobility from sitting for extended periods of time.
Once properly diagnosed, treatment often involves stretches of the piriformis muscle to relieve the pain of the sciatic nerve compression.
Supine Piriformis Stretches
- Lying flat on your back with legs flat, pull one leg upward toward your chest by the knee with the hand on the same side. Then with the opposite hand, grab the ankle and pull the ankle and leg across the body until a stretch is felt.
- Lying flat as above, raise one leg and place the ankle on the other side of the opposite knee. Pull the knee across the midline of the body using the opposite hand until a stretch is felt.
- Lying flat as above, bend both legs and cross one over the other. Then gently pull the lower knee toward the shoulder on the same side of the body until a stretch is felt.
Another common nerve problem among athletes that effects nerves apart from disc radiculopathy is carpal tunnel syndrome. This occurs when the median nerve from the forearm becomes compressed at the wrist joint on its way to the palm of the hand. The median nerve which controls feeling on the palm side of the hand as well as the fingers (except the pinky) becomes pinched while passing through the carpal tunnel, a narrow passage way of bone and ligaments at the base of the hand.
Symptoms of carpal tunnel syndrome usually appear gradually as a burning, itching, or tingling sensation. In many cases, symptoms occur most commonly at night while the person sleeps with their wrists bent. Untreated, carpal tunnel syndrome can lead to diminished grip strength and chronic pain. Causes range from cysts in the canal, to overuse, to fluid retention, to long exposure to vibrating hand tools. LOL!
Hand numbness can also be attributed to ulnar nerve entrapment, where the ulnar nerve (one of three in the arm) becomes compressed or irritated. Although this can happen at the cervical spine, it can also be caused by compression at the clavicle or the wrist although it’s most commonly compressed through the cubital tunnel, just behind the elbow. Somehow along the way, the sensation of bumping this nerve on the inside of the elbow became known as hitting your funny bone though I don’t find it all that amusing. Benchers, listen up.
Less common conditions of nerve compression in athletes include nerve entrapment on the back of the shoulder blade. In some cases the N suprascapularis nerve can become pinched in the small channel called the incisura scapulae causing sharp or burning pains and even muscle weakness in the shoulder. This condition was seen in volley ball players, thought to be brought about by the repetitive overhead range of motion of their sport.
Nerve regeneration rate
Depending on the severity and duration of the nerve damage, nerves may regenerate albeit very slowly. Human axon growth rates can reach as much as 2mm a day in small nerves and 5mm a day in larger ones. For a multiple disc herniation of the Cauda Equina (L1 and below,) this can be anywhere from months to years to never. When it comes to regeneration, the PNS has an intrinsic ability for self-repair whereas the CNS, because of its environment, does not. Unfortunately, this is where when hear about irreversible brain damage and spinal cord paralysis.
If you suspect that you are experiencing something more than muscle, tendon, or joint pain; do not hesitate to get into a doctor’s office and explain your symptoms. Nerve injuries should be addressed and treated as soon as possible for the best chance of recovery. Depending on the severity of the nerve compression, if damage has been done it may still be possible to regain full sensation and strength back. You can only push through and training around injuries if you know what those injuries are and what’s really causing them.
nerve root table: Jasvinder Ps Chawla 7/4/2011
Recknor, J.B. and S.K. Mallapragada, Nerve Regeneration: Tissue Engineering Strategies, in The Biomedical Engineering Handbook: Tissue Engineering and Artificial Organs, J.D. Bronzino, Editor. 2006, Taylor & Francis: New York
Suprascapular neuropathy in volleyball players. Witvrouw E, Cools A, Lysens R, Cambier D, Vanderstraeten G, Victor J, Sneyers C, Walravens M. Br J Sports Med 2000 Jun;34(3):174-80.