In his last article Dr. Anthony Falco discussed the opioid epidemic and how widespread it has become. This week, I intend to discuss how training itself can provide benefits that help deal with pain, and I will also breakdown use of maintenance training for athletes who either are in-season or need to recover after a long and grueling season. This can be done via extensive plyometrics, aerobic capacity work and maintenance load percentages with main movements (squats, deadlifts and bench presses).
To start, endorphins are produced by the central nervous system in response to pain or stress. That is, physical activity such as running, strength training or sports can provide endorphin release. Contrary to opioids, however, endorphins brought on naturally by the body do not create addiction or dependence. So, instead of turning to pain medication physical activity such as strength training or running can reduce pain while also riding of addictive substances that can damage the body and ultimately lead to death.
With that being said, there are some easy strategies for athletes to utilize in order to limit stresses on their body while training, but also achieve some much needed endorphin release to deal with the pains of their seasons and physical activity and the stresses of everyday life.
Extensive plyometrics are less intense and stressful plyometric exercises that are often used to perfect jumping mechanics, while also adjusting the body while it learns to properly use tendons and ligaments. Not only are these a good way to teach young athletes landing mechanics and proper use of the body while jumping, but also they can be implemented during hypertrophy cycles for athletes recovering early in the off-season or even during their respective season. Extensive plyometrics are often performed with more repetitions than their intensive counterparts, so you may find yourself performing sets of 6-8 box jumps that are significantly lower than your max jump height, but allow you to pause at the bottom of your jump and land smoothly.
Aerobic Capacity Training For Recovery
As I covered in past articles, (http://www.challengerstrength.com/blog/using-the-aerobic-energy-system-to-promote-recovery) the aerobic energy system can be used to stimulate recovery if done in certain thresholds. This would entail performing aerobic conditioning while remaining within 60-75% of your max heart rate (220-age). Using aerobic conditioning can be vital in promoting recovery and endorphin release.
Using Maintenance Loads To Reduce Physical Stress
While maintenance loads are commonly perceived as just that, “maintenance,” true gains can still be made while reducing stress. For example, I have seen athletes achieve 5-10 pound gains in their one rep max (1RM), after a 6-week maintenance cycle never exceeding 85% of their previous 1RM. For maintenance lifts I would normally stay within 70-85% of your 1RM while keeping volume similar to your strength aimed sets.
References and Useful Links
The Opioid Epidemic
The opioid epidemic has received a lot of attention over this past year, and for good reason. In 2016, there were 1,901 deaths in New Jersey due to opioid overdose (See an interesting article and interactive map here).1 In New Jersey there have been nearly 6,000 deaths due to opioid overdose since 2004 and the rate of opioid overdose in New Jersey is 3x higher than the national average.2 The federal government declared opioids a public health emergency and in 2017 the state of New Jersey started the “Facing Addiction Task Force to help combat the problem in our state.3
Opioid medications can be prescribed for pain after a surgery, a traumatic injury, or any severe pain. Any time opioids are prescribed there should be a clearly defined plan on how long to use the medication and how to transition from using it. Unfortunately, opioids have often been over prescribed with no clear plan to discontinue use. There is little to no research that supports the use of long term opioid pain medication for musculoskeletal pain.4,5 Pain medication can help treat the symptom of pain but it does not get at the root cause of why you are having that pain in the first place. So, if you are currently dealing with a painful condition or on an opioid pain medication what should you do? Go see your physical therapist!
Your physical therapist can be your best teammate when dealing with a painful condition and to help you avoid the use of opioid pain medication. Especially with chronic pain, education is an extremely important component of treatment. Our nervous system works like an alarm system and under normal circumstances things that are painful need to meet a certain threshold to cause pain (see the dotted line “firing level below”). When the nervous system becomes “extra sensitive”, which is what happens with chronic pain, activites that normally would not be painful can now easily reach the pain threshold (“firing level” in the image below).
As an example - someone who has had back pain for years and has a nervous system that is in an “extra-sensitive” state, basic things like bending forward to tie their shoes can be painful. Understanding how pain works and working with a physical therapist who can help you better understand your specific situation is the best first step in treating pain.
At Performance Physical Therapy and Sports Conditioning we treat people who are in pain every single day. Unlike opioid pain medication there are no harmful side effects to physical therapy! We utilize multiple approaches to control pain including pain science education, manual therapy, and most importantly, exercise. With every patient that we treat our goal is to empower the patient with the confidence, knowledge, and ability to manage their own body. Check back next week when Coach Gerry of Challenger Strength discusses how he keeps his clients and athletes in top shape despite pain, bumps and bruises.
References and Useful Links:
2 - http://www.njtvonline.org/addiction/
3 - http://reachnj.gov/
4 - Ballantyne JC. Avoiding Opioid Analgesics for Treatment of Chronic Low Back
Pain. JAMA. 2016 Jun 14;315(22):2459-60.
5 - Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, Donovan MI,
Fishbain DA, Foley KM, Fudin J, Gilson AM, Kelter A, Mauskop A, O'Connor PG,
Passik SD, Pasternak GW, Portenoy RK, Rich BA, Roberts RG, Todd KH, Miaskowski C;
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel.
Clinical guidelines for the use of chronic opioid therapy in chronic noncancer
pain. J Pain. 2009 Feb;10(2):113-30.
Gerry DeFilippo: ISSA CPT- CPPS, AAPS. Founder/Owner: Challenger Strength.