Mental Gear Closet
* Pain vs. Injury: An Interview with Dr. Chris Van Thiel
Updated: Feb 22, 2020
Brought to you by: Mental Gear Closet & Odyssey Performance
As a competitive swimmer, the only injury I sustained in sixteen years was a broken baby toe from jumping on the Vasa trainer wrong. No level of unbridled intensity (from racing through my own vomit to training through mono) seemed to cause any “consequence” besides annoyance. Injury shm-injury … what are those?! Then I switched to land sports.
From CrossFit to rock climbing and Krav Maga combat training, I’ve realized that ruthlessly ignoring pain DOES have serious consequence (e.g., a blown shoulder, two blown out wrists and a persistent neck injury later).
Therefore, when meeting Dr. Christopher Van Thiel, physical therapist and owner of Odyssey Performance PT in Arvada, I had a few questions about what athletes need to know in order to better identify and respond to pain before it quietly segues into injury. Here is what he had to say:
Mental Gear Closet: Dr. Chris, what is your title and specialty in the field?
Dr. Chris: I have my DPT, doctorate of physical therapy, and specialize in sport and performance injuries.
MGC: I assume you were an athlete yourself. What sports did you play?
Dr. C: Mostly soccer, ultimate frisbee and volleyball.
MGC: As a PT, what is your typical clientele?
Dr. C: I see a lot of clients in the age range of 30’s to 50’s with shoulder, knee and low back problems from CrossFit and other sports. Many come in with previous injuries, often because they either haven’t stopped to address their injury, or didn’t receive previous proper care.
MGC: Speaking of injuries, given your experience how would you define pain versus injury? It can feel like a fine line between the two.
Dr. C: Pain is an uncomfortable sensation – an interpretation of the brain from signals received within a part in the body. These are due to either physical or emotional stimuli.
Injury on the other hand is structural. This is when a body part is not able to withstand full force or function due to an actual impairment.
MGC: So then what would you say to an athlete who tells you, “I’m not injured because technically, I can still do XYZ movements when training”?
Dr. C: That’s the good and bad thing about the body. We are primed to compensate for injured areas so that we can keep moving. It’s a survival mechanism.
To break it down a bit, almost no movement just recruits one single muscle group. Therefore, the body can easily adapt and compensate by finding one of many other surrounding muscles to use instead. But in reality, without working around or recruiting these other muscles you wouldn’t be able to do what you’re doing.
You have to know … Tolerating is not the same as healthy functional movement.
A great example of this is when athletes use momentum to get through a movement pattern because they don’t have enough strength or stability. We see this a lot in CrossFit.
MGC: Ok, so let’s get more specific about the difference between pain and injury. What do these look like?
Dr. C: A good place to start is soreness versus if it’s preventing movement. Pain is … pain. But injury often also comes with:
- More pain with more force.
- When you can’t generate as much force as you would normally be able to.
- The body giving out when you try to perform a movement, sometimes even if you have NO pain.
One thing to know though is that if you’re pain-free when you’re not putting weight on the movement, but then feel pain when you start adding weight, it could be because your body is just not ready for that weight yet. You may need to strengthen it but have no impairment per say.
MGC: Are there other warning signs that an athlete can watch out for? A lot of us will realize that we’re injured when we’re too far down the road, but are there other alarm bells to notice early on?
Dr. C: Yes. A sudden sensation in an area – your brain saying “hold on, that wasn’t right” – can often be a sign of pre-injury. Back off and see how it feels.
Also, noticing over time the same pain or stiffness when you’re doing the same movement patterns, and it lasting for a longer than normal recovery period (up to 48 hours, max 72) is something to pay attention to.
In other words, if the same pain is chronic don’t blow it off! Many people I work with have gotten to the point where they say, “Oh yeah that’s just how it is.” It doesn’t have to be how it is though. You want to ask yourself some basic questions:
· When do I feel the pain?
· What does it feel like?
· How often does it happen?
Also, notice if you experience pain in the same areas of the body from similar types of movements. This is your body’s way of saying, “Pay attention. There is something going on here.” Lower the intensity or weight of the movement and consult a trained professional.
MGC: Speaking of taking care of ourselves, what should athletes do once they notice a concerning pain? How might this differ if it becomes an injury?
Dr. C: To start with … recovery and recovery education. This used to be a very passive word, often referring to just sitting down and not moving. But now we know that recovery is actually an active process. Light, low volume movement such as jumping on the bike brings nutrient-rich blood flow through the body and regulates the inflammatory response that helps you heal.
Another thing athletes can do is to be aware of how often they are working the same muscle groups with no rest, and modify the routine. One of my concerns with certain types of gyms is an idea they push on their members that they need to come in, pounding the same muscles – albeit it in different ways – for five days a week. Not allowing for proper recovery in between sessions like that can become a real problem.
This is where your mental training comes in though too. Knowing how to be self aware and mindful, and then being able to tolerate limiting or adjusting your physical training is key. That’s what can really help you notice the pain and stop before it becomes injury.
If you’re paying attention though and just don’t know if it’s bad enough to be an injury, check in with a movement professional. That’s what we’re here for - to assess and then create a program of rehabbing the injured area, and at the right pace for you.
Recovery really doesn’t have to be scary like a lot of people think!
MGC: Anything else you’d like to add about prevention?
Dr. C: Sure. Again, watch out for when you may be telling yourself “it just always hurts that way” and do something about it. I call this a mental limiting belief, and it can keep people in a lot of unnecessary pain for a long time. Then without realizing it people can get themselves on some sort of regular pill regimen. This just sets them up for injury down the road.
A couple of other things athletes can do would include accessory and mobility work, and making sure they’re building antagonist (opposite) muscles rather than just one side of the body.
MGC: We’ve been talking a lot of about pain and things that hurt. Let’s touch a little bit more on the moving forward process. What does this look like?
Dr. C: As I mentioned, one of the first steps to take if you’re either questioning your pain or suspect an injury is to check in with a movement professional. That’ll really set you up physically but you’ll still have to address the mental side of things too.
You’ll be reintroducing movements in a slow, strategic way during which you really have to keep in mind, “I can do this. I will be fine.” You’re rehabbing the mind to be able to do things just as much as your body. You’re also prepping the mind for being back at max intensity, which can be scary.
Also on the mental side of things is hesitation. Being aware is helpful but hesitation is actually responsible for a lot of re-injury in ACL’s, for example. Therefore you may want to add a mental health professional to your recovery team.
It’s really about recalibrating the brain. “I was injured but I have this amount of strength I’ve redeveloped and I can keep going.”
MGC: This has been really helpful. Any final thoughts?
Dr. C: Stop making excuses for your pain, especially if it’s become chronic. Get it checked out and go from there. And don’t be scared of the process.
MGC: And finally, where can people reach you with questions about what we’ve talked about today or more information?
Dr. C: Phone, text or email. Here’s how people can get in touch …
Take care and be well!