Pain is a rather complex event that is perceived in the brain through a variety of inputs coming from both the internal and external environment. It does not happen in isolation as many commonly think, rather, it is composed of many variables and has a strong psychological component, so much so that there can even be a perception of pain/threat without any nociceptive input.
Training can oftentimes lead to delayed-onset of muscle soreness (DOMS) which is an increased amount of muscular pain and soreness lasting anywhere form 12-48hrs following a bout of new, unfamiliar, or overly strenuous exercise. DOMS can often lead to impairments in performance as the intense amount of soreness causes the athlete to decrease their muscular output in an effort to prevent painful sensation. Additionally, there is a strong psychological component attached to this scenario in the form of fear-avoidance.
Fear-avoidance may explain why some athletes develop chronic pain conditions following musculoskeletal injuries. The fear-avoidance model works in the following way:
- Injury leads to disability and a functional limitation
- This limitation is followed by a cycle of increased pain interpretation and hypervigilence to pain sensation
- Due to the increased pain sensation the athlete may begin to avoid activities that they fear will cause them more pain, ultimately leading to an inability to regain function and return to competitive form in a healthy manner (both physically and psychologically)
A recent study published in the journal Pain, by Trost, et al., set out to examine the relationship between pain-related fear and physical performance utilizing a DOMS protocol for the trunk extensors in healthy subjects.
The subjects, thirty in all (16 male/14 female) ages 18-24, were healthy, free of back pain, and were not currently engaged in a low-back resistance training program (to ensure that the DOMS protocol would be sufficient).
A variety of questionnaires were used at both baseline and post exercise (24hrs later) to determine the effect that the exercise program had on the subjects psychological state, muscular strength, and impairments in daily activities.
Baseline strength was conducted on a back exercise machine in the form of 3 maximum isometric back extensions. The DOMS protocol was conducted on the same machine where the subjects performed 25 repetitions of eccentric back extension (rep tempo = 4 seconds per repetition) with a load of 75% of their peak extensor performance.
Twenty-four hours following the exercise program the subjects returned to the lab to re-test their back extension strength and fill out the questionnaires again.
The researchers reported that following the exercise induced DOMS, pain-related fear was predictive of perceived disability. Additionally, pain-related fear was able to predict decreases in muscular performance. These findings led the researchers’ to state that “pain-related fear is associated with perceived disability at an early stage of injury.” Finally, two of the key points the researchers made in the paper were that:
- “Avoidant behavior patterns among high fear individuals may persist even in the absence of initially triggering pain stimuli, setting the stage for a range of potentially deleterious physical and psychosocial consequences.”
- “Following DOMS induction, higher fear participants may be hypervigilant to pain sensations and may experience difficulty disengaging or using cognitive strategies to cope with pain or distressing pain cognitions.”
Wrapping up
As stated earlier, pain is highly complex and it is something that athletes deal with throughout their competitive career. Many things can influence threat perception and pain and as strength coaches or therapists, we should be aware of these influence to ensure that we meet the athlete’s individual needs and help them perform to their highest abilities.
This study was conducted on healthy subjects who are were not elite level athletes (or athletes at all), however, it does give a glimpse into the psychological and physiological aspects of pain and fear-avoidance, which are often overlooked in athletes who are in pain as many tend to only focus on the functional limitations the athlete is displaying following injury or pain. While returning the athlete back to function and ensuring they can meet the physiological demands of their sport is critical, we should also take into consideration the entire person and be aware of their psychological state and perceptions.
Reference
Trost Z, France CR, Thomas, JS. Pain-related fear avoidance of physical exertion following delayed-onset muscle soreness. Pain2011; 152: 1540-1547.