Follow up to “DOMS, Performance, & Pain”

Last week’s article, DOMS, Performance, & Pain, generated some pretty great discussion via email, however, we did have some people post comments in the comment section.  The following is a comment from a strength coach out of Maryland, Kevin Neeld.  Kevin wrote:

Patrick-Great article! The complex integration of psychological interpretation and physical performance is an interesting topic and one overlooked by most in the performance world. The results of this study certainly aren’t unexpected, but provide some evidence of the power of performance psychology. In our setting, it’s amazing how empowering it can be for athletes to realize that they can tolerate and push through more discomfort than they previously thought. Keep up the great work.

I think it is always cool to see how different people interpret different books, articles, and papers.  I don’t think that there is a right or wrong way to interpret something you read or a lecture you heard, but I do find it interesting to see the different conclusions that people come to.  This is why I encourage people to go out and read the articles or books that others cite, recommend, or say they were influenced by, in order to see if you come to similar conclusions.  Sometimes you may be surprised!

Anyway, back to Kevin’s comments…

I found it interesting that Kevin brought up the topic of athletes’ tolerating a certain level of discomfort and learning to “push through it”.  When I read the above paper that sort of thing wasn’t even on my radar!

The above paper, to me, was giving me insight into the way in which an athlete may develop a fear avoidant strategy following an injury which intern would challenge their ability to compete or train since they are always playing with a certain amount of fear or uncertainty.  This can be a very dangerous place for an athlete to be in as they are attempting to play at the highest level with a lack of confidence in their body, even if the sports medicine staff has cleared them to play, the injury has been healed, and the rehab has gone well, in their mind, they are still not ready.

Leaving my thoughts on the paper aside, I think that Kevin raises some good points.  Some athletes are real work horses and if you told them that running through a brick wall would make them better they would probably do it without questioning you.  These are the guys that show up to train and never let on that they are having a bad day – they operate like machines.  Other athletes may need a little more pushing and may not be as motivated or may not psychologically be prepared to handle certain amounts or intensity of training – they give up too easily.

One way I believe we can impact this is the way we program workouts during the training week, perhaps even if the athletes are slightly under recovered and even a little sore, as it can help the athletes psychologically in terms of knowing that they can work a little harder or push a little more than they may not think they can.  Obviously monitoring stress in some way and monitoring the athletes ability to recover from training is necessary to ensure that you aren’t doing anything inappropriate, however, once an athlete has done some consistent training and developed a general level of fitness, performing back to back workouts (and these can be intense workouts) can sometimes be a great way to not only illicit some increased adaptation, but also, tap into the athletes psyche and teach them to push themselves.

Another thing to consider, in regard to the athlete, is how frequently you would do this and how many days in a row training can take place before a “back off” day or more recovery based session is needed.  This would be something you can build up over time.

As strength coaches we often get wrapped up in the idea of “getting them strong” or “getting them fit” that things tend to become very mechanical that we can forget about how important the psychology of the athlete really is.

DOMS, Performance, & Pain

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:

    1. “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.”

    2. “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.

When is it OK to guess and not assess?

Today I have a guest blog from Sam Leahey regarding both qualitative and quantitative testing in an athletic environment.  The main point Sam addresses is whether or not there is a right or wrong time to perform quantitative testing.

Sam Leahey is currently pursuing a masters degree in exercise science at Springfield College and serves as a strength and conditioning coach at American International College.  He can be contacted through his website www.samleahey.com.

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When Is It OK to “Guess” and Not Assess? 
Sam Leahey

“If you’re not assessing, you’re guessing.”

“Don’t assume, assess.”

The novelty with the above two statements is that when most coaches say this in reference to program design, they’re specifically speaking about “movement/orthopedic” types of assessments and not so much about “performance” type assessments.  What exactly do I mean by that?  In order to properly address the argument we have to start with as much objectivity as possible.  Consider the following categorical paradigm:

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  • Movement:  Mobility, Stability, Fundamental Movement Patterns, Symmetry, etc.
  • Performance:  Absolute Strength, Elasticity, Impulse, Agility, Energy Systems, Power, etc.
  • Skill:  Sport-specific Skills (throwing/striking a ball, tackling an opponent, shooting a puck)

Given the pyramid we can see how foundational movement acts as a buffer to performance markers which further buffer our skill level in sports.  Ultimately, semantics prevail here and you could argue that the way I’ve defined said categories is not universal and just a mental construct.  This is true.  But for the sake of argument let’s continue with this outlook to provide better clarity in the end.

When we talk about assessing our athletes we need to attach an adjective that tells others if we’re referencing “performance assessments” or “movement assessments”.  Sport coaches will usually handle the “skill assessments.”  Given the system of buffers described above it only makes sense we invest thorough attention to the foundation via our assessment process. However, the Risk:Reward ratio for many performance tests may not be advantageous at times.  If a highly ectomorphic high school freshman walks into your facility with zero training background is it worth the risk to perform a 1-3RM just to prove (aka “assess”) he/she is weak?  Is it sensible to perform agility tests on that same athlete just to obtain an objective measure that labels him/her “non-agile” and slow?  Do we really need to use the tendo-unit with every incoming athlete to see whether speed-strength or strength-speed is the limiting factor?  Might someone get hurt if we attempt to compare counter-movement and depth jumps with an entire high school team just to “assess” their elasticity when we could simply “guess” via their training age that they’re not adequately elastic enough?  Perhaps.  Perhaps not.  It depends on the individuals involved and certainly logistics play a governing role in what we can or choose to perform.

Undoubtedly things will be missed without an assessment no matter how much experience, insight, or prediction one has.  I believe this to be the case especially in our “movement” assessment category but not as realistic of an outlook in our “performance” category given the potential Risk:Reward ratio previously mentioned.  This is why I propose the general rule of thumb that we be most thorough with our movement tests and conservative with our performance tests.  We wouldn’t want anyone to get hurt during a performance test just because it’s better to “assess” then “guess.”  Simply “guessing” the obvious that they lack absolute strength and training for it is perfectly fine.  It’s equally as acceptable to “guess” a beginner athlete lacks elasticity and training them for it without having to “assess” a depth jump to counter movement jump comparison.  Also, the performance test outcomes will most likely change after foundational movement has been brought up to adequate.  In this light we could argue that doing many performance tests are simply an expression of current limitations and the athlete’s true potential will only be realized after the base of the pyramid has been fixed.

Now, if you’ve developed a battery of performance tests for a particular population then it only makes sense you run them through it provided there’s no contraindications from movement assessments.  But if you’re applying a battery of performance tests to all populations irrespective of individuality you may run into trouble and someone might get hurt.  Ultimately, the decision to perform any test relies on your priority of qualities and/or estimation of the probability that the client has a particular condition in question via algorithmic thinking.

In conclusion, sometimes a “guess/assumption” is a good thing and you’re safest estimation towards a desired outcome without having to take them to a threshold point.  It should not always be frowned upon, especially in regards to performance assessments.  Heck, sometimes “guessing” is a better option than assessing in a certain situations.  It depends.

Stretching, recovery, and HRV

Recovery is an important component of any good training program given the fact that if you can’t recover from the training stress you won’t be able to make any progress (in fact you will more than likely begin to slide backward).

Thus, athletes have sought out various recovery strategies to help improve their ability to adapt to the training load and one such method that has been proposed in the past has been stretching regimens (Siff, 2003).

Of course stretching has come under a lot of fire over the years:

  • “Should I stretch before or after training?”
  • “Does stretching decrease power?”
  • “Does stretching really improve muscle length?”
  • “Can stretching really help stave off injuries?”

While these are all good questions, I think one component that is not addressed with any of them is the potential role that stretching may play in relaxation and recovery.  Perhaps, instead of focusing on what stretching does or does not do to our power output or our muscles, we can look to various stretching programs as a method to aid the athlete in getting into a more relaxed stated, performing these stretching programs later in the day, maybe several hours after training or near bed time, or on a separate day when the goal of training is to recover from harder training sessions the day(s) prior.  Anecdotally, some athletes feel more rested following a short stretching program; however, I will say that the coach should determine what the athlete should be stretching and setting the ground rules for how long each stretch should be held, sets, reps, etc, instead of just letting them do whatever they want.

A recent study published in the Journal of Strength and Conditioning Research by Fariatti et al (2011) evaluated the response that stretching had on Heart Rate Variability (HRV) in subjects with low flexibility.

Note: I have talked about HRV in a few previous blog posts – Using Heart Rate Variability to Measure Stress: There’s an app for that! and Massage, Stress, and HRV.

What They Did And What They Found

The authors took 10 male subjects, approximately 23yrs of age, who had at least 1yr of strength training background, and had low flexibility (classified in percentiles 10-40 on the sit-and-reach test according to the ACSM standards).

During the study the subjects performed three stretches – right hurdler stretch, left hurdler stretch, and butterfly stretch – each held for 30sec at maximum end range, with 30sec rest between sets, for 3 sets, and one minute rest between each exercise.  The total session lasted approximately 10min.

The heart rate of the subjects was recorded for 30min. before the stretch program, during the stretching program, and for 30min. after the stretching program.  To evaluate HRV changes, the last 10min. of each testing period (pre, during, post) were used to for this measurement.

The subjects had increased their heart rate during the stretching session; however, their heart rate did decline during the recovery period to a value significantly lower than their pre-exercise heart rate.

The researchers also found that the 10min. stretching sessionincreased post exercise vagal tone, as evident by a decrease in low frequency to high frequency power during the recovery period following its increase during the stretching session (although it was still higher than it was at rest, during the pre-stretching session).  Thus parasympathetic activity improved (HRV improved).  This paper was in agreement with a previous paper that the authors cited, showing increases in HRV following a 15min. stretching routine performed by athletes over a 28 day period.

One of the unfortunate things was that the study did not include a control group.  For example, what would the HRV and heart rate response been for a group of low-flexibility individuals who lied on a table for 70min. during the entire testing and stretching session period?  Additionally, what would have been the results of the study if the subjects had been individuals with adequate flexibility?  Would there have been the same changes in heart rate and HRV?  What if the subjects were high level athletes?  Of course these are all things that will hopefully be looked at in future studies; however, I think this information might be a good start in helping us formulate more ideas to assist athletes in recovering from hard training sessions or competition.

Practical Application

As stated earlier in this post, recovery modalities can be utilized following training (commonly a brief period after training or even later in the day, as a second session) or on the day following a hard training session.

About 6 or 7 years ago, when I realized that I couldn’t kill myself in the gym every single day, I purchased the book Real Men Do Yoga: 21 star athletes reveal their secrets for strength, flexibility, and peak performance by John Capouya.  I figured it would be a good idea to supplement my training with some sort of flexibility regimen.  Slowly, over the years, the book worked its way to the bottom of a large pile of other books, and I forgot about it, until I read this paper and decided to pull it out.  However, one of the limitations of yoga is that taking a large class at a gym/fitness facility usually has some drawbacks.

First, the stretches being performed are not specific to you and your needs.  They are just a sequence that teacher tends to favor, so perhaps, specific limitations that you bring to the table may hinder your ability to perform some of these movements or potentially cause you injury.

Second, it is hard to get help or instruction when you are in a large group like that; as the teacher is commonly in the front of the room and the first few rows of the class are dominated by the women who take the class 10 times a week and can perform every pose perfectly.  Those of us who are not as flexible or who lack competency in the poses tend to move towards the back of the room where we will be less embarrassed or feel like we are less in the way.

Finally, the teacher dictates the flow of the class and there are many forms of yoga.  If you are attempting to recover from hard training, it may be difficult to locate a class or teacher that understands those needs and the class may be more aggressive than what you really need.

What to do?!?!

I think the best thing you can do is find a coach/trainer that can assess your needs, assess your training program, and prescribe some things that you can do to help improve your mobility and in a sequence that is rather slow and controlled so that it can be performed on days in between hard training or later in the day following training to perhaps reap some of the benefits that the above paper is suggesting (improved parasympathetic state, decreased resting heart rate, etc).

One of the things that the book Real Men Do Yoga has is various stretching schemes which flow from one stretch to the next, which may be of value, and of course you can swap some of the stretches in these schemes that don’t fit into your needs for stretches that do.  When I look at some of these schemes, I am reminded of some of the mobility schemes that Gray Cook lays out in his book Athletic Body In Balance.  There ar a lot of similarities between these two books with regard to the movement sequences.  This is one of the reasons why I have often recommended to various yoga practitioners that they take the Functional Movement Screen course, to help drive their stretching routines for their clients.

Conclusion

Recovery is an important component of sports conditioning.  Stretching routines may be one aspect that can aid an athlete in getting into a more relaxed/parasympathetic state.

Before just going out and stretching, try and find a training, therapist, or yoga practitioner who understands assessment and can individualize a mobility/flexibility scheme to your needs.

Deconstruction and Reconstruction

“Are you getting tired or are you getting better?”
– Vern Gambetta

In talking with a few athletes this week, I was amazed to hear how their mentality of training is centered around the bravado of deconstruction.

It is unfortunate that so many are still under the belief that a workout is only productive if you are lying on the floor in a puddle of your own sweat and vomit.  The “last man standing” mentality of training is not one that should be sensationalized and often leads to a very short sighted view of the overall training picture – which is much larger than any single workout.  This thought process is often accepted by sports coaches as well, who commonly don’t understand the goal of a good training program and are typically the first coaches to prescribe “penalty” workouts/runs for those who do poorly in competition.

I am not saying this to give athletes a free pass from working hard, in fact, hard work is extremely important.  However, periods of hard work (or sometimes hard training days) should be followed by days of reconstruction to allow the athlete time to recovery and adapt to the training stimulus you have just imposed on them.  You can have the best program on paper, but if an athlete cannot recover from it, then it is pretty much worthless.

The training program should by thought out and satisfy the goals of the individual and the specific sport.  Doing workouts is not the same as performing a program.  As Vern’s quote above states, the goal is not to get tired, it is to get better!

“Make your hard days hard and your easy days easy.”
–Charlie Francis

Just as Charlie Francis states, if the day is going to be a “hard” day, then really get after it, and if the goal is to recover and give the body a break, then do so appropriately.  The biggest error most athletes make is the later, as their mind tends to play tricks on them, causing them to think that they are “Not working hard enough” or “This is too easy.  I need to add in a few more sets or increase the intensity a little bit to make it worthwhile”.  Unfortunately, your body can only handle so much and eventually you begin to go backwards in your training or, even worse, sustain some sort of injury.

Remember, training is a process and not everyday is going to be your day.  Not everyday is for breaking personal records or adding more weight to the bar.  Keep the end goal in mind and slowly hack away at that goal.  Don’t be so focused on a single workout and the idea that every workout should absolutely destroy you for it to mean anything.

You are only as good as your ability to adapt to the stresses that are placed upon you.