We’ve all experienced physical pain and probably work regularly with clients who have pain. Pains can come and go, or pain can be chronic and relentless. Some of us seem to have great tolerance and resilience toward pain, while others seem to fall apart at even the thought that something might ache.
Pain is very individual, very personal, so one person can’t really judge another person’s pain. As trainers, while we don’t want to judge our clients’ pain, we can serve as something more like interpreters of their pain.
When a client says a movement “hurts”, we then have to ask a series of follow up questions, which might include:
“Does it ‘hurt’, or is it more of an ache?”, “Is it a sharp feeling, or more of a dull feeling?”, “Where exactly do you feel it?”, “Always in the same place? Or does it move?” “Only when you move, or afterward as well?”, “ "Have you felt this before? If so, how long?, how frequently?”, “Do particular activities bring it on?”, “Is there something you find relieves it?” "Does it feel like muscle soreness, as if it’s worked hard, or does it feel like strain?", " Does it go away quickly, or does it last a long time? How long?", etc.
We also can’t help but interpret the situation based on our experience and knowledge of the client. Is this someone who never complains even when we suspect they might be pushing too far into discomfort, or is this someone who gets really uncomfortable if the towel they’re lying on is a little bunchy? Or do they fall somewhere in between on that spectrum.
The one question I’ve never asked a client is how they rate their pain on the “pain scale”, the ten point scale you’ve probably seen in doctors’ offices or emergency rooms. I’ve been asked to rate pain before on this scale and found it to be perplexing, ambiguous, and highly subjective. I’ve often side stepped the question by answering something like “it hurts more than second degree burns, but less than labor contractions”, because this is my specific reference for pain. Someone else’s is probably quite different.
I started to think pretty deeply about the subject of pain after I was run over as a pedestrian by a pickup truck and suffered a shattered tibial plateau and a displaced fracture of the medial malleolus. The meniscus was torn and there was other pretty nasty soft tissue damage. I had surgical reconstruction of both my knee and ankle and was non-weight bearing for three months, relying on a walker and a wheelchair, and occasionally crutches.
I was given morphine in the ambulance, and then prescribed narcotics. And again, I was given morphine after surgery and then prescribed another assortment of narcotics. The paramedic in the ambulance who had given me morphine for transport had also given me a great explanation. He said “the morphine won’t take the pain away, but it will make you not care about the pain”. In the foggy, drugged out state that followed I pondered how true and profound his statement was. But soon I discovered it really didn’t matter because I couldn’t tolerate narcotics.
Somehow, I’m not sure why, but the pain medications didn’t really work to relieve the pain. They did however make me so nauseated that I couldn’t eat. So my leg still hurt and now my stomach hurt. So they gave me an anti-nausea drug, which didn’t really work, but gave me splitting headaches. So now my leg hurt, my stomach hurt, AND my head hurt. So I stopped taking everything after pretty much right away.
The thought came to me that if there was no dulling the pain my only other option was to dive into it and explore it. I spent the next year immersed in and fascinated by pain.
My first realization was that pain is really just communication from the body. If I tune it out I’m missing out on a lot of useful information my body is trying to give me. I’d experienced this before when I gave birth to my son at home without any medications. I’d found that the intense sensations, along with my experienced midwife, guided me as to what to do through a difficult, three day labor. But this time the pain was going to have to guide me through a much longer process.
I tuned into the pain, all of the sensations, and found I could discern subtle differences. “This is bone pain” I’d say to myself, “My bone is growing and repairing and so it’s okay that I feel that. It’s as it should be.” Or I’d notice “this deep ache that makes me feel nauseated and sweaty is my tight fascia being stretched after having been immobilized in the boot and the brace. This is okay. It’s beginning to move again.” But sometimes I’d feel a sharp, piercing pain and know “this is my body saying stop. This range of motion is going to cause damage. I’m not ready for this yet”
Once I could understand the pain I had less anxiety toward it. And once the anxiety lifted I could get to the business of doing what I needed to do to heal.
So how does this apply in working with clients? First of all, I feel I really do have a deeper understanding now of what they may be going through. While it’s not my place to tell them what their pain means I can help them explore it and help them begin to interpret it for themselves. This may be challenging for people with less body awareness, but even just bringing their attention to the shades and layers of sensation, helping them focus in on the differences, can help them feel less anxious.
Often times I’ll notice someone may wince slightly before they even begin a movement, as they’re only just preparing to move. I might have them talk me through the sensations they’re feeling and the emotions they’re having surrounding those sensations. Often times they realize that they can do more than they expected, but that they are so conditioned to brace against the pain they’ve felt in the past that, even as the pain has subsided over time, the anxiety they feel about it begins to act like the pain itself and becomes the restriction to a feared range of motion.
Or the pain may still be present and real. But I won’t know until we connect with it. As trainers, we can help them navigate the pain. Together, trainer and client, we can then determine what their true restrictions are, and not hold them back from reaching their potential out of fear.
All of that said, we must remain within the scope of our practice. If a client is experiencing ongoing pain they should be working with a good physical therapist or other body worker qualified to provide manual work and adjustments in addition to the physical conditioning they’re doing with us. And of course we never want to pressure a client to "just push through it".
If it’s okay with your client and you can have a bit of communication with their other practitioner(s) this can be immensely helpful, both from a programming prospective and to make sure the client isn’t hearing conflicting information, which can be discouraging. (As a side note, I like to have a client email or text me permission to share information about our sessions. This way I have a written record that they agreed to me discussing their confidential information, just to have all bases covered)
While going through a period of pain isn’t going to be fun, pain can be a great opportunity for the client to learn about their body. They’ll hopefully come out of the experience with a better understanding of their anatomy, alignment, movement patterns, habits, as well as their capacity and potential. My perspective is that if you’re going to be in pain you might as well glean as much as you can from the experience.
Have you thought about your relationship with and attitude toward pain, be it yours or your clients’? I’d love to hear your thoughts on the subject.