Making Friends with discomfort

The Path Is The Goal

A common link I have found between improving general fitness and decreasing physical pain is that both are process-oriented endeavors. This indicates that neither can be or should be expected to be dealt with in an acute manner. Which is to say, there is no "top of the mountain", no "end game", no cure, but instead a constantly changing state of where you are. Often times a physical pain or realization that we can’t do something we used to take for granted, awakens us to the reality of this current “now”. This reality often seems undesirable due to fact that the symptom that awoke us was unpleasant, and our initial response is to seek a method for a quick eradication of the “danger” so that we can return to normalcy. However, if we are able to reflect on the path we took to get to this point, we will realize that our current state cannot be defined by an isolated diagnosis that can be remedied by a single intervention, but is instead, the current expression of the causes and conditions of our experiences to this point. This awareness has the potential to be liberating, as without it we do not truly have control over our circumstances. Instead, we are “riding the wave” of our habitual patterns until those patterns reach the point of noticeable discontent. Once we are able to enter into a path of awareness, we are able to be in the process of experiencing how our thoughts, emotions, and actions effect our consistently changing existence. This process is not one of metaphysical faith but instead a direct experience with how “what we do” creates “what we are”. This realization separates clearly what we can control versus what is beyond our control, and opens our eyes to the decision-making process of our potential. That is to say, we can choose to embark in the processes that allow us to progress, or we can choose not to; but we can no longer believe we do not have a choice in progress. Our awareness has laid out the path too clearly for that fallacy to be considered.

Pain Does Not Equal Damage

Pain and discomfort are often considered inherent realities of a structural abnormality or disorder, that we only have control over to the extent that the bodily damage is “healed”. Although, this notion is common, it is hardly supported by any scientific or physiological evidence. Over and over again scientific studies have demonstrated minimal association between structural damage and the extent of one’s pain, discomfort, or state of disability. Moreover, although worthy of admiration, it is not uncommon for individuals with physical disabilities to optimize their physical function well beyond those with comparably able bodies. Although this information is widely available and often well accepted, the lessons that may be gained from it will often be disregarded when pain rears its head in our lives. Immediately, we will search for “the answer” to what it wrong with us, and seek out those individuals/groups promising cures and quick fixes. This disregard for situations that contradict the notion that our pain can be independent of physical damage is often led by fear. Fear that the pain indicates something unchangeable and beyond hope. These notions are often more overwhelming than the physical experience of pain itself. Contrary to the poor association demonstrated scientifically between pain and structural pathology, feelings of fear, a tendency towards activity avoidance, and a lack of self-efficacy regarding control over our progress are associated highly with increased levels of pain and disability. 

For this reason, it is the opinion of this healthcare professional that we explore those activities that we find uncomfortable or promote fear in us and approach them in a process-oriented manner that allow us to:

  1. Improve our physiological tolerance to them
  2. Change our relationship with them from that of being fear-based to one of curiosity and acceptance.

Common examples of fear producing activities:

  1. Enduring cold or hot temperatures
  2. Bodily stillness for longer durations (meditation with the object being not to fidget or move as opposed to sedentarism)
  3.  Lifting heavy weights
  4. Moving continuously for longer durations
  5. Exploring greater joint ranges of motion
  6. Moving at faster speeds
  7. Eating gustatorily unpleasant foods 

Making change to any of the above examples, must be gradual enough that the body and mind only register a slight discomfort so that the already fear-producing nature of the activities does not become so great that fear is increased after the stimulus is removed. Therefore, the addition of the discomfort should only be enough to provide the body with a gradual, progressive experience that disproves the fears initially imagined. Gradually as we track progress via metrics such as time, load lifted, bodily positions attained, foods conquered, etc. we will prove to ourselves that we are capable of the change we feared impossible. Moreover, we will have gained confidence that we do indeed have control of our own change, as opposed to being slaves to the inevitable change of a cruel world.

References

https://www.researchgate.net/…/8378790_Knee_Pain_and_Radiog…
https://link.springer.com/article/10.1007/s00256-006-0100-x
https://www.medscape.com/medline/abstract/20739918
https://www.sciencedirect.com/…/artic…/pii/S0304395904003173
 

A DISCUSSION REGARDING PERSONAL RESPONSIBILITY AND THE BENEFITS/RISKS OF THE GROUP FITNESS ENVIRONMENT

I love group fitness, and over the years, I have been a member, coach and collaborator with various group fitness organizations. Moreover, as a physical therapist for greater than a decade, I have treated injuries from group fitness practices such as yoga, Pilates, Crossfit, Bodypump, P90X, Spinning, Barre, the Lithe method, kettlebell training, and various bootcamps. Therefore, I am never surprised when I encounter individuals that have incurred an injury participating in one of these modes of fitness. I am surprised, however, when the individuals that have been injured are somehow surprised that they were injured during the process. Moreover, I am even more surprised when these individuals blame the fitness environment for their injuries. I have no intention of offending anyone but to me blaming a group fitness environment for your injury is like blaming McDonald’s for your obesity. As adults there is a certain amount of personal responsibility we must take for our own choices. Joining a group fitness environment is a choice, therefore, responsibility must be taken for any consequences that come from that decision. This statement by no means indicates that we should not participate in these endeavors, but instead we must be informed consumers regarding what decisions we are making. My intent with this discussion is to separate out the benefits of group fitness from the risks, as well as discuss ways that we as adults can be more responsible for the health of our bodies and minds in these environments. 

BENEFITS

University of Pennsylvania psychologist, Dr. Martin Seligman, coined the acronym PERMA to describe the basic tenets of Positive Psychology, which is simply stated, the scientific study of that which makes life worth living. With a little contemplation we can easily connect this acronym to the group fitness environment. Moreover, this acronym can act as a checklist for factors that we can seek out to make sure that we are in an environment that is promoting well being.

P - POSITIVE EMOTIONS 

Exercise and physical movement have been demonstrated over and over again to create positive change in the brain that decrease incidences of depression, and promote more positive feeling towards life.

E - ENGAGEMENT

This is seen in group fitness environments when the activities that are being performed are actually being enjoyed by the participants. In my professional opinion, this would tend to include activities where there is a progressive improvement of a skill, as opposed to activities that are random or routine with the sole purpose of making someone “work hard” to produce a “sweat or burn”.

R - RELATIONSHIPS

To me this factor is the benefit that is the most unique to the group setting. This factor refers to the community that we adopt when we add a group fitness practice into our lifestyle. This factor also helps to promote the previous two mentioned factors by creating positive emotions of love, kindness, and compassion towards others we encounter in this community, as well as by encouraging us to engage deeper into the endeavors introduced in this environment so that we can enjoy a greater shared experience with our new found fitness friends.

M - MEANING

This factor is vital to the value we gain from our group fitness experience. If we approach our time as something we are surviving through because we are “supposed to exercise” we are unlikely to find much positive meaning in the experience. However, if we view the time we spend working on our physical fitness as a major contributing factor in allowing us to improve our abilities to play with our kids, embark on active traveling expeditions, and/or minimize the all too typical degenerative effects of the aging process, we will likely find greater well being in our lives through the group fitness environment. 

A - ACHIEVEMENT

This factor can make or break both the quality and the safety of the group fitness environment. If there are no true metrics for progress but only a promise of an intense workout that creates lots of sweating and calorie burning, the value of achievement will unlikely be realized. Moreover, without a focus on progress there is a much greater risk of injury when performing high quantities of movement as the body is not given an appropriate time period or stimulus to create change that would make it more resilient to progressively increasing physical challenges. On the other hand, if the focus of the group fitness environment is that of gradual, progressive improvement in the amount of load we can lift, the speed/explosiveness of motion we can create, and/or the amount of time we can endure, we will notice meaningful change in not only our fitness lives but also our lives outside the gym. Ideally we will be able to notice this at a pace that allows our bodies to gradually adapt to the increased challenges we are throwing at it. This pace will be specific to us as individuals and not based on competition created by the group as whole. After all we all have different starting points and rates of adaptability. To not recognize these individual differences is our choice as adults, however, it must be understood that it also will increase our risk of injury. Therefore, we give up the right to be surprised or accusatory when we get injured.

RISKS:

Being a former coach in a group fitness environment, and contrasting that to my current situation as a one-on-one physical therapist and fitness professional, I can say with reasonable certainty that there is no way to make a group environment as targeted to an individual’s needs as a one-on-one session. With this being said, there will always be more risk of injury in the group environment. Moreover, as long as the general public believes that healthy exercise is based on how high we get our heart rates and how much water weight we can sweat out, there will be businesses that meet our needs by offering simple solutions through a daily sweat. This mindset creates an environment where we perform greater volumes of activities that we can already do, but rarely address physical limitations that we currently do not have access to. This is because in order to address physical limitations we would not be able to spend all our movement time moving fast, spiking our heart rates, or “working hard”. Instead, by improving activities that we are currently limited with we need to take time to PRACTICE. We need to take the time to LEARN how to do something we currently can’t do. We need to be STUDENTS again. For many adults, this is the last thing we think we have time for. We are too busy and too old to learn new things. “Please somebody just give me a program I can mindlessly follow so that I can put my physical activity on autopilot.” Unfortunately, this mindset feeds the marketing machine of the fitness industry that makes the formula for physical change sound simple, and makes us feel inadequate and lazy because we are not working hard enough. Therefore, we think we need to DO more instead of LEARN something. Instead of seeking out a teacher we seek out a simple solution. As long as this continues, we are asking for environments that promote overuse injury instead of improved physical performance.

SELF REGULATION:

As adults, when we decide to take part in group fitness classes we need to take responsibility for our own bodies and to what movements and activities we can control. With this being said, it vital that we have an understanding how to appropriately progress and regress any movement prescribed to us. More importantly, we need to understand markers for loss of control within a movement so that we know when it is time for us to rest or regress a movement. Furthermore, we need to know what our baseline level of skill is for any individual movement so that we know where to train in any given session. Finally, it is our responsibility to understand how to manipulate different movements to accomplish the modality of fitness (strength, power, endurance) that our body needs the most. 

If not well studied in the field of fitness, I would expect this to sound a bit overwhelming. Luckily, there are well educated movement professionals that can teach us the skills to self regulate our readiness for what is asked of us in a group fitness environment. In my opinion, the personal fitness professional needs to collaborate instead of compete with group fitness practices to prepare clients for the movements they will routinely encounter in their communities. If an individual fitness session is utilized to motivate a client to work harder instead of educate him/her to be resilient to more challenging environments it is a dangerous waste of money and time.

 

LOADED MOBILITY - THE KETTLEBELL WINDMILL

Loaded mobility is adding an external resistance to a movement in order to add stability, feedback and directional guidance to the position trying to be mobilized. Loads used for mobility training should be moderate in nature. Not so light that positional or directional feedback is not experienced, but not so heavy that muscle tension overpowers the intent of the stretch or mobilization.

This video tutorial is of the "Kettlebell Windmill" which uses a load (12kg) overhead to allow for feedback for an uncompensated shoulder position and directional guidance into thoracic rotation while the hip moves into internal rotation and adduction.

closed chain mobility: banded shoulder extension

Closed chain mobility is fixing the distal body segments such as the hands and feet and moving the proximal segments such as the pelvis and scapulae around the fixed extremities. This method of mobility allows for increased awareness of your body's tendency to compensate around limitations, while also building awareness of the musculature that needs to be active in order to better stabilize your position.

This video is a tutorial of "Banded Shoulder Extension", in order to improve mobility and positional awareness as the shoulders are held in extension.

closed chain mobility: band assisted squat

Closed chain mobility is fixing the distal body segments such as the hands and feet and moving the proximal segments such as the pelvis and scapulae around the fixed extremities. This method of mobility allows for increased awareness of your body's tendency to compensate around limitations, while also building awareness of the musculature that needs to be active in order to better stabilize your position.

This video is a tutorial of "The Band Assisted Squat", in order to improve mobility and positional awareness into the bottom of a squat. This movement also helps to differentiate between a stable spinal position versus a mobile spinal position in the squat.

Closed chain mobility: banded hip hinge

Closed chain mobility is fixing the distal body segments such as the hands and feet and moving the proximal segments such as the pelvis and scapulae around the fixed extremities. This method of mobility allows for increased awareness of your body's tendency to compensate around limitations, while also building awareness of the musculature that needs to be active in order to better stabilize your position.

This video is a tutorial of "The Banded Hinge", in order to improve mobility and positional awareness into hip hinge, the foundational positional for deadlifting, as well as kettlebell swinging, cleaning, and snatching.