You’re in Control of Your Pain and Your Recovery

Oct2nd 2019

A call to challenge traditional practices among competitive athletes

Pat Stanziano
Written by Pat Stanziano, MPT, Hons BSc Kin
Reg. Sport Physiotherapist (Dip SPC, IFSPT)
Cert. McKenzie MDT Practitioner (MIC)
Cert. Complete Concussion Management Practitioner
Cert. Strength and Conditioning Specialist

I was recently interviewed by popular figure skating fitness professionals at FLEXAFIT for a blog series they were doing on pain and injury pertaining to figure skating.  Here they are: Know Your Limits and Empowering Your Recovery.   A couple of points to bring up: (1.) some of my answers were modified or omitted to accommodate the blog length, and (2.) the answers I gave can be implemented by any athlete, not just figure skaters.  Here are my answers to the questions, unedited.

How can you tell a normal ache from an injury? 
Exercise or activity-related aches and pains are healthy, and if you push your body to the limits of its capacity, they are an expected part of improving your performance.  The sensation is felt in the muscles and may also make that muscle a little stiffer than normal for 2-3 days.  After recovery, the same exercise or activity routine will result in subsequently less soreness which indicates adaptation of the tissue and a sign that you can progress the routine.  
Pain related to an injury may be noticed during the exercise or activity (i.e. there was a mechanism of injury) or, in some instances, afterward.  It typically occurs when performance exceeds the capacity of the tissue.  The sensation may be sharper, felt in the muscles or joints, and may linger beyond 2-3 days if not addressed. You may notice some additional signs and symptoms, like swelling, increased tissue temperature, and loss of one or more performance parameters (ROM, strength, etc).  Pain due to an injury often requires a reduction in training load, before gradually exposing the area to progressively increasing loads again.

What kind of pain is okay to work through? 
I like to teach my athletes how to assess their pain behaviour through use of an activity traffic light guide.  Before applying the guide, specific to a particular exercise or activity, I will have them assess their pain from 0 (no pain) to 10 (I need an emergency room), as well as a baseline movement (or two) that has been affected by the particular area in pain.
traffic light model for exercising with pain
The red light scenario depicts performing an exercise or activity that causes an increase in pain and a major change/loss of their baseline movement(s) which lasts for several days after.  In this case, action needs to be taken to calm things down, before attempting the performance of the exercise or activity at a reduced load (i.e. decreased resistance, decrease reps, increased rest time, or manipulating other performance parameters that contribute to reduced load).
The yellow light scenario depicts performing an exercise or activity that causes an increase in pain but little-to-no change/loss of their baseline movement(s) AND these changes do not last into the next day (i.e. baseline symptoms and movements are not worse next day).  In this case, maintain the current workload.
The green light scenario depicts performing an exercise or activity that causes little-to-no increase in pain that returns to baseline shortly after completion, and no change/loss of their baseline movement(s).  In this case, action needs to be taken to add a little more load the next time the exercise or activity is attempted (i.e. increasing resistance, increasing reps, decreasing rest time, or manipulating other performance parameters that contribute to increased load).

What red flags should skaters and coaches look for? 
When you notice the following signs and symptoms in a muscle, joint, or bone, it’s an indication that you should go get it checked out: deformity, swelling, or bruising of the body part and/or an altered function of that body part (ex. an unwillingness to move it, a loss of ROM, or a loss of strength, or other performance parameter).

Why or why not do you recommend foam rolling for recovery purposes?  Does it speed up muscle recovery? 
(Yikes, you’re going to put me in an unpopular spot here with the figure skating community).  Although I like the fact that foam rolling is a tool that promotes self-efficacy and it is intended to prepare muscles for activity or help muscles recover from activity; unfortunately, research has not done a very good job at justifying its use.  In a recent systematic review of 21 papers, Wiewelhove et al (2019)  concluded that foam rolling does not release fascia, break up adhesions, remove lactic acid, flush out toxins, improve blood flow, or improve performance.
The challenge becomes implementing change into practice.  For those who have used foam rolling as a practice for X number of years, the psychological ramifications of removing it from practice when you believe that it works for you has to be considered (a topic for another day).  So I think the change has to come from coaches and trainers working at the grass roots level and turning to more proven tactics for muscle preparation and recovery.
This evidence has been available for at least 10-15 years now, yet the practice of foam rolling seems to be as strong now as it ever was.  So it’s hard to turn away from traditional practices, but it doesn’t mean these traditions are right.
lady foam rolling her calve muscle
How would you recommend skaters recover their muscles in place of foam rolling?
That all depends on what he or she thinks the purpose of the foam roller does for him or her.  So without getting into too convoluted an answer:  My suggestion for warming up would be to break up your elements into component movements and do those components under control, especially at the end ranges, and eventually combining those components and building up the speed until you are performing that element itself.
My suggestion for recovery would be to bring your heart rate down and go through the same component movements under control, almost like a system check to to assess that everything after your session feels the same as it did prior to your session.

How often should athletes see a physiotherapist, massage therapist, chiropractor, etc? Is additional care an essential part of staying strong and healthy?
These practitioners are an essential part of your team, but much too often, they are relied upon for quick fixes of typical (and normal) aches that cause athletes to panic. Unfortunately, they are often sold on the physical and psychological need of these pseudo-therapies by these very same practitioners that they like and trust (some popular ones recently are colourful taping and cupping that aren’t that helpful at all).  This dependency has been linked to future chronic pain sufferers and all the physical, psychological, and social baggage that comes with it (again, a topic for another day).  The primary role of the sport therapist should be to ensure that the athlete is staying as close to the training plan laid out by coaches (technical, strength and conditioning, etc) as possible.  Furthermore, they need to normalize typical responses to loading like the aches and pains we discussed above, and ensure the athlete that what they are doing on their own (strength and conditioning, proper nutrition, adequate sleep/rest, stress management, etc) is the most essential part of being strong and healthy.  Talk about empowerment!

Pat is an internationally recognized sport physiotherapist and a member if the integrated support team for Skate Canada.  All opinions are his own and don’t necessarily reflect those of Skate Canada.

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