You’ve probably heard this phrase: “World records are
broken by athletes who are in pain.”

Even if you haven’t, it’s no surprise to coaches,
athletes, or serious sports fans. We all know athletes play with
pain.

However, being aware of it and understanding what you can do
about it are very different things. To put it bluntly, the strength
and conditioning community is still very much in the dark when it
comes to understanding how pain affects the body, and how
individuals like you can effectively reduce or eliminate that pain.

It’s not that they’re wrong when they recommend
sensible solutions, like more balanced strength-training programs,
soft tissue work, and mobility protocols. Those techniques are
extremely effective, and I’ve produced my own DVDs on those
very subjects.

The problem is this: they aren’t enough to deal with
physical pain and dysfunction. There’s still a major component
to dealing with pain – and to making gains in your training
despite pain – that’s been left out. Until
now.

Before I get into that missing piece of the puzzle, I want to
make it clear that I’m talking about chronic pain.
I’m absolutely not talking about acute injuries or direct
trauma. If you have pain in your back from a herniated disc, or in
your knee from a torn ligament, you need to see a qualified rehab
specialist.

On the other hand, if you have chronic aches or tightness in
your muscles or joints, this article is for you. And if you’re
a coach who works with athletes who complain that their knees ache
or their lower back tightens up after games or workouts, please
keep reading.

Pain Is Not All the Same

People like us – serious lifters, many of whom also train
serious athletes – will experience two different types of
pain in our careers.

Type 1 pain occurs during or immediately after high-load
activities, but isn’t felt when doing normal daily activities
like sitting or walking. A few examples:

• A guy can walk for miles with no knee pain, but his knees hurt
when he runs, plays basketball, or squats or lunges with weight.

• A guy can push his lawn mower around for hours without
shoulder pain, but his shoulders hurt when he does chest or
shoulder presses in the gym.

• A guy never experiences any back problem except right after he
works out or plays a round of golf.

This category also includes most overuse injuries, like
tendonitis and bursitis.

Type 2 pain is associated with low-load activities. A lifter
with Type 2 pain might be able to squat a house without flinching,
but if he has to stand for a half an hour or sit in a movie theater
for any length of time, his knees get stiff and achy.

Or his back hurts when he sits at his computer or takes long
drives.

Or he wakes up in the middle of the night with shoulder pain he
hadn’t felt during the day.

Or he always feels tight in certain areas no matter how much he
stretches or how much soft-tissue work he gets.

Or maybe he can’t say where he feels chronic pain, since it
moves around to different parts of his body without any particular
reason.

Chances are, you’ve experienced both types of pain, and if
you’re a coach you probably work with athletes suffering from
one or the other. And chances are the advice you’ve gotten,
and the rehab strategies you’ve used, all start with the idea
that all types of pain should be treated the same
way.

Which is not the case at all.

A Quick Detour to the Motor Pool

You probably know that your muscles contain millions of fibers,
which are organized into motor units. A motor unit consists of a
single motor neuron, plus all the muscle fibers it controls.

<!– the motor unit –>

You probably also know that not all motor units are the same.
Just to keep it simple, let’s say they fall into two big
categories: slow and fast. Slow motor units are easily activated
and take a long time to fatigue. Fast motor units need more of a
stimulus to come into play. Whereas slow motor units are working
all day in the muscles responsible for posture, and handle simple
tasks like walking or typing, the fast ones don’t get going
until you’re doing something that involves at least 40 percent
of your max strength and power. The tradeoff is that they fatigue
faster.

I don’t want to bog you down with exercise science, but
before I can explain how slow and fast motor units relate to
chronic pain, there are some key details about muscle function to
keep in mind:

• All of the muscle fibers in the single motor unit are of the
same fiber type. So a nerve that controls a slow motor unit only
activates slow muscle fibers.

• Postural control and simple, low-load functional movements are
primarily a function of slow-motor-unit recruitment

• You can selectively exercise the slow motor units with
low-load exercises and motor-control training.

• When you do a high-load activity, like lifting or sprinting,
your body recruits both slow and fast motor units.

• Those high-load activities are dominated by your body’s
biggest and strongest muscles, especially the multijoint muscles,
which are ideally positioned for strength, speed, and a large range
of motion.

High-Load vs. Low-Load Dysfunction

So we now know that there are two general types of pain, and two
general types of motor units. As you probably guessed, there’s
a connection.

Athletes with Type 1 pain are better at controlling muscle
tissue during low-load activities, but experience problems when
they shift to high-load activities. These athletes have a high load
dysfunction, and that requires a high-load solution.

As luck would have it, we’re really good at resolving this
kind of dysfunction. Good coaches and qualified rehab professionals
know how to create well-balanced strength-training programs, and we
know how to prescribe mobility exercises and soft-tissue
work.

In other words, just about every good training article ever
written by a qualified professional can help you if you have Type 1
pain. That’s precisely why this article doesn’t address that issue.

Instead, I’ll focus on low-load dysfunction – Type 2
pain.

If you have Type 2 pain, you tend to be fine with high-load
activities; the discomfort kicks in when you aren’t running
fast or lifting something heavy. That means you have a low-load
dysfunction – a problem with the way your body activates its
slow motor units – and that requires a low-load solution.

The problem you have can’t be addressed with mobility work
or a foam roller. You don’t need a better strength-training
program, simply because the dysfunction has nothing to do with
strength. It’s all about the way you recruit and control your
smaller, weaker, slower motor units.

How Pain Affects your Body

In a pain-free state, your brain and central nervous system
(CNS) can utilize a variety of motor-control strategies to perform
functional tasks, and to give you equilibrium and joint
stability.

There’s no one correct order of muscle recruitment or
firing pattern. Your body will simply choose the best strategy
available to meet the demands of the given task or situation. A
pain-free body is very adaptable.

However, when pain is present, things change
drastically.

The options available to the CNS become limited, and your body
ends up using consistent, repetitive co-contraction patterns,
usually with exaggerated recruitment of the big multijoint muscles
instead of the deeper, smaller muscles – the ones responsible
for stabilizing your joints.

In other words, your body bypasses the low-load system and makes
the high-load system responsible for all types of movement. This is
an imbalance that will surely lead to a breakdown.

Now you understand why you tend to feel “tight” and
“locked up” when you have chronic pain. It’s because
the prime-mover muscles are being called on to do everything,
instead of just the specialized activities they’re supposed to
perform. Muscles that are never given a chance to rest and relax
will react by tightening up.

In other words, tightness and mobility restrictions are symptoms
of the problem, not the cause. If something is tight, it got that
way for a reason. And the reason, as you just read, is a flaw in
the motor-control system.

Now you understand why high-level athletes are able to play
through pain, and sometimes play at the top of their game. Their
high-load muscles can still express strength and power.

And now we get to the big question: What can we do to fix the
low-load system so we, or the athletes we work with, no longer have
to deal with chronic pain?

Training the Low-Load System

The goal of the following exercises – which are listed in
no particular order – is to retrain your slow motor units. At
Performance University, we call it “muscle activation
training.” We use them on a daily basis with our athletes to
improve their low-load motor-control systems and thus enhance
performance.

We call these “general” exercises, since they
aren’t designed to address pain at one specific joint or
region. In our experience, they successfully address 75 to 100
percent of the most common motor-control deficits athletes and
lifters experience in their shoulders, back, hips, and knees.

My advice: If you’re going to try these exercises,
don’t just focus on the ones that appear to address whatever
problem you currently have. Pain that shows up in one area can be a
sign that your entire system needs reprogramming.

The Bird Dog Series

Most of you should be familiar with the bird dog. For most
people, it would be considered a low-load muscle-activation
exercise. It’s generally non-fatiguing and based on building
control, rather than strength.

Basic technique: Maintain a neutral spine as you reach straight
out with one arm and the opposite-side leg. Then pull the arm and
leg back in without touching the ground. Move your limbs in a
controlled tempo while breathing normally. We normally perform this
exercise for 1min on each side.

<!– dog birddog bird –>

Performing the bird dog on a bench reduces the
base of support and thus increases the
recruitment challenge.

Inverted (supine) bird dog: Lie on your back. Keep the hand of your nonworking arm between the
floor and your back to make sure your lower back stays in a neutral
arch throughout the exercise.

<!– dog bird

the motor unit

the motor unit

1 | 2 | 3

–>

One-inch bird dog: If your hips and/or shoulders
“click” when they move, this variation is for you.
Athletes with this type of issue, in my experience, usually have
lost the slow-motor-unit ability to control their joints while
they’re in motion.

It begins exactly like the traditional version: You’re on
all fours with your wrists under your shoulders and your knees
under your hips.

<!– dog bird –>

That’s where the similarities end. Instead of reaching out
with one arm and the opposite-side leg, which can end up being
dominated by the high-load muscle system, you lift your arm and leg
just an inch off the ground, as if they were hovering.

<!– dog bird –>

With this subtle movement, you pull your shoulder and hip joints
farther into their sockets, helping the low-load system relearn the
way to control these joints before movement. Avoid lifting the hand
and knee so high that your shoulders and hips rotate and you lose
ideal alignment.

<!– dog bird –>

Do 3 to 10 reps of 10-second holds on each side.

Upright bird dog: Exercises can be classified by the predominant
plane of movement. A bench press, for example, involves
shoulder-joint movement in the sagittal plane. A rotational
exercise occurs in the transverse plane. The bird dog variations
I’ve shown so far mostly occur in those two planes. So my
colleagues and I developed the upright bird dog to bring in
what’s called the frontal plane.

Sit on the side edge of a flat bench with your hands on the
bench alongside your hips, as if you were going to do bench dips.
You want your feet on the floor, and your hips, knees, and ankles
all bent at 90-degree angles. Shift your weight forward so your
butt is no longer in contact with the bench and all your weight is
on your hands and feet.

<!– dog bird –>

Now lift one leg and the opposite-side arm without changing the
alignment of your body.

<!– dog bird –>

You want to minimize lateral shifting of your torso, maintaining
the alignment.

<!– dog bird –>

As with the one-inch bird dog, do 3 to 10 reps of 10-second
holds on each side.

Half-kneeling In-Line Torso Rotation

This is a great exercise that we learned from Gray Cook,
although we use it with a different goal in mind. Whereas it’s
part of his balance-training repertoire, we use it to help develop
a disassociation between pelvic/lumbar rotation and thoracic
rotation. If you can’t twist your shoulders and thoracic spine
(middle back) while keeping your pelvis and lower back in a stable
position, you’ll be on the fast track to
injury.

Grab a broomstick or dowel rod and get down on one knee, with
your feet lined up as if you were on a tightrope. (We like to use a
narrow board to ensure the proper alignment.) Keep your torso upright and hold the broomstick across the
back of your shoulders.

<!– Torso Rotation –>

If you struggle to get into this position, then this is the
exercise you need to do. Work at it until you can hold for one
minute on each knee.

If the position isn’t particularly challenging, or it is
initially but you work up to those one-minute holds, add a torso
rotation. Your shoulders are the only part that moves; your pelvis,
knees, and feet stay in the original position.

<!– Torso Rotation

Torso Rotation

Torso Rotation

1 | 2 | 3

–>

Using These Exercises

I recommend doing these exercises at the beginning of your
workout, as part of your warm-up. We typically spent three to six
minutes on them with the athletes we train, although we sometimes
go up to 10 minutes. We find that’s enough to accelerate
recovery in our injured athletes while helping our pain-free
athletes stay that way.

You should be able to do all these muscle-activation exercises
without pain, or at least without provoking additional pain. In
other words, nothing I’ve shown you here should make your
current symptoms worse.

Make sure you breathe normally, and don’t consciously draw
in or brace your abdominals.

Finally, the exercises should be challenging, but not fatiguing.
If your low-load system gets fatigued, the high-load system will
take over, which is the opposite of our goals here. The key is that
it’s not the movement itself that matters, but how you respond
to it. What’s easy and non-fatiguing for one athlete might be
difficult and fatiguing for another.

That’s why we use a wide range of exercises, each of which
has its own set of progressions.

<!– warm up progressions –>

I can’t emphasize enough the importance of progression, but
I use it here to mean the opposite of what you normally think of.
Whereas you make strength gains by progressively increasing the
load, you improve muscle activation by progressively removing load,
and thus increasing the recruitment challenge.

Otherwise, you don’t have to change anything you’re
doing right now. Keep lifting, and do your mobility drills and
foam-roller work. Just make muscle-activation training part of your
warm-up. It’ll help alleviate any pain you have, help prevent
pain you don’t yet have, and enhance the effectiveness of
everything else you’re doing. Not bad for an investment of a
few minutes a week!

References

Warm Up Progression Vol. 1 Muscle Activation.
Performance University, Nick Tumminello (2008)

Diagnosis, Classification & Movement Solutions for
Mechanical Lumbar Pain. Live Workshop by Mark Comerford.
1st International Lumbo-Pelvic Symposium. North
East Seminars. Chicago, IL. Oct 2007

Understanding Movement and Function. Live Workshop by Mark
Comerford. Kinetic Control. 2006

Pain and motor control of the lumbopelvic region: effect and
possible mechanisms. Hodges PW, Moseley GL. J Electromyograph Kinesiol. 2003
Aug;13(4):361-70

Pain differs from non-painful attention-demanding or stressful
tasks in its effect on postural control patterns of trunk muscles. Moseley GL, Nicholas MK, Hodges PW. Exp
Brain Res. 2004 May;156(1):64-71. Epub 2003 Dec 19.

Immediate changes in feedforward postural adjustments following
voluntary motor training. Tsao H, Hodges PW. Exp
Brain Res. 2007 Aug;181(4):537-46. Epub 2007 May 3.

Changes in motor planning of feedforward postural responses of
the trunk muscles in low back pain. Hodges PW. Exp
Brain Res. 2001 Nov;141(2):261-6.

Delayed postural contraction of transversus abdominis in low
back pain associated with movement of the lower limb. Hodges PW, Richardson CA. J
Spinal Disord. 1998 Feb;11(1):46-56.

Altered trunk muscle recruitment in people with low back pain
with upper limb movement at different speeds. Hodges PW, Richardson CA. Arch Phys Med Rehabil. 1999 Sep;80(9):1005-12.

Are the changes in postural control associated with low back
pain caused by pain interference? Moseley GL, Hodges PW. Clin J
Pain. 2005 Jul-Aug;21(4):323-9.

Pain differs from non-painful attention-demanding or stressful
tasks in its effect on postural control patterns of trunk muscles. Moseley GL, Nicholas MK, Hodges PW. Exp
Brain Res. 2004 May;156(1):64-71. Epub 2003 Dec
19

Experimental muscle pain changes feedforward postural responses
of the trunk muscles. HodgesPW, Moseley GL, Gabrielsson A, Gandevia SC. Exp
Brain Res. 2003 Jul;151(2):262-71. Epub 2003 Jun 3.

Mechanical considerations in the design of surgical
reconstructive procedures. Friden J and Lieber RL (2002). J
Biomech. 35 (8): 1039-45.