Any Idiot Can Make Someone Sore- but is more always better?

The longer I work as a physical therapist, I see over and over again that pain is often used as a badge of honor or a measure of success from patients and previous practitioners they have visited. There are so many sayings floating around these days such as "No pain no gain" "pain is weakness leaving the body" "if it ain't hurtin it ain't workin". These tend to get applied to various forms of manual therapies and exercise. People are under the assumption that a massage should hurt to be effective, bruising after an IASTM treatment is a positive sign and a badge of honor, foam rolling should make you writhe in discomfort, and exercise should make you so sore you have to fall to the toilet the next morning for it to be considered a good workout.

I beg to differ. Any idiot with two hands can make a massage hurt on tender spots. Any "twatwankle" (shout out to Roger Kerry) with a whistle and timer can make you sweat during a workout and want to chop your legs off the next day to get away from the pain of the delayed onset muscle soreness. The question becomes whether or not this is the best and most effective course of action to optimize benefits of the given intervention. 

Don't get me wrong. Some manual therapies can be taken up to the edge of "pain" in some people, but if it "hurts so good" is it really even pain after all? Considering the definition of pain is an UNPLEASANT experience I would venture to say no. Some individuals really love "edge work" as it has come to be known. Edgework is essentially taking a stimulus right up to the edge of pain, or flirting with the edge of a ROM or movement that is the painful one. With manual therapy, the "hurts so good" area can have central nervous system effects on pain processing and give a great novel stimulus to decrease threat perception and subsequently pain levels. Not to mention, there is an inherent placebo effect associated with getting what you feel like you need. I personally love manual edge work on myself, but it should be noted NOT EVERYONE DOES. Additionally, I have found ROM/movement based edgework to be extremely beneficial to patients, and it gives you immediate test-retest capability. 

Manual therapies should be applied at and graded to the intensity the patient reports is most comfortable and effective for them. There should be a constant dialogue between the provider and the client to best provide an effective intervention "Better? Worse? The same? Good? Bad? Painful?" are all questions that are posed and ANSWERED HONESTLY by the client consistently throughout the course of treatment. 

On the flip side of the coin looking at exercise, there is actually plenty of research out there to show that causing excessive muscle soreness in the form DOMS is a poor marker of a successful workout. This research also shows that DOMS is not associated with improved outcomes in the long term. In fact, it is quite likely that excessive DOMS diminishes returns as it leads to impaired muscle function and less force production (as much as 50%) in subsequent workouts. This leads to less capacity to lift higher volumes and also decreases the possible training frequency for said muscle group as you will need excessive rest time before training the affected muscle group again. Brandon Roberts has done an outstanding job hereexplaining DOMS in depth on Greg Nuckols website.

Furthermore, emerging evidence is demonstrating that higher frequencies (2+x/week) are likely to be more beneficial for maximizing muscle hypertrophy. If you are too sore to work the same muscle group again for an entire week you have effectively decreased possible potential for progress. To put it in perspective training bi-weekly gets you 104 workouts/muscle group/year. Being too sore to train more than once cuts that to 52. If you assume a hypothetical total volume for chest training days as 10,000-12,000lbs/day (literally only 5 sets of 10 with 200lbs on bench press) across the course of a year, that amounts to a difference of approximately 570,000lbs of weight you DIDN'T lift this year that you could have. This is a conservative measure with a relatively low volume and doesn't account for strength gains over the course of the year.

Considering the direct dose response relationship between lifting volume and hypertrophy this could obviously be a less than ideal scenario. Again, if you are so sore that it decreases your force output in subsequent workouts, you are yet again losing volume unnecessarily.  Am I saying you should never be sore after a lift? No, any novice lifter will be sore after their first few workouts, and even experience lifters get sore when they change their routines due to the temporary novelty of the movements.

However, if you are planning on getting into working out, please don’t listen to the idiot with the weekend personal training certification that tells you the more sore the better. There is in fact gain without pain. Try isntead, to find someone who will ease you into training and build a program that is customized to you, your goals, and your training age. Find a trainer who understands progressive overload, periodization, and how to gauge if a program is effective in other ways than your pain levels. If you are looking for a massage or soft tissue work, please do not listen to the “twatwankles” that tell you bruising is normal/expected and that they are breaking down all of your adhesions with their ridiculously aggressive approach. Seek someone who uses techniques that feel good to YOU, and help you to relax. Find someone who asks you "better, worse, or the same?" during the treatment. Find someone who realizes that the nervous system is king in manual therapy.

 

End rant….

As usual thank you for reading,

Jarod Hall, PT, DPT, CSCS

 

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