Reader Q & A: Thanksgiving Edition

Happy Thanksgiving!

I am thankful for my readers, especially the ones who have provided me some some good questions that I can paste together with my answers to create a blog post.

Questions include: why does it hurt here; why doesn't it hurt here; why is my hamstring stiff; and should I use resistance on sports movements?

(By the way, if you want to ask a question and get it answered in a future post, contact me here.)

Here we go.

From Cynthia:

Hi Todd,

New to your blog, interesting stuff.

I have a question regarding this post- I have some hip issues related to piriformis, glut medius and TFL injury (getting better slowly and not really that bad while running, though painful afterwards strangely) and relatively weak glut maximus (working on them now). Since the injury appeared (snuck up on me- not acute), I’ve felt some aching going down my leg (the outside, not the back) and slight numbness in my big toe. Does this correspond to inflammation in the nerve or compression where it passes through the hip? Any suggestions for treatment?

My response:

Cynthia,

Thanks for reading and sorry to hear about your hip issues. First off, keep in mind I'm not a doc.

I think its generally very difficult to determine why something hurts. In my view, the body’s interactions are fabulously complex – think chaos theory. Therefore it is often impossible to determine an exact cause of pain, unless there is a knife sticking in your back or something.

That being said, sometimes an understanding of nerve mechanics will allow you to tell a pretty plausible story about pain – for example if someone has three painful points, all of which lie along the track of a major nerve, then it’s a good guess that the nerve is compressed or inflamed at some point. In your case, I can’t think of a nerve that goes down the outside of the leg and to the big toe. The sural, tibial, femoral and peroneal nerves all come from the hip and reach the big toe area, but go down the front and back of the leg, not the side. Of course I suppose its possible that any of those nerves might refer pain to the outside of your leg instead of the back or front.

So I would assume that a nerve might be sensitive to compression or tension somewhere between your back and hip. The hip seems like a good candidate because that’s where the pain started.

So what can you do with this info? In my opinion the best thing to do (movement-wise) about ANY pain or performance issue is to increase the coordination of your joints and decrease sensory motor amnesia (see post on SMA) without causing nay pain in the process. Because the body is a unit, as I’ve discussed in the post of the same title, you might need to work on the coordination of many joints, but in your case the prime candidates would be the hip, foot, and low back. How do you recoordinate? My favorite movement modalities are Z-Health, Feldenkrais and Somatics. I’m not a big fan of PT-style stretch and strengthen regimes. Good luck!

From Erick:

Hi Todd,

Does absence of pain indicate absence of injury?

I lost a fair bit of cartilage in my left knee over the years playing basketball. This was confirmed by constant pain and an MRI. I had microfracture surgery performed, but the surgeon figured it was a temporary stopgap procedure – my lesion was just too big to be fully corrected by simple microfracture. He told me I’d probably need an autologous chondrocyte implantation, which is an invasive procedure designed to embed new living cartilage in the affected area, or risk certain knee replacement surgery in a few years.

I declined the surgery and have been exercising pain-free for about two years now. I squat, deadlift, sprint, hike, even play basketball, without any pain. I supplement with Vit D (or get lots of sun), Vitamin K2, and follow a paleo eating plan. No grains, sugar, seed oils – the basics. Obviously I’m not necessarily out of the woods yet, but I wonder if my lack of pain indicates some sort of recovery or a deadening of my pain receptors.

Any thoughts?

One last thing, sorry: I also wonder if indeed significant structural damage remains, are the lack of pain and lack of immobility indications that the structural damage is no longer a problem?

I guess I’m unclear whether structural/tissue damage is necessarily a bad thing. Pain may not exist now, and I may retain mobility and function, but will it manifest as something worse down the line?

Interesting to think about. I suppose I’ll just have to wait and see, eh?

My response:

Erik,

Thanks for the comments, interesting story, you are a good example of what my post was about. Absence of pain does not indicate absence of tissue damage, but I do think it probably indicates absence of a problem to worry about.

In my recent post I talked about the many ways that the pain alarm system can fail us by getting ramped up and start causing pain even without injury. I think it is much less likely that the system will fail us by not alerting us to an injury that needs time to heal. I think the system is much more likely to err on the side of creating too much pain and not too little.

So, if it doesn’t hurt, don’t worry about it. Of course be mindful that the knee might have a harder time taking extreme work than a younger one but if you just listen to your body I don’t think it will lie to you. Apparently your system is just like the many others that were measured in the above-referenced studies – an injury heals, objective damage remains, but function returns and pain is gone – exactly the way it’s supposed to work.

Jeffrey G. asks:

I have a question for example if you were practicing boxing and trained with components that made you work harder at the sport like heavier gloves or a vest weight or footweights would you then improve your strength and skill at boxing or other sport while doing the sport instead of working out at the gym? for example if you were running and you were trying to improve balance would it be beneficial for someone to try and push you for you to get better balance or running an obstacle course? or if you were trying to get explosive power and speed for running would it be beneficial to strap on a parachute for resistance? or in boxing for strength would it beneficial to strap some sort of concoction that adds resistance to your movements while boxing? basically im just asking does adding resistance to specific movements in sports increase your strength or speed at the sport itself? or to a lesser extent endurance?

My response:

Jeff,

Good questions. Many athletes have tried to improve their speed or strength at a sport related activity like throwing or hitting or kicking by increasing the resistance while throwing or hitting, such as using a heavier ball to throw with. The verdict on this type of training activity is definitely negative. Studies show that using extra resistance to perform a sport specific activity actually makes you worse, not better. The explanation is that doing the activity with extra resistance is actually a slightly different skill than the actual sport activity, so that the new skill interferes with the one you want to perform in the game. So, for example if you throw with a heavier baseball, this practice this will actually make you worse at throwing with the regular baseball, partly because it will subtly alter your throwing mechanics for a different ball. I think the same logic applies to parachute for running, although I don’t think I’ve read studies on this specific issue.

If you want to get better at running an obstacle course, I would practice running on obstacle courses. Maintaining balance while someone pushes you is likely a completely different skill, useful on the soccer field maybe, but irrelevant if your sport doesn’t include people pushing you while you run.

Geff asks:

I have one incredibly stiff hamstring. i haven’t injured it. it feels frozen stiff? stretching does not seem to loosen it there is no pain just discomfort from the tightness. Why??? i am totally fit and healthy everywhere else.

My response:

Greg,

I don’t know exactly why your ham is stiff, but I think we can safely guess (barring some structural problem) that your CNS is for some reason threatened by the idea of it lengthening. You can think of the stiffness as a protective mechanism. A stiff ham might be protecting the low back, or the hip capsule, or is part of bracing for a fall because balance in the feet or elsewhere is poor. My recommendation would be to try some mobility drills for joints nearby and progressively further away and then reassess the stiffness. You might notice differences immediately after mobility drills. Good luck.

Tim Terlegard asks:

Do we know approximately for how long a certain nerve stimulus will be providing information for the map before it’s pushed out again? Let’s say I stimulate nerve A and this is recorded in the map. Let’s say I don’t stimulate nerve A again. For how long does the map know about nerve A? When can I expect SMA?

Phantom pain, why does one have that? Does the CNS feel threatened because it can’t sense the lower limb?

Pilates seems it could be something for me. Will definately try it out. Seems it can be a good workout both for the nervous system and for the muscles.

Some people can perform splits. I assume that one usually do stretch exercises again and again and again in order to be able to perform a split. What is it that one actually is achieving with the stretching? Do the muscles get longer or is it only about learning the brain that lengthening the muscles is not a threat? Just being somewhat curious.

My response:

Tim,

Good question about how long a stimulus will cause a change in the map. I think it depends on how relevant and interesting the brain finds the new sensory information. If I just brush a finger on my leg it will remain easier to sense for maybe a few seconds and after that will feel just like the other leg. It would be a bad idea for the brain to make huge changes to its movement maps every time it wiggled a toe or brushed up against a leaf. I assume that the brain will only make permanent or meaningful changes to the sensory and movement maps for a good reason, such as a clear demonstration that the new way of moving or sensing is more efficient or less painful. Feldenkrais does a good job of making the movements very novel and interesting to get the attention of the CNS, and also doing them in a way that will convince the CNS that this is a better way to move. My personal experience is that movement work sometimes makes me feel better for just an hour, and sometimes I experience benefits that are more or less permanent.

Re phantom pain, there is evidence that the CNS is threatened by smudged movement maps, just as you would be threatened by walking around with a blindfold. Researchers can sometimes create pain in subjects by creating sensory illusions that they call a sensory mismatch. Perhaps phantom limb pain is a kind of sensory mismatch.

Re splits, I would guess that for the avg. person to learn the splits, there might have to be some structural change to the length of the muscle, by adding sarcomeres. This takes a huge amount of effort, e.g. sitting around in the splits while watching t.v. every night. Of course CNS training and threat reduction would be necessary as well.

H writes:

this article is totally wrong. as someone who had bad posture i can tell you that it takes conscious discipline to improve posture. this is simply due to the fact that it takes good muscle tone to have strong posture. you must slowly train your muscles to hold better posture and you will slowly develop. only after devotion will good posture become natural. another point that blatantly stood out to me was that you say you have to suck in your abs to improve posture. no. your abs should be stretched with good posture, like you’re pushing them out, but still keeping them taught. this is done by having a straight back, starting from the butt. the small of your back should be taught, and your butt should be clenched, naturally, your abs are now out and stretched. this is good posture.

My response:

H,

This is one of the first negative comments I have ever received! Thanks you for keeping me on my toes.

I disagree that the article is totally wrong. In all likelihood, I have made numerous true statements in there.

In regard to muscle tone, I’m sure it takes good muscle tone to have good posture, but that does not mean it takes any significant strength. Little toddlers have excellent posture and they are very weak. When the body is not fighting itself, it takes very little effort to remain upright and comfortable.

Your approach seems to be that good posture requires that you train your willpower to stiffen the musculature. Mine is that posture is about skill not will. If you compare the postures of young children with soldiers standing at attention, you can see the difference the two approaches yield.

I’m surprised that one of the points that blatantly stood out for you was my claim that you should suck the abs in. Because I didn’t make that claim. Instead I said that sucking in the abs was poor advice.

I agree that the small of your back should be taught (to relax), but not taut.

I disagree that good posture requires clenching your butt. There’s a reason that the phrase tight ass isn’t used to describe someone who is relaxed and at ease with himself.

That's it! Feel free to contact me to ask your own questions and I will make them the subject of a future post.