The Pain-Injury-Surgery Cycle

When working with people at my facility I always need to help them get over the “no pain, no gain” myth. Actually, I guess I should say that I need to help them understand it better. You see, muscular “pain” and discomfort are alright and needed – if you are not uncomfortable you are not pushing hard enough to elicit a change in the body.

However, joint pain is a totally different thing. Joint pain is a sign that your body is not moving correctly and is much like the “check engine soon” light has gone on in your car. You can ignore it for a while but a break down is going to eventually occur.

So, gutting through an exercise when your knee, low back or shoulder are talking to you is not the type of “no pain, no gain” you want. The vast majority of surgeries and rehabbing going on for mountain bikers are not acute, traumatic injuries like those that occur when you crash. Most of them followed a pattern similar to this:

Step 1: You notice a little pain in an area while you are riding or working out but it goes away after you get into your workout a bit.

Step 2: The pain doesn’t go away as fast and now it tends to linger for a while after training or riding, sometimes for a day or two afterwards. You can still work through it; it is just a bit more annoying now.

Step 3: You have to pop a few Advil before training or riding in order to keep the pain under control. Without some sort of pain reliever you just couldn’t train or ride are hard. You are also much more likely to need a day or two off after a long ride or hard workout to let the painful area recover.

Step 4: You are forced to go see your doctor after the pain relievers stop working as well and you can not get through a ride or workout with some serious consequences. Your doctor says that you have some sort of tendonitis or bursitis or some other “fill in the blank-itus”. You get some physical therapy prescribed and you do the work but it doesn’t seem to get a whole lot better.

Step 5: You are now scheduled for surgery. Maybe the pain just got so bad you couldn’t take it any more or a minor impact injury caused something to “break” but you now have some serious damage to a key joint that is going to impact you for the rest of your life.

This process may take years to get through but the sad part is that a lot of active people tend to go through this cycle a couple of times in their lifetime. Think about how many people you know that have had a knee “cleaned up” or a shoulder “tightened”. This speaks volumes about the poor level of understanding about preventing these injuries in the first place.

With rare exception, bad movement causes pain. In addition, where the pain shows up is usually not where the real problem is. Look at the joint above or below the area that is painful for dysfunction and you will find the real culprit. The low back is a great example of this – low back pain is not caused by a “weak” low back but instead from poor hip function and mobility. Ignoring the hips role in low back pain will never take care of the problem and will result in a lot of pain relieving drugs or, God forbid, surgery.

Going into the off season you have a golden opportunity to address the bad movement that causes you pain and holds you back. Don’t spend the next few months ignoring the pain and simply popping some pain relievers or just sitting on the couch to “let it rest”. Work on your mobility and core strength. Clean up your movement and get strong on that movement.

The secret to riding faster and longer each year is to address things when they are still in the Step 1 or Step 2 phase of the pain-injury-surgery cycle. You’re stuck with that body for a long time so take good care of it – you’ll be stoked when you’re 70 and can still be active and have fun!

-James Wilson-

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  1. Geoffrey says:

    Hey James, I went to physical therapy yesterday (healing from a broken pelvis). Of course, it was a lot of mobility work. As we were talking about the muscles that got whacked by the damage (quads, hip flexors, my IT band), my PT revealed something I had never heard before. Did you know that the hip flexor attaches to the lumbar spine?! IN other words, if your hip flexor is tight, it is pulling on your lower back. Therefore, lower back pain. I’ve always known that tight hip flexors can produce lower back pain, but I never knew it was so directly linked. Anyway, thoguht I’d share.

    Reply • December 16 at 9:57 am
  2. Toke Henriksen says:

    Great post James,

    I’ve have been through that exact cycle a couple of years ago, and I am unfortunately going through it again.
    Fortunately I have learnt a great deal about injuries and correct training in the meantime.
    But after 15 years of martial arts, 10 years of Snowboarding, and recently 6-7 years of mountainbiking, my shoulders couldn’t hack it anymore. I’ve had surgery on the left shoulder a few years ago, and now the other one is to follow soon.
    Had I been wiser about my (preventive/strength) training 10-15 years ago, this might very well could have been avoided.
    I hope there’s a lot of riders who take your recommendations into consideration, since crashes for the most part is sure to happen at some point.

    Keep up the good work, always interesting to follow your point of views.
    Best Regards
    Toke / Denmark

    Reply • December 16 at 10:48 pm
  3. Jason says:

    This is one reason I am in the gym. I had a stupid wreck about 3 months ago. I wasn’t even on the trail yet. Headed from the parking lot to the trail head I bunny hoped a curb and landed funny causing my front tire to burp. This ended up in a faceplant. No big deal aired back up and hit the trail. About then I noticed something very wrong with my shoulder. Ended up being a grade 2 seperation. Wrecks like that should be laughable incidents not trips to the ER.

    Reply • December 17 at 4:53 am
  4. Dave Phreaner says:

    James, I love the injury article! I’m the family doc in Santa Barbara that his written you before. After practicing FP and some sports medicine for the past 15 years, along with riding MX and MTB a couple times per week, I think I’m finally getting it! I just started doing your DB quick workout about 3 weeks ago and I’m already seeing the gains. Because I haven’t been in a gym in 20 years, my hamstrings, etc burned for 4 days after my first workout but last weekend I had my best DH race ever. I was 2nd overall and for a 46 year old I was super stoked.
    I owe that performance to your excellent core training work out. I was able to out sprint my friends and hold that good DH position on the bike longer than I ever have before. My ‘old man’ knees and shoulders are already starting to improve with a little more muscle above and below those joints, along with improving hip flexibility. I’m hooked and can’t wait to see how much better I will feel in a couple months of your workout!

    Reply • December 17 at 8:06 am

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