Insult, Irritation, Injury, and Pain: A framework to understand long-term and recurring conditions
My clinic deals largely with chronic injuries and acute flare-ups of chronic conditions. Often, the advice to “rest” an injury is given, but the discomfort remains; other times rest helps the issue. On other occasions, I have a client come in who has been “resting” for years and now lives in fear of doing anything physical to avoid a flare-up. Years of rest however have caused their health and fitness to dramatically decline and now their risk of disease and acute injury (slips, falls, trips, etc) is greatly increased. How are we to deal with all these situations?
I find it best to define the phases of injury in order to deal with with each phase in a slightly different manner.
INSULT: Every single day of our lives we do something physical, be it walk down the stairs, walk the dog, help a friend move, or run 10 miles. Each and every physical activity creates some “insult” to our tissues. Insult is a small amount of damage that goes un-noticed by us. When we eat good food and go to sleep for sufficient time our body heals this damage. The principle behind strength and conditioning is creating an exact amount of damage that our body heals “slightly” better. This process is called super-compensation.
Irritation: When we have enough insult to our physical body our nerve endings start to send signals to our spinal cord that moves up into our conscious mind that allows us to be aware of it. This is called an irritation. Most often, a client will say “I feel my knee” when they do a certain movement or activity. This can happen in one short time period. A certain activity will cause enough insult for us to notice it and we have an irritation. It isn”t enough to stop, but we “notice” it.
It can also happen chronically when we don”t heal from a “normal” amount of insult. Remember that everything we do creates insult and our body heals it as we eat/sleep well. BUT, if we fail to get enough proper food/sleep we don”t heal. Now, we have two days of insult. Continue this path and we have three days of insult and develop an irritation, continue further and we can develop a “chronic” irritation: days, weeks, months, years of pain in a certain region. ”I always feel my back”.
Injury: When we have enough irritation to make us not want to continue an activity I term it an “Injury”. Injuries can happen suddenly, like getting hit by a bus, but often happen chronically. When a chronic injury begins one will say “I”m not sure how it began. My shoulder usually feels tight, but then one day I just couldn”t do push-ups anymore. ” This is an accumulation of insults causing tissue damage and eventual irritation and injury. This is often when a healthcare practitioner will give the advice to “rest”. However, I disagree on a case-by-case basis and you”ll see why later.
Pain: Pain is the emotional response to tissue insult, irritation, and injury. However, the emotional response is not dose-dependent on the insult. A huge insult can cause very little pain for someone; watch a Pro football game, those guys undergo a LOT of insult each game, but keep on rolling. A small amount of insult can cause a big emotional response. Watch a small toddler walk around and fall over. They fall perhaps six inches (toddlers have pretty short legs) and land on their butt. If alone they get up and keep moving, but if an adult sees them and rushes over asking if they”re ok (with fear in their voice) the child begins to cry uncontrollably. Three minutes later they return to their activity. The child underwent “pain” without much true insult. They had an emotional response to the discomfort.
In chronic injury there is always an amount of pain involved. The pain is derived from fear of always feeling discomfort, fear of not being able to return to their beloved activity, fear of surgical or medical intervention side-effects, and a whole host of other issues.
When dealing with chronic injury, we must always deal with the emotional pain aspects as well. Developing a sense of confidence in one”s ability to perform an activity without creating insult is of absolute necessity. I”ve dealt with a large number of back pain patients who are physically able to bend forward but have a great fear of doing it because it will create insult, irritation, and injury. However, thru intelligent progressions I am able to get these individuals to lift hundreds of pounds off the ground without issue during nor afterward, a great thing for injury prevention in the future!
Framework for progress:
- Good movements: The human body was built to push, pull, lift, squat, jump, and run. Insult to tissue occurs with every movement, good or bad; we heal at night and continue on. However, incorrect movements create MORE insult and therefore require MORE healing. By ensuring that the way each person lifts, squats, pushes, pulls, jumps or runs is correct we can minimize the insult of those activities and allow for faster, further, and more consistent progress.
- Better healing: By education on timing of activities, timing/portion/volume/types of foods, and nightly habits/patterns/rituals nearing night-time that can affect sleep we can improve how fast someone heals. This means a correct movement with minimal insult creates GREAT progress, and incorrect movements with more insult can still heal and leave us without irritation, injury, and pain.
- Intelligent work volume: Doing too much or too little of each movement can lead to greater insult. It can also lessen the healing that occurs each night. Our body heals with a reactive hormonal response to the activity we”ve done. Too much lifting relative to squatting can create a lot of insu< too much "cardio" relative to strength training can limit the healing response. AND doing more than your body is currently able to handle will create more insult, irritation, injury and pain.
- When to rest:Insult is damage that must be fixed. However, it may fix improperly unless we give it the correct stimulus. If a muscle partially tears, we have damaged a lot of little proteins called collagen. These collagen fibers can be replaced. If they are replaced in the right direction there is minimal remaining issue afterward. If they are replaced in the wrong direction we can have longer lasting problems (lasting until they are signaled to line up in the correct direction). How do we give them the signal? By using them correctly.
- If we insult our back by lifting something the wrong way, we can heal that insult by lifting it the correct way. If we insult our shoulder by pushing the wrong way, we heal the injury by pushing the correct way. Rest, or disuse, will only cause the healing to be incomplete and incorrect.
- If we are doing something correctly but too much of it relative to other activities we can create damage that way and resting the over-used activity is a good idea, temporarily.
- Why not to rest: If we rest completely from any activity, our body fails to produce the hormones that allow us to heal as we sleep at night. Complete rest will simply prevent the proper healing response from occurring as we sleep. If we have an injury, irritation that prevents us from continuing an activity, we must find OTHER activities that allow the proper response of hormones to get us to heal. Most often, strength training will produce a great healing hormone reponse and put healthy force through the damage to get it to heal correctly. We must then create a calm in the mind to sleep deeply and allow the process to occur.
Every client I work with has their own unique combination of the above issues. As such, it is my job to educate them on how to better balance their choices to create a healing environment and continue progressing towards better strength, fitness, health, and enjoyment of life!
Are you currently running too much for how strong you are while standing on one leg? Is the amount you squat to the ground comparable to the amount you lift from it each day? Is the flexibility of your ankles enough to allow a proper looking squat that keeps all of your joints safe? Do you perform the proper amount of strength training, cardio-respiratory work, meditation, and focus to ensure you”re strong enough to lift heavy things but won”t tire if you have to help a friend move? Do you eat foods that help you heal? Do you allow your body to calm as the afternoon fades to evening to get deep sleep? Are you comfortable with past choices leading to your present state, proud of your current position in life, and optimistic towards future progress?
Whenever you encounter your specific level of insult, irritation, injury, and pain you should ask yourself the above questions. In there you shall find the answer and correct path to continued development!