Listening to Your Instincts

Robert Rinaldi, DPM
Posted October 29th, 2008

Exploring pain has been on my agenda for several years. Pain can be a good thing, especially if it is heeded. Too often, we have learned to block pain out, and this is when problems can start to happen. My email in-box is always filled with notes and letters from readers and patients, and I do my best to respond to them all in some way. Recently, I received a letter from an athlete that sparked an urgent need not to just respond, but to get on in this monthly column with a small discourse about pain.
After three years of training in any aerobic sport, an athlete will begin to know a little about the sport and the human body that is being used to pursue that activity. Add another two years (five total) and the athlete will really know how far his or her anatomical “machinery” can be pushed. During these first five years, athletes will experiment with cross-training, nutrition, hydration, and rest. This is the time that the sport and competition becomes most interesting. Any athlete must know his or her limits to get through events to completion, with or without a competitive edge.
An athlete is a person who is exercising with purpose. The exercise must be routine in fashion, with the desire to take the body to its best performance. Walking, running, swimming, cycling, or any repetitive-motion sport requires the mind and body to work in harmony. These activities require an expenditure of energy that is measured and limited by the body’s ability to transport oxygen to all tissue. Failure to deliver will cause poor performance, compensations of motion, and perhaps injury.
Should participation in a sport produce pain? No, it should produce fatigue and that is not pain. An athlete engaged in aerobic sport becomes accustomed to pain. The mantra, “No pain, no gain,” is imbedded in every training session. However, aerobic activities produce endorphins that create feelings of well-being and block some pain. These signals can confuse the athlete, making it difficult to separate pain associated with injury from pain associated with the activity.
Clinically, injury to boney structures will cause an intensity of pain with activity. We can use a stress fracture in the foot or leg as an example. At the beginning of a training session, pain may be at 1 on a scale of 1 to 10; noticeable but not limiting motion in any way. As the session progresses, so does the pain level, until it eventually reaches 8, 9, or 10 on the scale and the session is stopped. Once stopped, the pain will begin to dissipate rapidly over several minutes.
have lost cartilage that produces smooth easy motion. Over time and with excessive use, joints often develop boney spurs that impinge on smooth function. An arthritic joint will initially be sore and stiff with exercise, but will gradually loosen with motion until it feels pretty good. Unfortunately, this sweet spot doesn’t last long and pain sets in with every movement until the session is stopped. At this point the joint will re-stiffen and freedom of motion is lost.
Interpreting pain associated with bone becomes a matter of listening to instincts. Paint a picture of an athlete who begins a training session feeling pretty darn good, but this feeling begins to fail after a short time and pain begins to intensify. The athlete needs to increase his or her consciousness and devote thoughts to the specific areas of pain. If the pain is ramping up, he or she may have an injury involving bone.
Ligaments, tendons, and muscles tend to respond to overuse injury with severe stiffness and pain after rest. As an example, the pain associated with plantar fascitis will be most severe in the morning, after a night’s rest. After a few minutes of movement, the fibers relax and discomfort retreats. There is a point of diminishing return with the painful soft tissues, however, and retreat of pain will have a short life. As demand from activity increases, the fibers will react with a release of jabbing painful cycles. The “No pain, no gain” principle applied to soft tissue will exacerbate injury. Here again, if it doesn’t feel right, it usually isn’t. Listen to your instincts.
The email that sparked this article came from an accomplished athlete with decades of sports stuffed in his training journals and gym bags. He wrote that his ability to get into “high gear” was lost. Last spring, this athlete cycled diagonally coast to coast. Then he spent the snowy winter pursuing another piece of his athletic repertoire, cross-country skiing. He is an accomplished skier, runner, and hiker, and has engaged in sports for more than 40 years. He knows his body’s machinery, but was confused by his inability to hit “high gear.” Was this natural with his advancing age? His health is excellent, but his instinct told him to question the problem. He queried his healthcare providers. He had no pain but was experiencing a slight and subtle pressure in his chest. His complaints were taken seriously by a cardiologist and appropriate tests were ordered. The result was a stent implant in an artery on the left side of his heart. After a very short stay in the hospital and some time at home recouping, he was allowed to return to all activities and told he could hit high gear. He could even hit
Listen to your instincts and be persistent about bringing, complaints, no matter how subtle, to healthcare, professionals.
Robert Rinaldi is a board-certified podiatrist and podiatric surgeon at the Gifford Medical Center in Randolph, VT. He is a fellow and a founding member of the American Academy of Podiatric Sports Medicine, and a podiatric consultant to the Dartmouth College track and cross-country teams. He is a former nationally ranked long-distance runner, having competed in 25 world-class marathons. You can reach him at Gifford Sports Medicine and Surgery Clinics in Randolph, VT, or at the Sharon Health Clinic in Sharon, VT, 802-728-2490 or 802-763-8000 or at [email protected].