pain science – ROCKSHOULDERS

The amount of pain that’s okay to experience when training depends on 4 factors: Where you feel the painWhen you feel the painWhat type of pain do you experienceWhat type of exercise you’re doing With this information, you can judge your pain as either acceptable for the moment, or as an alarm signal which needs to be understood. To help you in this process I’m first going to discuss the nature of pain, which types of pain you may experience, and how to rate your pain intensity. Next, (with this information in the back of your mind), I’ll explain the 4 factors that influence pain acceptability. All together this information will help you make solid judgment calls on how much pain is okay when training for rock climbing. Ready to understand your pain? Let’s go! 1. What is Pain? Pain is an unpleasant sensory and emotional experience associated with or resembling associated, actual, or potential tissue damage.1 That’s a mouthful, isn’t it? So, let’s have a look at what this means for you. Pain is subjective and personal. Meaning that everyone feels pain differently. You cannot compare your pain to someone else’s. Because pain is influenced by biological, psychological, and social factors. In research where the pain thresholds of 40 Israeli army veterans were tested, the results showed that veterans who previously suffered severe traumas were able to better tolerate pain than the ones that got milder injuries in the past.2 This means that not only present biological, psychological, and social factors play a role in your pain perception, but also past experiences. This underlines the fact that we, humans, learn our concept of pain through life experiences. Thus, pain doesn’t need to have a direct connection to tissue damage. The amount of nociception (alarm signals coming from your nerves) has no direct correlation to the amount of pain you experience. The bottom line for you as a climber is therefore that you need to discover for yourself how you perceive pain and how this relates to your training. Luckily though, I can give you some direction as to how to start evaluating your pain. Some are very straightforward, others more abstract. Let’s start with which types of pain exist. 2. Which types of Pain Exist? There are roughly 3 types of pain: Nociceptive pain is pain that arises from tissue damageNeuropathic pain is pain that arises as a result of damage to the pain system (nervous system) itselfOther pain, is (all the other) pain that can’t be attributed to category 1 or 2 Nociceptive pain can often be influenced by changing load, movement, and position. Meaning that if you strained a pulley ligament in your finger you might be able to reduce the pain by not using the finger, or using it differently. Typical forms of nociceptive pain are the pains you feel when your skin gets thin after climbing a lot, holding on to sharp edges, when your muscles are sore, when you subluxate your shoulder, or when you strain a pulley ligament. Neuropathic pain can be caused by direct damage to nerves, pinching of nerves, or disease processes like multiple sclerosis. As a climber, you might experience neuropathic pain as a consequence of an accident like hitting your elbow against rock. Or due to a condition like carpal tunnel syndrome, where the median nerve passing through the carpal tunnel in your hand gets “stuck”. Other pain includes pain originating from musculoskeletal problems. In my day-to-day practice, this pain is often the cause of my patients’ discomfort. There’s no tissue damage but still, they’re experiencing pain. This can be due to trigger points, muscle imbalances, or movement disfunction within joints. A typical example of this is back pain due to lack of movement within a facet joint (the joints between separate vertebrae). A mobilization with an impulse of this joint, commonly called “cracking” your back, maybe all that is needed to make your pain go away. 3. Is Something Broken when you feel Pain? When you feel pain, it doesn’t necessarily mean that something is broken. This depends on the onset of your pain, other symptoms at the site of your pain, and your history with it. Also, something I didn’t mention when I discussed the 3 types of pain is that there are other ways to categorize pain. One of them is to categorize pain as either fast or slow. Fast and slow pain refers to the speed with which the pain signal is realized in your brain and to which nerve types are used to send the message. Fast pain is delivered via highway-like A-type nerve-fibers and slow pain is delivered through provincial road-like c-type nerve-fibers. Fast pain is acute pain and tells you to stay away from what provoked the pain. Like crimping onto a razor-sharp edge or when you twist your ankle swinging onto the rock face after a big fall. Slow pain, on the other hand, tells you to consider yourself until the origin of your pain is healed. This is the type of pain you feel in your feet after wearing your climbing shoes too long, or when you’ve been forcing your shoulder by climbing too often over the previous weeks. So, if you’re experiencing fast pain the chance that something is broken is higher than when you experience slow pain. 4. How to Rate your Pain Intensity? The easiest way to rate your pain intensity is by giving it a number from 0-10. Where 0 is no pain at all and 10 is the worst pain you can imagine. This system is called the Numerical Pain Rating Scale (NPRS) and is often used by healthcare professionals. I often ask my patients “How painful is this activity on a scale from 0-10?”. Another way to rate your pain intensity is by using the Visual Analog Scale (VAS). In this case, you have a piece of paper showing the image below. Then you point at the number which represents your pain best. This is a rating system often used in healthcare as well. It’s more reliable than the NPRS but you always need to “carry” your VAS with you. Image taken with courtesy from Greatbrook For you as a climber wanting to evaluate your pain, I think it’s best to write your pain intensity down. This makes it a lot more reliable than a floating number in your head. Besides avoiding forgetting something you never wrote down you’ll start to see patterns in the amount of pain you felt at which moment. This brings me to my next point, just writing down your pain intensity is insufficient. To make more sense out of it, I propose you write the following information down well: A description of the pain sensationWhich movement you made when you felt painHow long the pain stayedIf there was anything specific that made the pain worse/betterAt what moment you felt the pain With this information, you can rate your pain and find patterns that might increase or reduce your pain. Now, let’s have a look at how much pain is okay when training for climbing. 5. How Much Pain is Okay when Training for Rock Climbing? Pain intensity of up to NPRS 6/10 and of a slow character is acceptable, as long as it subsides as soon as you stop climbing and as long as it’s not recurring for prolonged periods (>1 week). Below I’ll discuss in more detail each aspect of experiencing pain while rock climbing. 5.1Where Do You Feel Your Pain? The site of your pain is essential information for determining its origin. If you’re experiencing fast, acute pain, the site of your pain gives you reliable information. If your pain is of a slow character the site of your pain is less reliable. As things go, slow pain can also be referred pain; pain coming from a different place than where you feel it. Referred pain is common in neuropathic pain but it is then fast. If you feel fast shooting pain down your arm or anywhere else in the body it’s time to take a break and figure out where it came from. Otherwise, referred pain can be caused by trigger points as well. These hard tense knots within your muscles have familiar referred pain patterns and can easily be found by a physiotherapist, general practitioners (often), or by yourself. Sometimes you feel where the referred pain “starts”. If you start pressing in the muscles around you might be able to find hard taut bands that provoke the pain that’s bothering you. Thus, you either feel pain where the origin of the pain is or at a location that corresponds with a familiar pattern. 5.2 What Type of Exercise Are You Doing? Depending on the type of training you’re doing the chances of experiencing pain vary. If you’re climbing easy routes in a slow controlled fashion, the chance of pain is little. Because you’re not pushing your body to the limit. If you’re climbing at your limit, doing campus exercises, or any other exercises that are at the limit of your capacities, the chances of experiencing pain increase. You might start feeling a burning sensation in your muscles, a pump in your forearms, strain in tendons and ligaments, or tension in any of the muscles you’re using. If you’re experiencing pain during relaxed exercise, you should question it more than during hard efforts. Because in the former situation pain wouldn’t be expected, whereas in the latter it would. 5.3 What Type of Pain Are You Feeling? I have mentioned 5 types of pain so far. Nociceptive, neuropathic, and other pain on the one hand and fast and slow pain on the other. Neuropathic pain should never be part of any exercise. Its “lightning”-like and shooting type of pain will force you to stop what you’re doing. Please don’t ignore this message. This is also true for all other types of fast pain. If you experience pain with a quick onset, take a break and evaluate. Only when you’re sure you’re not making things worse by continuing training, you can continue. If you’re experiencing slow pain at an intensity of no more than 6/10 during training which subsides right after, that’s ok. Important to remember in this case though, if the pain keeps coming back for more than a week after you initially felt it, figure out why that’s the case. 5.4 How Long Do You Plan to Continue Climbing When You Feel Pain? If you feel pain at the beginning of your training session your response should be different from when it’s at the end. You’re less likely to experience pain at the beginning of exercise than at the end. Thus, if you feel pain when you start climbing make sure you understand why. If it is at the end of a session, it’s more likely to originate from fatigue and overload. This is to be expected and shouldn’t worry you as much. Nevertheless, the pain shouldn’t return for longer than a week. If that’s the case, figure out the origin. 5.5 Can You Move Around Your Pain? If pain is movement-dependent you might be able to move around it. If your finger is hurting you might reduce the pain by taping it, or if your muscles hurt you might be able to reduce the discomfort by warming up well and training at a lower intensity. It’s important to remember though if you want to move around your pain you need to know its origin specifically. Because if you manage to move around an unknown pain that doesn’t mean you’re not making it worse. Moreover, moving around pain should always be done with quality movements or by just leaving certain movements out of your climbing repertoire. Simply put, sacrificing climbing quality is never an option (except when it’s the difference between winning or not at the Olympics). 6. How Much Pain is Okay: A Quick Recap As you’ve read there are many aspects to pain and not all of them are as easy to pin down. This abstractness of pain is further increased by the fact that pain is different to every single one of you. Nevertheless, here are the most important take-aways of this article: If you feel fast, sharp, shooting pain; stop what you’re doing. And figure out the reason for your pain.If you feel pain during light and easy exercise or at the beginning of your training, figure out where it comes from.If you feel pain at the end of intense training or during intense exercise it’s okay to continue as long as the pain doesn’t go above 6/10 and is of a slow character.If you know the origin of your pain you can think of strategies to climb and train around it. But only if it doesn’t worsen your pain in the long term. 7. Sources & Citations 1. Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. doi:10.1097/j.pain.0000000000001939 2. Dar R, Ariely D, Frenk H. The effect of past injury on pain threshold and tolerance. Pain. 1995;60(2):189-193. doi:10.1016/0304-3959(94)00108-Q