Improving Chronic Muscle Pain

By Tom Toth, Movement Specialist & Fitness Expert May 11, 2022

EVERYBODY HURTS… MOST OF THE TIME?

As a fitness trainer that focuses on helping people with injuries, it is clear to me that many of us have chronic aches and pains in our muscles. Obviously, it could be confirmation bias at play, but there is no question in my mind that many of us suffer from some type of irritating muscle pain that won’t go away. Maybe it’s that annoying, painful pinch between your shoulder blades that flares up whenever you sit too long, or a hamstring injury from running that won’t stop hurting even though you have been babying it for months.

I am also dealing with a chronic injury. Six months ago I overloaded one of my rotator cuff muscles, and it is still bothering me. I have finally taken the time to work on fixing it, and it is getting better. Here I want to give you some tips that I’m using successfully to improve my chronic shoulder issue. This is for all of you who have pain that’s muscular in origin and does not want to go away on its own.

LET’S TALK PAIN

Why do some injuries never seem to get better? The strange thing is that they do get better in the sense that the injury itself heals after a few weeks or months. The problem is that the site of the injury does not stop hurting when it should. Pain initially develops to tell us not to use a damaged body part so it does not become injured further. However, the pain receptors near the site of an injury often become extremely sensitive to pain stimulus, much more so than they need to be, a process known as sensitization. Overcoming this sensitization is an important step in making the pain go away. So how do we do that?

Step 1: Be Positive!

The good news is that 95% of muscle pain eventually goes away. Staying optimistic about your particular situation is very important because studies clearly show that a negative mindset significantly impacts all pain. If you say things like “my back will never get better” to yourself, well, it might not get better. I find that the biggest way to boost positive thinking about pain is to do something about it. Being proactive about your pain is the best way to approach the issue. The next few steps are a good way to do that.

Step 2: Avoid Re-injuring the Muscle

Repeatedly injuring the same area is a common issue for a lot of people. The painful pinch between your shoulder blades isn’t going away because you still sit for 14 hours a day, and that achy, tight hamstring isn’t improving because you haven’t reduced your weekly running mileage. One of the main reasons my rotator cuff hasn’t improved for so long is because I often end up sleeping with my arm overhead, sometimes tucked under my pillow. This position puts the

rotator cuff in a strained position, and while it was fine to sleep like that when my shoulder was healthy, my damaged muscle can’t handle it. Avoiding this arm placement was a critical step in my rehab plan.

If you suspect that a particular activity is causing or exaggerating your pain, take steps to avoid it while your muscle recovers. If certain habits, such as sitting too much or sleeping in a certain position are causing the damage, then making changes for the long-term may be necessary. If your pain is exercise-related, reduce the movement or modality that is causing the problem in the near term. This will help you get back to your fitness routine pain-free in a few weeks.

Step 3: Exercise (in General)

Here’s some good news: exercise helps with muscle pain. It’s that simple. I’m talking about all kinds of exercise for all kinds of muscle pain. The exception is anything that specifically causes pain. For example, my rotator cuff yells at me very loudly if I do a bench press. Therefore I don’t bench press. Push-ups of various types achieve the same result of exercising my chest and shoulder muscles, without any pain during or after my workout.

Similarly, if running hurts, substitute it over the short term with cycling, swimming, skipping rope, circuit training, yoga, or anything else that allows you to stay in shape without aggravating your injury. The good news is that studies show that we don’t lose fitness very fast. You can not run for a month and barely lose any conditioning, especially if you do other types of exercise. Strength training is always a good idea, and a routine that focuses on a combination of strength and mobility using free weights or your own body weight is best.

Step 4: Exercise (Specifically for the Injured Area)

You can even go to a physiotherapist or trainer and get an exercise routine to help with your injury specifically. Maybe your hips are super tight, which contributed to your hamstring issue, or a muscle imbalance is contributing to your hockey groin. Downtime from injury is a good time to work on your weaknesses, not just to fix your pain but also to prevent it from coming back in the future. I also believe in working on the injured area directly and slowly strengthening the damaged muscles. There is definitely some controversy over this in the rehab world, but I firmly believe that a painful muscle that has been sore for months has likely healed and is ready for some work. For example, my rotator cuff pain is steadily getting better since I have been working on strengthening it. I started extremely light: just lifting a 1 or 2 lb weights about 10 times every other day. I have now progressed to using 8 lbs and the results are very positive.

Research indicates that the most significant positive effect of direct exercise is not increased strength, but decreased sensitivity. You are exposing healed tissue to stress. You are essentially teaching the brain that using that muscle is OK and that it can let go of the pain. Again, this sort of exercise is very particular and controlled, so I urge you to find a good clinician who can design a program for you and show you how to do the exercises safely. You will also need to know how to progress the routine.

Step 5: Sleep More and Eat Better

Inflammation is a big part of pain, and controlling it can really help make a difference. The best way to do that is to make sure you get enough sleep and that you eat well. If you need help with sleep, try reducing your caffeine or alcohol intake and eliminating screen time at least one hour before bed. Eating well to control inflammation is not that complicated: less fried and processed foods, more veggies and fruits.

Supplements may also help. I don’t take too many of them, but there is interesting research on vitamin D and pain. It seems that many chronic pain sufferers have low vitamin D. The relationship is still murky, but since vitamin D is a very important nutrient with hundreds of roles in the human body, supplementing with it is a no-brainer.

The other supplement I like for pain and inflammation is omega-3 fatty acids. They are strongly anti-inflammatory and just like vitamin D, they have many important functions in our biology. Most people tend to have a low intake of omega-3s. However, before starting any supplementation, talk to your doctor.

EVERYTHING WORKS TOGETHER

It’s important to note that all these steps I’ve just mentioned are synergistic. For example, letting your injury heal by avoiding situations that cause pain allows you to exercise more. Sleeping better and eating healthier helps you feel great, which, as I mentioned, is critical to feeling optimistic about your pain. Being rested also makes it easier to move more. All these things require a plan, though. If you’re tired of living with nagging pain, sit down and come up with a plan to make it better using my tips above as your guide. Make sure you consult a physiotherapist or trainer for the exercise portion of your plan!

Tom Toth is a strength coach, movement specialist and fitness educator from Toronto, Canada. Since graduating from the University of Waterloo in 2003, he has dedicated his career to making people move better, feel better, and live better. His primary specialties are helping people with injuries and medical conditions, as well as training high-level athletes. His website is tomtothfitness.com
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