Do your clients regularly come in for their workouts complaining of back, knee, hip, shoulder or neck pain? Do you have to alter your own fitness program, or adapt those of your clients, to avoid stressing body parts that constantly hurt? You and your clients are not alone. It is estimated that over 100 million Americans suffer from ongoing aches and pains (Thernstrom, 2010). The body has an innate capacity for healing, so it seems strange that so many people suffer from pain that extends beyond the normal healing period. Why does pain disappear in one area of the body only to resurface as a new problem somewhere else? This article will explain some of the most common physical and mental causes of musculoskeletal pain. It will also provide direction for fitness professionals to help both themselves and their clients break free from the cycle of recurring muscle and joint pain.
- Readers will learn how structural imbalances can cause recurring muscle and joint pain.
- Readers will learn how myofascial restrictions can cause recurring muscle and joint pain.
- Readers will learn how clients’ mental attitudes to pain/injury can lead to recurring muscle and joint pain.
Common Causes of Muscle and Joint Pain
There are many causes of muscle and joint pain that may be either physical or mental in nature. The purpose of this article, however, is to highlight only those problems that a fitness professional is qualified to handle. Remaining firmly within the scope of practice, and referring out to licensed health professionals when medical intervention, treatment and/or diagnosis is required, will enable trainers to better assist their clients and serves to elevate the status of personal trainers in the health and fitness industry (The American Council on Exercise, 2010).
Fitness professionals realize that the bony structures and soft tissues of the body are inherently interconnected (Kendall, 2005; Rolf, 1989; Myers, 2008). However, a more profound understanding of these concepts can provide additional insight into why people continually suffer from recurring aches and pains.
Past and current injuries, habitual movement patterns/activities, work environments, postural habits, degenerative changes and disease all cause the bony structures of our body to adapt and change to the stresses placed upon them (Price & Bratcher, 2010). Adaptations/imbalances in one area of the body not only cause problems for that body part, but can lead to compensations and imbalances elsewhere in the kinetic chain. Here is an example. One of the most common structural imbalances is overpronation of the foot and ankle complex. This imbalance is characterized by excessive motion of the foot and ankle collapsing toward the midline of the body (Kendall, 2005). Habitual overpronation can cause excessive wear and tear to both the joints and connective tissue (i.e., tendons, ligaments and fascia) of this area and lead to inflammation of these structures. Over time, this localized inflammation will limit movement of the foot and ankle. This will subsequently impede their ability to help transfer one’s body weight from side to side during weight bearing activities. As a result, structures above the foot and ankle such as the knee, hip, pelvis, spine, shoulder girdle, head and neck will have to compensate for the lack of range of motion in the foot and ankle.
As you can see, the compensation patterns caused by the initial imbalance are far-reaching and can lead to recurring pain and inflammation in multiple areas of the body. The ability to identify the major causes of joint pain, and to prevent it from either occurring in the first place or returning repeatedly, is a must-have skill for fitness instructors and personal trainers. Utilizing systematic assessments during initial consultations will enable trainers to identify any bony structures of the body that are either misaligned, immobile or not functioning as they should (Price & Bratcher, 2010). Incorporating structural assessment strategies at this stage of working with clients ensures that any imbalances are noted and addressed with appropriate corrective exercise strategies before progressing to the more dynamic activities of a regular exercise program.
Recurring aches and pains can also result from restrictions in the myofascial system. Structural imbalances, overuse, past surgeries, injuries, nutritional deficiencies, genetics, handedness and activity choice are just a few of the things that can lead to such restrictions (Rolf, 1989; Myers, 2008; Petty & Moore, 2001). The interconnectedness of the body dictates that when soft tissues become damaged or unable to perform their jobs correctly, other myofascial structures must work overtime to keep the body functioning in whatever tasks it demands (The American Council on Exercise, 2010). For instance, myofascial restrictions are common in the gluteus maximus muscle. Restrictions in this muscle prevent them it working optimally which can eventually lead to any number of dysfunctions (and accompanying pain) in the other soft tissue structures of the posterior hip. Here’s an example of what can happen. The gluteus maximus is required to work to decelerate movements of the spine, pelvis, hip and leg during all weight bearing activities. However, if it is not working correctly due to myofascial restrictions, then the smaller hip rotator muscles (i.e., piriformis, gemellus superior, obturator internus, gemellus inferior, quadratus femoris and the obturator externus) are sometimes unwillingly recruited to perform the roles that the gluteus maximus can no longer handle. However, these smaller muscles are not designed for this increased load. Consequently, they can become inflamed and/or irritated and cause pain and further dysfunction to not only the lumbo-pelvic-hip girdle area as a whole, but down the legs to the feet in the form of referred nerve sensations.
If this dysfunction of the gluteal muscles persists, the pelvis and hips can become unstable, causing further problems in the feet, ankles, knees, spine, shoulder girdle, head and neck. Ultimately these complications can lead to constant and/or recurring pains in these areas. To help identify issues and/or mitigate the effects of myofascial restrictions, you can use the results of your structural assessments to direct you to the muscles and other soft tissues that originate or insert on the bony structures that you have found to be out of balance. This will enable you to identify specific soft tissues that may need addressing with myofascial release exercises. This information can be used to direct homework strategies that focus on those areas of your client’s body that need remedial help. Implementing such corrective exercise assessment and program design elements helps you catch muscle and/or movement dysfunctions early before they become complex and far-reaching problems.
While it is obvious that the physical structures of the body are interconnected, fitness professionals sometimes overlook the role the mind can play in causing ongoing musculoskeletal dysfunction. However, by learning to recognize those mental habits that contribute to recurring pain, trainers can communicate more effectively with clients (and also help themselves) to design long-lasting pain relief exercise programs.
Emotions and Thoughts
Everyone has experienced the physiological changes that occur in the body as a result of mental stress. For some, the thought of speaking in front of a large group of people causes their heart to race, stomach to churn and blood pressure to increase. For others, the thought of asking someone they are attracted to out on a date may cause them to break out in a rash, disrupt their sleep patterns or give them a dry mouth (Rankin, 2013). No matter what scenario triggers these stressful reactions, the source of the distress experienced is the same for everyone. It is our emotions, and the thoughts that accompany them, that bring on the physiological reactions.
These emotions and accompanying thoughts are created by our past experiences and future projections about certain events. For example, if a client has experienced an injury or long-lasting muscle/joint pain in the past, then they are more likely to create thoughts and emotions of anxiety surrounding any new injuries or aches that might develop. This is because they believe, based on their past experience, that any new musculoskeletal pain is going to take a long time to heal. Furthermore, these past experiences may cause them to project feelings of fear into the future believing that this new injury or pain will prevent them from reaching their ultimate health and fitness goals. As such, your client’s past experience and future projections in regard to pain and injuries can trigger even more stress and an increase in physiological symptoms (Ozanich, 2014).
While it is not appropriate for fitness professionals to attempt to address a client’s emotional health issues, they can use their position of trust to influence clients’ mental reactions to muscle and joint pain. Being more cognizant of the way they utilize and convey the results of their structural, myofascial and movement assessments can decrease their client’s current feelings of pain and lessen the likelihood that future symptoms will occur. For example, a trainer who specializes in corrective exercise may typically focus attention on all the imbalances a client presents with and continually search for dysfunction throughout sessions to highlight during current or future workouts. However well-intended, this strategy only serves to increase client anxiety by placing unnecessary focus on their past/current injuries and fueling negative thoughts about future physical capabilities. A more effective method for communicating program components to clients concentrates on shifting the focus from what is wrong with their bodies to a more positive approach that identifies corrective exercise strategies that can be implemented to create safe, effective and fun workouts. Approaching pain-relief programming in this manner decreases client anxieties about moving, reduces the likelihood for pain/injury, increases their confidence in being more active and finally puts an end to their merry-go-round of pain.
Recurring muscle and joint pain is a widespread phenomenon. Fitness professionals can help break the cycle of pain by incorporating strategic musculoskeletal and myofascial assessment protocols into their client programs. The results of these assessments can then be used to identify specific corrective exercise strategies to reduce pain as well as to motivate clients to feel empowered about improving and increasing their physical capabilities.
American Council on Exercise. 2010. ACE Personal Trainer Manual (Fourth Edition). American Council on Exercise.
Kendall, F.P. et al. 2005. Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore, MD.: Lippincott Williams & Wilkins.
Myers, Thomas W. 2008. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists (2nd edition). New York: Churchill Livingstone.
Ozanich, Steven. 2014. The Great Pain Deception. Ohio: Silver Cord Records.
Petty, N. & Moore, A. 2001. Neuromuscular Examination and Assessment: A Handbook for Therapists. Edinburg: Churchill Livingstone.
Price, J. & Bratcher, M. 2010. The BioMechanics Method Corrective Exercise Educational Program. The BioMechanics Press.
Rankin, Lissa. 2013. Mind Over Medicine. Carlsbad, CA: Hayhouse.
Rolf, Ida P., PhD. 1989. Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-Being (revised edition). Rochester, VT: Healing Arts Press.
Thernstrom, Melanie. 2010. The Pain Chronicles. New York: Picador.