Strength Training: Working Around Pain

There’s a lot of interesting research around pain that’s beyond the scope of what we do here at Present Tense, but these academic battles will begin to inform how we approach injury in a strength training and yoga context. Our work isn’t in diagnosis and treatment, but given that we work with the human body we inevitably encounter people who are injured, experiencing pain, or both.

The guiding principle behind our work is to ensure that the injured person doesn’t get worse because of something we’re doing in our studio. Philosophically, this means not exacerbating any pain, of course, but it also means ensuring that the dancer doesn’t completely stop training. This might be as important as avoiding reinjuring damaged tissue because lack of confidence can potentially cause pain to linger long after the danger to the body has vanished. I want to be careful not to wade too deeply into the science here because I’ve not digested a lot of it, but I find passages like this to be compelling.

“There is compelling evidence that these adaptations do not necessarily resolve when the injury does, which rails the very real possibility that movement and interaction with peripersonal space will remain disrupted, and the pain production system will continue to be overly sensitive and responsible to situations that are in fact not dangerous.”

—Journal of Dance Medicine and Science (2017)

Returning an injured dancer to a training floor is not unlike long-term athletic development for young artists. The strength coach’s job is to carefully identify a training stimulus that will challenge and provoke adaptation while simultaneously lying within the range of the dancer’s capability.

For the adolescent athlete that might mean introducing a 2-to-1 box jump (jump off of two feet and land one foot) and drilling that movement for an entire month or more before introducing jumping from one leg and landing on one leg. By the time the young person jumps from one leg and lands on one leg, they’ll have gained the confidence that they can safely land on one leg.

In the context of injury, if you give a dancer something to do that lies beyond their capability, you might not re-injure them (unless you’re being really stupid), but you could diminish the confidence they have in their body. If you think about the excerpt from the pain review above, that alone could possibly be a harbinger of lingering pain. The danger to the body might be gone, in other words, but if the dancer lacks confidence in their strength, the pain might not be.

Maybe it’s obvious that you want to give a dancer progressive confidence in her injured ankle in the training space. You wouldn’t throw her right into single leg plyometric work over hurdles. But what might not be as obvious is even in the early stages of her ankle recovery, you want to give her challenges that make her feel STRONG. Does that mean loading the ankle? No. But it might mean an 8-rep max landmine press from a half-kneeling position (to avoid stressing the ankle). It might mean something fun and challenging like a hollow body hold in which she has to resist rocking as the coach pushes her legs or hands. It might mean prioritizing interval work on a HIIT-style bike. The point is to give the dancer something genuinely difficult to overcome that you’re confident they can do, then coach them and support them as they do it.

The difficulty of the exercise will turn their focus away from their injury, the work (if smartly chosen) will help them perform at a higher level, and the sense of accomplishment will give them a much needed win after the emotional setback of the injury itself.

Coaching isn’t just exercise selection and counting repetitions. It’s a relationship business. It’s a psychological business.

It’s a people business.

Assigning exercises is maybe the easiest part of all of it. But helping the person in front of you thrive as a multi-dimensional human being operating in what can be a judgmental and insecure world is really the work.