Pain Modulation in Strength and Physique Sport Athletes


Demand is coming-Are you ready?

Nicholas M. Licameli, PT,DPT

What do bodybuilders, powerlifters, Olympic weight lifters, strongmen/strongwomen, and crossfitters all have in common other than a love for the Iron Game?  They will all likely feel pain at some point.  In fact, it is hard to imagine an athlete going through a career and never experiencing some sort of pain.  After all, pain is a normal human sensation just like hunger or thirst.  One of BFR’s greatest areas of impact is the management of pain and injury.

First, let’s briefly talk about pain and injury.  This is an excerpt from a previous article of mine titled, A Guide to Injury Reduction and Management, which can be accessed right here.

Injuries, like pain, are multifactorial, poorly defined in the scientific literature, extremely variable from activity to activity, and rarely are simply due to a single traumatic tissue-damaging event.  One of the most impactful ways to reduce injury lies in our ability to manage the balance between load and capacity…and that is where a qualified healthcare practitioner, like a physical therapist, can help.  Workload management is the management of the load we expose ourselves to and our bodies’ capacity to recover from it. 

In order to gain a better understanding of how to properly monitor workload, let’s quickly define load and capacity.  Load includes physical stress such as miles ran, weight lifted, daily step count, duration of a sporting bout, and gardening/yard work.  Capacity is impacted by things like sleep quality/duration, mental stress, anxiety, depression, prior beliefs, expectations, past experiences, illness, training age, muscle strength, endurance, bone density, tendon resilience, skill, coordination, comorbidities that impact recovery such as diabetes, preparedness for a specific activity, and mental resilience.  

After ruling out red flags, we approach pain and injury by gradually exposing the body to the edge of discomfort to desensitize the system to the desired movements while maintaining a training effect.  It is here where BFR truly shines.  The goal is to find a pain-sensitizing variable such as load, volume, RPE, range of motion, exercise selection, sleep quality, stress management, hydration, recovery, etc., then offer modifications to keep the athlete training as close to the desired level as possible.  Once we load and train the system with the modifications in place, we slowly progress back to where we want to be, in a stepwise fashion.  As we modify training variables, we are likely forced to sacrifice adaptation to some degree.  However, BFR helps maintain a training effect while modifying around pain and injury!  Basically, it allows us to achieve a minimum effective dosage at volumes, loads, and intensities that would otherwise be insufficient.  

Not only can BFR help with training around injuries, it may also have implications in the short-term modulation of pain.  There appears to be a pain-reduction effect following a bout of BFR training, which allows for a window of opportunity to use loads that would otherwise reproduce pain.  In this instance, BFR becomes a bridge to heavier loading, which in my opinion, is the most significant effect of this training method.


****Remember, the use of BFR training should not be based solely on a success story.  The decision to use BFR, or any treatment for that matter, should be based on the pillars of evidence-based practice.

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