For people with chronic pain, it's important to identify muscle dysfunction and imbalances. Fixing dysfunctional muscles and muscle imbalances can be an arduous process. It's a process that requires you to identify weaknesses and dysfunction and then do the right movements to build strength at every length. (You can learn how to identify muscle dysfunctions here and how to fix muscle imbalances here).
Whether you’re going through the process alone or with the help of a coach or therapist, one thing is almost guaranteed: you’re going to have moments of pain. You’ll have pain flare-ups.
You may have trouble moving around your home. You’ll wonder if what you’re doing is the right thing...You may fall into despair.
Before you give up on fixing your own body and surrendering yourself to a life of numbing medications, endless internet research, or the modern quackery that is orthopedic surgery, read the rest of this article first.
First, let's be clear. The most important step is to stay calm and try to identify what caused the flare-up.
Once you identify the factors that led to your pain flare-up, you can make adjustments to how you train. Training your muscles with the right movements and addressing the root causes of pain flare-ups will help you become a human that moves right and feels right.
Now let's address a crucial question when fixing pain...
When you're in the middle of a pain flare-up, it's easy to get discouraged. You'll want to give up and call someone to give you pills, a shot, or an invasive surgery.
Before you jump to that, remember three things.
First, discomfort is temporary. You can shorten the duration of the pain flare-up if you can quickly identify the cause and begin to address the underlying issue.
Second, rushing to a quick-fix treatment rarely works in the long run. Relying on "treatments" where someone allegedly fixes your body is a disempowering strategy for chronic pain with a high failure rate.
Third, pain does not mean you're damaged. People often think "If I'm hurting, I've damaged myself." This creates needless fear and anxiety. Medical doctors often amplify this fear and anxiety by connecting pain with "damage." You then start to worry that you are so damaged that you NEED someone to be your savior.
While pain CAN mean something is damaged, pain does not necessarily mean something is damaged.
Pain sometimes has to do with damage, but pain and damage are NOT linked as tightly as you think. Pain CAN be a sign that something is damaged but it can also mean NOTHING. Sometimes, pain is linked to damage but oftentimes it is not.
Take, for example, this woman who sent me an email years ago. She was diagnosed with avascular necrosis of the femoral head. The head of her thigh bone was chunked up and clearly damaged. Her pelvic bone was jammed into an indentation in her femoral head.
She was unable to move her hip joint. She limped as a result. The limping caused her lower back pain. She consulted with multiple surgeons about hip replacement so she would no longer have to limp.
Still, multiple surgeons said, "No!" to the surgery.
Because she had ZERO PAIN IN THE HIP JOINT.
The surgeons told her that they did not want to do the hip joint replacement because she had no hip pain. She had a clearly damaged femoral head that no longer allowed for any articulation at the hip joint. The femoral head was DEFINITELY damaged.
But zero hip pain. This is a clear example of how pain and damage can be dissociated. It's also a clear example of why looking at an X-ray is unreliable for finding the cause of pain.
Pain can be useful and have nothing to do with immediate damage. It can be a helpful advance warning so you don't end up with damage in the future.
Let's think about times when you get pain signals that are a natural and helpful part of life.
If you don't eat for twenty-four hours, you'll get aches and sharp pains in your stomach. That doesn't mean you've seriously damaged yourself. Your stomach is trying to tell you that you aren't getting enough food! If you go several days without eating, you will definitely experience more discomfort in your stomach.
None of this means you're permanently damaging yourself. There's no need to consult a gastrointestinal surgeon. You need to do some basic maintenance! You need to eat!
Likewise, if you find that your muscles are aching and giving you sharp pains, it does not necessarily mean they are damaged.
In fact, muscles that are starved of motion and challenge for even a few weeks will ache and complain. Starve muscles for months and years and they will give you chronic and recurring pain signals just like your stomach would! This is how you end up with "tight muscles" that never relax.
So when you have pain, don't let it fill you with fear and anxiety. Stay calm and start looking for the maintenance work you may have overlooked.
Pain rarely means you're severely damaged or injured.
We're going to cover some specific training issues as well as some pain causes that are not directly tied to exercise.
These are some of the most common factors that I have observed lead to pain flare-ups. I'm going to provide strategies to address these issues as well. All of these observations and ideas are based on personal and professional experience with thousands of clients and online students since 2008.
Whenever you train a muscle, you’re going to experience a temporary reduction of extensibility of the muscle. You'll experience soreness. This is true for any muscle of any condition anywhere in your body. If you challenge a muscle enough beyond its current abilities, you’ll have a short-term loss of range of motion and get the sensation of soreness in the muscle itself.
This is normal. This is your body telling you to take it a little easier and not push it too hard.
Many people have experienced muscle soreness in large leg muscles or in their calf muscles after running. This type of soreness tends to feel manageable.
But the soreness and stiffness in some muscles can get debilitating. This makes you fear the worst.
Here’s a common scenario: you have weak hamstrings. You do three sets of a hamstring exercise.
Single-Leg Hinge for your Hamstrings
The next day you can barely walk. Your knees feel sore. The bottom of your butt feels sore. You can barely straighten your knees.
Is this a sign that you’ve done the wrong exercise? That you’ve horribly injured yourself? That you need to see an orthopedic specialist to cut your tendons and shave your bones?
Your hamstrings are giving you a warning signal that they are in a temporary fragile state. They are stiff (unable to lengthen). They are weaker than usual because you worked them hard enough to require some repair and regeneration time.
You’ve just made them do work they’ve not done in years (or decades). Even though the after-effects feel crippling, they are temporary. Just stay calm.
Some stretching, massaging, and more movement to restore range of motion will help your brain and body normalize the new levels of exertion.
Stretching and massage restore length to shortened muscles. Muscles that are stuck short (i.e. stiff) don't work well. This limits joint range of motion and can lead to pinching and jamming sensations around the joint. Restoring length helps restore some strength. In addition, massage helps move fluid in and waste out of the soft tissues.
More movement may sound completely counterintuitive and counterproductive. However, I know many people experience a reduction in soreness and improved range of motion after light movement sessions.
A light movement session doesn't mean you maximum effort contractions. Instead, I'm suggesting gentle movement that restores and retains range of motion. It means you keep gently moving to maintain range of motion. This doesn't work for everyone all the time, but many people will find it effective.
If you consistently ask your body to perform, it will eventually meet your expectations.
This is the same strategy that works for people who want to acclimate to weeks-long hikes like the PCT. First, you start off REAL sore. After a few weeks of constant movement, the muscles adapt and no longer get so sore.
Contractions help the muscles move blood and fluid around. It's a big part of circulation in your body! If you've got waste products hanging out in your muscles, contracting muscles helps move that out. It also keeps your brain talking to the muscle and establishes better communication lines with dormant muscles. The more your brain and muscles talk, the more accurate a sense of the muscles you'll have.
The ability to feel parts of your body is called "proprioception." Having good proprioception will improve coordination, strength output, and your quality of life. An extreme example of poor proprioception would be when your leg falls asleep. You go to stand up, and you cannot feel or use the leg.
The positive end of proprioception would be a dancer or other athlete who can accurately track any part of her body in space. She wants her right thigh to be at exactly 47 degrees relative to the torso while the left arm is exactly 15 degrees away from the torso and the head tilted slightly back and to the left... None of that would be possible without perfect proprioception. And that perfect proprioception leads to better performance overall.
If you aren't an athlete or dancer, you still need to practice feeling and using your muscles so you can learn your limits AND protect yourself when life throws you ice or banana peels on sidewalks.
A special note on the hips: A stunning level of soreness can happen ALL THE TIME when retraining hip muscles. Because the muscles of the hip are an intricate network, soreness can get scary with new hip exercises. A simple hip exercise that targets deep, small hip muscles can result in crippling soreness. But that still doesn't mean you're permanently damaged.
Muscle dysfunction of any kind in the hips can cripple your ability to walk. Your hips may hurt in a "deep" spot. Your knees may hurt. Your back may hurt. Even your feet may hurt. The key again is to stay calm and pay close attention to the activities that cause the flare-ups.
Massive soreness can also happen with shoulder, spine, chest, back, ankle, foot, muscles etc. so don't be surprised if you get crippled by new exercises there as well.
When crippling soreness strikes, look for cause-and-effect relationships. Identify what specific areas are uncomfortable and look at what specific exercises may have caused the issue. Sometimes this takes several recurring incidents over the course of weeks or months before you can draw clear connections. Patience pays off.
In summary, the first time you experience crippling soreness, it might be scary. Don't let it cow you back into a sedentary life of helplessness. After you've experienced this kind of discomfort a few times, you'll recognize that it's just an intense version of muscle soreness. You'll be able to identify what specifically is causing your issue, and stretching, massage, and more movement will help you maintain mobility going forward.
As you develop strength and extensibility in your weak, stiff muscles, your body will get less sore and more functional. As you improve proprioception, your muscles and overall coordination will improve.
You start doing corrective exercises to improve hip mobility. One day you decide to do more hip flexor strengthening exercises. The next day you find your low back is KILLING you. You feel pinching and jamming in the front of your hip. You can barely walk because of the pain.
Have you just TORN YOUR LABRUM TO SHREDS? Do you now need ARTHROSCOPIC HIP SURGERY to fix your bad bone shapes? Are you a candidate for hip replacement? Is your spine degenerating with every second?
No. Again, this is a common situation. You should respond calmly. The network of muscles around the hip joint is complex. When muscles start pulling at uneven and imbalanced rates, your range of motion may change for the worse and pain may be the result.
In this example, your already short, strong hip flexors yank your pelvis into anterior tilt. That puts your lower back into end range hyperextension.
Your high anterior thigh muscles (hip flexors) can trap your low back into too much concave curvature.
That doesn’t mean you broke your back or that you suddenly grew a stenosis (which wouldn’t matter anyway based on studies like this). It means your muscles are forcing your low back into a position it doesn't want to be stuck in. Sure, your spine should be able to go there, but it doesn't want to be stuck in end-range extension all day.
Training your hip flexors to shorten, positions your body parts poorly. You are now getting a warning signal in the back. This is a normal function of your body's warning systems. It's not a sign of damage.
If someone put you in an armbar and your shoulder and elbow started to hurt, you would consider this a proper, valid, and useful warning.
If someone put you in an armbar for three hours, you would expect your body to give you pain signals.
If you train muscles to trap your spine into submission, you should also expect your body to give you pain signals.
As for the pinching in the front? The muscles in front could be very weak (something we'll get into in a moment). Sometimes people with very weak muscles experience a sharp pinch sensation as soon as they activate the weak muscles.
But in this case, it's more likely the muscles are just too stiff and SHORT. You've already been training them to be short with your normal workouts, and -- with the added hip flexor exercise -- you've shortened them even more. Some stretching and massage will help those short, stiff hip flexors. That will help restore pelvis and low-back position so you can feel right again.
If you experience pinching and jamming in any joint, you'll find proactive and practical strategies in this article.
Another common example of short muscles causing problems is around the knees. Often, people learn to do shallow squats where their knees never go into a full, deep bend. They train their quadriceps (thigh muscles) to operate in a limited, shortened range of motion.
They squat and squat and squat. They add weight and squat some more. They do as many squats as they can, always thinking "I'm doing something great for myself!" and then BOOM. One day their quads have gotten so overworked in a shortened position that their knees hurt constantly.
The solution is not to strengthen the quads more in the shortened range. The solution is to teach the quads to lengthen and build strength through a FULL range of motion. You want strength at every length.
When you're training small muscles in the hips, shoulders, or spine, remember that if you shorten short muscles, you may end up with more pain.
Then remember that pain doesn't necessarily mean you’re broken or damaged. If exercises trigger pain flare-ups, it means that the problem can be solved. You’re just temporarily sidelined because you have to figure out the sequence of things to strengthen and lengthen.
If you were mindful while exercising, then there’s zero chance that you broke a bone, tore a tendon, or snapped a ligament.
When training your body, poor form or poor exercise selection can lead to undesired muscles firing which may contribute to pain flare-ups. Look at what exercises you’ve done, how you’ve done them, and see what adjustments might help.
You may need to:
In our hip flexor shortening and back pain example, we're assuming you were doing everything properly and felt the right muscles firing (first two bullet points). In that case, you would take out your hip flexor shortening exercises and substitute exercises with a focus on different muscles.
When exercises flare your pain, use it as an opportunity to learn and make progress.
This happens most often with yoga practitioners, dancers, and gymnasts. It can also happen with people who have spent decades suffocating their butt muscles in chairs.
Let’s look at two examples.
Case 1: Let’s say you’re already flexible in your hip flexors. You can do squared-off front splits with ease. But you feel tight and pinchy in the front of your right hip. So you stretch it. And stretch it. And stretch it. You massage it. You roll it on a foam roller.
Every time you stretch or roll your hip flexors, you feel better but then the tightness comes right back. It just seems to get worse over the weeks and months until you’re clawing at your eyeballs due to pain and discomfort.
Case 2: You feel like your butt is tight all the time. So you do the pigeon pose as hard as you can. And then you get up and find that your hip feels locked up and jammed in the inner thigh! Everything hurts! What gives?
Watch this video for an example of someone just hammering at the pigeon stretch.
In both scenarios, you’ve got a nagging sensation of tightness. That tight sensation is misleading. It's not telling you that you have a "knot" that needs to be stretched. It’s trying to tell you that you have weak muscles there.
But we are often told to interpret chronic tightness as “I have stiff muscles that need stretching.” Read more about this phenomenon here.
The “tight” muscles are weak muscles that are barely keeping things together as is. They’re telling you, “Hey! We are too weak to do this job! We're trying to hold things together, but we can’t produce enough force! Pay attention!”
And, in response, you stretch the muscle. But here's the thing.
Stretching tells the muscle, “Get longer and relax.”
In a best-case scenario, your brain and the muscles learn to handle this lengthening process calmly. You practice calm breathing, and over time the muscles learn to handle the extra length.
But static stretching can further destabilize your body if you're using it at the wrong time or in the wrong way.
In case 1, you may go insane because you’re doing the same thing over and over again and getting the same result. Your range of motion is the same, and the muscles keep yelling at you because they're getting longer and weaker.
In case 2, you go insane with worry because your range of motion gets worse, and you get sharp aches and pains in your groin and/or outer hip. Your body is going into full revolt. You're messing up the way the bones of the hip joint articulate, and you may actually be pinching and jamming stuff as you keep trying to push the range for more progress.
The solution for aches and pains like this is to strengthen muscles. Again, it’ll be helpful to read more about this "tight muscles" idea here.
In case 1, strengthening your hip flexors is the better option (knowing that you may get muscle soreness - possibly intense if you’re very weak). Strengthen the hip flexors in a shortened position AND a lengthened position. Above all, make sure they get stronger - not just longer.
In case 2, strengthening your butt is likely the better option (knowing that you may end up with some normal muscle soreness - possibly at a debilitating level if you’re extremely weak. You will need to strengthen the butt muscles in multiple positions AND potentially also the inner thighs, hamstrings, and muscles on the anterior thigh (hip flexors and knee extensors).
In summary, weak muscles can feel "tight." Telling weak muscles to relax is a recipe for more pain. If stretching and massaging muscles have no positive effect after a month, change tactics and try strengthening instead.
This factor has nothing to do with exercise selection. It's also the one people resist the most.
You’re sitting at a computer 12-16 hours a day. You’ve got deadlines looming. You’re pounding away at the keyboard with a jug of coffee and a bag of pork rinds on your desk. As the deadlines loom, your shoulders creep into your ears, your hip flexors tighten, your low back muscles tense, your knees, ankles, wrists, etc. lock up...
You aren't sleeping well. You pass out with your phone on your pillow. The few hours of sleep are restless and filled with anxiety. You wake up and immediately check your phone for work or catch up on the news or see what's on your social media...
This is a high-stress life.
I know the majority of productive personalities will say, "No, it's fine. I'm not stressed by it."
That's simply because you don't recognize/remember the feeling of a low-stress life.
If your muscles are dysfunctional, a high-stress life doesn't help. Not only are you stuck in the same positions and postures all day, but your brain is operating at too intense a pace to process new movement patterns.
A high-stress life means you will barely have the mental bandwidth to process what you're doing with your physical training. If you're too stressed, you aren't able to accurately feel your body. This is backed up by neuroscience research: when highly stressed, you won't able to notice and learn subtle lessons that your body teaches you.
You’ve got a recipe for slow or no progress.
In addition, stress hormones and brain circuitry tend to make you more likely to experience pain quicker. You’re likely to over-interpret pain signals as something CATASTROPHIC. You’re likely to start thinking “this must be bone damage…” or “this must be permanent damage from that car accident seventeen years ago…”
Being constantly stressed (and having a medical system tell you that you’re always one fragile moment away from shattering to bits) does NOT help you become stronger. It makes you weaker.
The solution is to treat yourself like an animal you love.
Treat yourself like your own pet. Would you force your dog Fido to stare at a laptop in one position for 16 hours a day? Would you cage up your cat in a tiny space with nothing to do but stare at a phone and tap its screen in the hopes that it doesn’t receive a nasty email from her boss? Sounds like a miserable, abusive existence, doesn’t it?
If you wouldn’t do it to your pet, don’t do it to yourself. Take yourself on a walk, feed yourself well, and get some rest. If you need help with some of this, be sure to check out this article on breaking phone and internet addiction.
This is a much larger problem than any “productive” personality will want to believe. It took me fifteen years of denial before I clearly saw the effect of long work hours on my mental and physical health. I was enamored with my own productivity and willfully blind to the true costs. I hope that you, dear reader, will not make the same mistake I did.
Now that we've covered our bases with exercise and general stress levels, we need to talk about some other potential issues. While exercise selection and execution are extremely important, some insidious systemic issues commonly come into play with aches and pains.
Some of these may require professional help, depending on the severity and nature of the issue and your own ability to play detective. I personally prefer to be my own detective for my body, but sometimes it's faster, easier, and more effective to just ask an expert. Nothing here should be considered medical advice, and anything you choose to do as a result of reading this is AT YOUR OWN RISK!
First, let's talk about why you might suspect a systemic issue is at play.
Let's say you're doing moderate levels of exercise for three months. You get enough sleep and relaxation time on a regular basis. Despite your consistency and overall good habits, you find that you have not made one single degree of improvement. You feel stiff, sore, and achy in your entire body in all the same places.
You can identify no specific areas where you have improved. Or, even if you have noticed some small movement improvements, you have a generalized sense of pain, malaise, and fatigue. Moving some joints feels extraordinarily creaky - like you're glowing with pain.
As wonderful as exercise can be, it won't solve everything. As potent as the ALWAYS THINK MUSCLES philosophy is, sometimes problems are NOT solved by dealing with muscles (until later). Addressing muscles first is a good idea because it's inexpensive and well within your control, but if you find yourself spinning your wheels (or if you want to speed up your progress), you'll want to start exploring the following issues as well.
Some individuals are highly sensitive to specific foods. The dose at which negative effects arise varies from person to person (and some lucky folks don't suffer much at all from these things!).
If you haven't ever explored this already, it's worth trying. Dairy, wheat, eggs, and sugar are common culprits. These foods can trigger reactions in the body that make you feel like garbage.
I know that I can tolerate a slice of cheese on a burger every now and then, but if I eat something cooked in butter for lunch at a restaurant, within two hours I'll feel a glowing body-wide ache that forces me to take a nap. Also, there will be sneezing and itchy eyes. And you will not want to be around me.
On the even more extreme end of the spectrum, my friend's son cannot drink cow's milk at all. If he does, he vomits.
Dairy intolerance can be a combination of things. It can be lactose intolerance, sensitivity to whey, and/or sensitivity to casein. After testing with various protein powders and lactose-free combinations, I determined that my own challenge with dairy is due to sensitivity to whey AND casein (so no more protein powders, milk, yogurt, or most cheeses for me).
Wheat gluten seems to cause me minor issues. If I eat a sandwich from a deli once, I'll be fine. If I have a slice of bread, I'll be fine (maybe a little sniffly). But if I have half a loaf of Irish soda bread because it tastes good, and I just can't say no because I'm a ravenous bread monster... I'm going to pay with an aching stomach for half a day and a lot of sneezing over the next few days.
Some people I've worked with cannot eat ANY bread, or they will have incredible bouts of pain and swelling all over their bodies.
As for sugar, I can tolerate a few pieces of candy (I have a weakness for good chocolate and Sour Patch Kids), but if I gorge on candy or have candy over two or three days, I'll notice my nose getting sniffly and my energy levels wavering in abnormal ways.
A final personal food sensitivity: if I eat too many almonds or peanuts (or have either one in butter form), I get an incredibly itchy, scaly patch on my neck for a week. If I have a small bit of either, I'll be fine, but more than a spoon's worth of almond butter, and I'll be scratching at my neck like a meth addict. It took me over a year of trial and error with my diet to figure this one out.
Luckily, most of my own food sensitivities result in annoying reactions that are not painful. But I've known many people for whom food sensitivities were a fast track to joint aches and pains.
If your gut reaction is to dismiss this category of potential issues because it sounds too annoying to experiment with, I invite you to reconsider.
If I said, "here, I'd like you to drink this bit of arsenic every morning. It'll sap you of 15% of your energy," you'd probably say, "No thanks, jerk."
Which brings me to this zen-like koan: "If you eat something that harms your body, but you don't realize it harms your body, does it still harm your body?"
This koan has a clear answer. The answer is yes. Ignorance of the effect does not protect you from the effect. So consider investigating this with an elimination diet. Get some professional help if you feel you need it and/or want to save some time.
Do you spend all your days indoors with no sun exposure? Do you eat the same microwaved entrees day after day to save time? Do you neglect eating specific types of food (say, vegetables?) because you just can't be bothered? If you have no idea what a good diet even looks like, you'll find this dietary breakdown helpful or this book (affiliate link). And no, I don't think you should eliminate all carbs from your diet.
We all know that if you don't get enough Vitamin C, your gums bleed, and you'll start to smell and act like a sailor from the 17th century.
Original artwork (public domain): Der Alte Matrose by Gustav Doré
Vitamin D deficiency can lead to anxiety and depression. It can lead to muscle weakness. It can lead to cognitive impairment.
And there are more than just these two nutrients to consider. Are you getting protein in your diet? Are you getting carbohydrates in your diet? Are you getting fat in your diet?
Reading a good simple book about food can be super helpful too (and in many cases is the most cost-effective and practical way to make progress).
Getting help from a holistic nutrition/health counselor or naturopath may be a good idea to zero in quickly on areas to improve.
These are the rarer issues, but they are worth ruling out with a professional if nothing else is helping.
On the medical side, these can include infection of structures within a joint.
For example, I've had two clients with hip replacements have infections and complications arise in their replacement joints several years after surgery. There was no way of addressing these issues without more surgery (this is one of the many reasons why I personally would never opt for joint surgery of any kind unless my bones have been shattered by severe trauma).
I've also had a client get a severely infected and inflamed elbow bursa from constantly injuring it. He had to get surgery to drain the elbow and excise the rotting tissue. Not fun.
Cancer, lupus, Lyme disease, and autoimmune issues can also come into play. I'm NOT AT ALL an expert in this arena, so I can't go into any useful detail. My strongest advice is to find a health professional who is a good critical thinker and 100% committed to helping and empowering you.
If they want to put you on an outrageously expensive and exclusive supplementation regimen for the rest of your life, something may be amiss. Likewise, if someone starts suggesting radically invasive procedures to fix you, be sure to use your critical thinking cap to analyze your risks wisely.
In summary, the pace, schedule, and expectations of our modern lives make it easy to be blind to basic issues that hurt our bodies.
However, it's your body. It's your responsibility.
It's the one vehicle you'll be cruising through life with, and it requires some upkeep. Give it the love it needs so you can keep cruising with it for years to come.
When muscles aren't able to do their jobs well, we should expect the body to give us internal warning signals. We often interpret these signals incorrectly and catastrophize about their meaning.
To make progress with your body, remember to interpret pain flare-ups and discomfort as guides rather than as catastrophes.
Your stomach hurts on a regular basis, especially if you ignore its signals too long. That's part of its normal function.
Likewise, your muscles will hurt if you ignore them for too long or do the wrong thing with them.
Pain and discomfort are guides that help you on a life-long journey. Sometimes pain is a warning of atrophy. Sometimes it is a warning of a temporarily weakened state. Sometimes it means you're not eating well. Sometimes it means you're eating a bit TOO well. 😁 Sometimes it's feedback that you've done something wrong. Sometimes it means you've done something right!
With time and practice, you’ll understand how to interpret your body’s signals so you can safely navigate yourself to a life free from chronic pain.
To effectively navigate your way out of pain, be sure you understand the fundamentals of muscle imbalances and dysfunctions and the strategies to fix muscle imbalances.
And learn the philosophy that has helped me heal my body in "Why am I in Chronic Pain?