The other day as I was gathering my grip and heels after a pole class, I overheard a classmate asking the instructor if she should be worried about some pain she was experiencing from the class. She essentially asked the instructor “how do I know if I am just sore from class or actually injured”.
To the instructor’s credit, she did a brilliant job trying to answer this seemingly simple question, but I ended up stepping-in (after apologising for eavesdropping) to provide further explanation and reassurance.
On the spot, it was actually quite challenging to come up with a quick and concise answer to this question. Especially in non-physio terms! And that classmate’s question resonated with me for quite some time afterwards and is the reason why I am sharing this story with you and why I’ve created this blog.
I love pole for its diverse community. People from all walks of life with an array of fitness levels and knowledge of exercise are welcome to partake. This means that not everyone has experience with sport related injuries. What’s more is that pole is tough, and it hurts!
From pole sits causing us pinch bruises in our inner thighs (more affectionately known as pole kisses), to straining our hamstrings in that super pretty “flexy” move, pole comes with a lot of challenges, not to mention the inherent risk of injury.
That’s why my goal for this blog is to help provide you with enough information that you can confidently answer that question for yourself. To do this, I am going to (briefly) dive into the fascinating science behind pain and establish what is good and what is bad pain (i.e. Hurt vs. Harm). Then I’ll discuss the common signs and symptoms to look out for in case of a suspected injury and give you a few guidelines on when to seek out a physiotherapist.
Sounds like a plan? Right. Let’s get started!
Pain Science
Pain is the bread and butter of our job as Physiotherapists, but is also the most complex and misunderstood aspect of our jobs as well because it’s so multifaceted. So you’re probably thinking all pain is bad, right? Well no, not necessarily.
To keep things simple, let’s start with the definition of pain. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. This all seems simple and easy enough to understand, but let’s break the definition down into pieces to build a better understanding of the complexities of pain.
Piece number one: pain is unpleasant. Well, duh! Pain sucks, but as I said above, it’s not necessarily a bad thing. Pain is a natural tool our body has for self-preservation. For example, think back to that time you were taking a cookie tray out of the oven and caught the inside of your forearm on the oven opening. Ouch! Or maybe that time the poorly placed coffee table jumped out at you again. Within milliseconds, and without conscious thought, your body pulled your hand (or leg) away. This is a built-in mechanism in our bodies called the withdrawal reflex that prevents us from causing damage to our body tissues and upsetting homeostasis - throwback to high school biology! Think of pain as an alarm system that goes off to alert us to danger, that way we may act to stop the threat.
Piece number two: pain is a sensory experience. We have millions of tiny receptors throughout our bodies that detect the slightest of sensory changes which include mechanical, thermal or chemical changes. These receptors communicate these abnormalities to your brain via pathways through your spinal cord. What’s interesting though is that these receptors don’t actually tell your brain that you’re in pain, they send messages that say “Danger!”, but it’s up to the brain to decipher these messages then decide how to respond and what emotions to use.
Piece number three: pain is an emotional experience. The emotional response to pain is created in several areas of the brain - two key areas are the frontal and temporal lobes. The frontal lobe is responsible for important cognitive functions such as our personality, conscious thought and the production and interpretation of feelings. Activation of this area occurs for everyone when we experience pain, but the amount of activity here can vary from person to person and also vary between occasions within the same person. The amount of activity in this area can be influenced by several different key factors such as our mental health, the salience of the pain, our past experiences and our knowledge of pain. Here’s a bit more detail on these factors:
Our mental status at the time of experiencing an injury can greatly influence the intensity of the pain. Think of a time when you were just in a plain old bad mood, when nothing was going right in your day causing you to be stressed and then you go and stub your toe. Argh! It’s the cherry on top and it just makes you want to sit down and cry.
Salience of pain refers to the prominence of the pain to your life. The greater the impact of pain in our daily lives and our ability to do the things we love (e.g. pole), the greater the emotion tagged to the experience.
Past experiences also dictate the emotional experience of pain. Another important area of the brain as mentioned above is the temporal lobe. The temporal lobe is responsible for the memory of pain. From a young age, we learn what things can cause us pain or injury and our brains commit this to memory to avoid repeating these things in the future. As well, if we’ve experienced similar pain in the past and recovered well from it, then it will be less intense overall because its perceived threat is lower.
Our knowledge of pain also influences the emotional side of our pain experience. As humans, we naturally worry about things we don’t understand. By better understanding how pain works, we can change our mindset and attitudes towards pain which will in turn help us better manage and heal from pain.
Piece number four: pain is associated with actual or potential tissue damage.
Not all pain causes physical/structural injury or damage. Take your time to wrap your head around this because, of course, this is the basis for this blog. We’re going to delve into it more in the next section when we discuss hurt vs harm.
Quickly though, with all this science racing around our heads now, let’s put it all together with a pole example. Take athlete A: they hurt their shoulder whilst poling, but they are able to manage their pain effectively because they’ve experienced a similar injury before that settled down through activity modification and rehabilitation.
Compare athlete A to athlete B: they have the exact same injury, but life for them is really difficult at the moment. They’re feeling symptoms of anxiety, stress and depression, and have struggled with injuries in the past that were slow to recover. Despite the injury being the same, athlete B will report a higher pain level, and it’s quite likely they will take much longer to recover based on these biopsychosocial factors. If athlete B had a better understanding of pain science and hurt vs harm, then despite the challenges they’re facing, they may have a better time recovering.
Hurt vs. Harm
So what do I actually mean when I say hurt versus harm? And how does pain science relate?
I’m sure you’re thinking that hurt and harm are just synonyms of each other and wondering what the big difference is, right? Well let's use the hot stove example from earlier. When we touch a hot stove the withdrawal reflex quickly gets us to pull our hand away. The hurt we are experiencing is telling us that our body has been harmed. The harm is likely a minor burn since the thermal receptors in our hand tell our brain that the surface is hot and if we don’t react then more damage will occur in the form of severe burn. In a way, pain is good! As I said before, pain is our body’s alarm system. Now, can you imagine not having this alarm system? There are those that have congenital insensitivity to pain, meaning from birth they can’t feel pain. I am sure this would make some pole moves a lot easier to perform, but think of how dangerous it is not to have that pain alarm system!?
On the flip side, just because something hurts really bad, doesn’t mean there is actually any significant damage being done. Think of the example of stubbing your toe from earlier. It’s not likely that there is any harm that was done, but it hurt really bad because it's annoying and you were already frustrated and emotional. I think another great example is a paper cut - how can something so small hurt so bad?
Another great example of hurt vs harm is D.O.M.S. (Delayed Onset of Muscle Soreness). This occurs when you’ve had an extra hard pole training session and you feel pain in the muscles one to two days AFTER the workout. This isn’t necessarily a bad thing, there has been no structural damage to the muscles. It just means that you likely “overdid-it” and you will need to take those couple of days to recover before easing back into your workout (more on this later).
Now, with all this being said, I think we can agree that pain is unpredictable and complex so it’s not always easy to use this logic when we’re hurting. But by better understanding pain and its complexities, we can decrease the overall threat that pain poses and allow us to better manage the pain.
So, bringing it back to our original question; how can we differentiate pain from hurt vs harm? How do we know we are experiencing pain because we have actually harmed ourselves? I.e how can you determine if the pain is because you’ve actually pushed yourself too hard in class or if you’re experiencing DOMS?
Well let’s cover what a physio would look for now to give you a better idea on how to differentiate these two concepts.
Signs and Symptoms/Injury and Healing
An acute injury is often accompanied with inflammation which is your immune system’s response to protect the body. When our body’s tissues are ‘damaged’ (i.e. skin, muscle, bone, etc.), more blood is sent to the area causing fluid build-up. The blood carries with it important chemical agents that help remove damaged tissue and rebuild new ones. Inflammation is a natural process and is essential for tissue repair.
Inflammation occurs within the first 24-48 hours and is the start of the recovery process.
Common signs of inflammation are:
Bleeding
Swelling
Redness
Heat
Bruising
Reduced movement
These signs are more or less pronounced depending on the severity of the injury (e.g. sprain, strain, fracture) and the type of structure (e.g. bone, muscle, tendon, ligament). The most common symptom of inflammation is, wait for it, pain! Yep, you guessed it! In terms of hurt vs. harm - experiencing inflammation hurts and is a strong indicator that you have been harmed and you should seek advice on how to manage this injury if you are not familiar.
Now keep in mind, bruising is technically a form of bleeding that can occur with inflammation and we get bruising with pole kisses. You may be asking yourself if this is something we should worry about then since inflammation is a sign of harm? Well, think of pole kisses as an exception to that rule because they may hurt a little, but they (usually) don’t harm us! Generally, bruising occurs when there is damage to small vessels under the skin surface known as capillaries leading to small pools of blood in the area. This can occur even simply pinching the skin too hard. Similar to the paper cut example, there isn’t a large amount of damage to the tissues that we need to be concerned about. We get more concerned about bruising when it is very large and paired with more signs and symptoms as listed above.
It’s also important to note that there are times when hurt (pain with no structural damage) can become more persistent and develop into harm (injury) if athletes aren’t careful. This occurs when there is persistent load and stress without appropriate rest and recovery along with compounding psychosocial aspects like stress and anxiety that can lower the body’s immune system function. Examples of these would be overuse injuries such as muscle strains or tendinopathies. Conversely there are times when we can experience harm (injury) without the hurt (no structural damage). See what I mean now when I said pain is complex!
When to see a physiotherapist
Now you’ve got some background in pain science, some more knowledge of what an injury looks like and hopefully you’re feeling more confident with the difference between hurt vs harm. But with all that information, would you still feel comfortable deciding your course of action if you’re experiencing pain from pole?
If not, ask yourself the following questions:
Is the pain affecting your ability to perform your day-to-day activities or to participate in pole?
Do you have any signs of inflammation?
If the answer to either of these questions is yes, then it likely means the hurt you are experiencing is from harm and you should definitely go see a health care professional. They will be able to thoroughly assess the injury, provide you with a diagnosis, treatment plan and prognosis. If it’s something more severe, they will make sure you are referred to the appropriate specialist.
Whilst a short period of rest is sometimes required after certain injuries, a Physiotherapist will be able to provide you with modifications to help keep you on the pole and gradually progress you back to your usual training. That’s why at The Pole Physio we aim to ‘keep you dancing’.
And even if the injury turns out to be minor, it’s never a waste of time to speak with a health care professional for reassurance. What’s more, we can always give you lots of other advice on how to improve your pole performance and reduce your injury risk in the future.
If you’re having trouble with pain after a hard pole workout and you’re suspecting DOMS, a physiotherapist can still help, but you are in fact safe to continue with exercise. Check out the other blog post “Good vs Bad Pain” to learn more about exercising with DOMS.
Now, we know pain is unique to every individual, so these guidelines are not hard and fast rules and pain will feel different for everyone. So when in doubt, don't hesitate to see a physiotherapist!
If you’re recovering from a pole injury and things aren't quite going to plan, check out our online telehealth appointments with our qualified physiotherapists.
Online telehealth appointments can be booked with the Pole Physio via our ‘Book Online’ page that can be found here. Assessment and tailored rehabilitation are provided in accordance with best practice and evidence-based treatment to help you unleash your 'poletential'.
Until next time, train safe
The Pole Physio
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