Workload, Fatigue Management, and Pain - Part 1

Introduction

On any given day here at Driveline, I will be approached by a handful of athletes who are dealing with some form of pain or discomfort. My primary job is to guide these athletes in how to manage and resolve their current problems while still training hard day after day. The fact of the matter is that Performance ≠ Health. When you are training to elevate your skill set in order to play at a higher level, you run the risk of encountering periods of pain or even injury. But, you can’t play if you’re hurt and the key to a successful training program isn’t the exact exercise selection or methodology. It’s having a strategy to monitor and finely tune the necessary variables in order to push the performance needle forward while managing workload appropriately to ensure you get to see the fruits of your labor.

Acute vs. Chronic Workload

Definition

In order to discuss the topic of workload management, we must define it. When discussing workload, we are referring to imposed stress and primarily talking in terms of Acute vs. Chronic workload. An important distinction to be made is that there is no specific span of time when discussing workload spikes in the context of pain and injury. Acute workload is always discussed in reference to the Chronic time frame. Acute could be in reference to one day in a week, a week within a month, or even one “bad” rep out of a day’s work that stressed a tissue beyond its current capabilities.

A Necessary Foundation

Similar to how injury rates are at their highest at the start of spring training, we see an increase in problems within the first few weeks of an athlete's stay due to a spike in daily workload. While we try to educate athletes on how to prepare for the demands of training before they arrive, we can only control so many variables before they step through our doors. It is these spikes in acute workload that exceed what the athlete has been chronically exposed to that often leads them down the path of experiencing some form of pain.

The body may be a resilient adaptation machine, but it takes time to adapt. This is where training progressions come into play in both the weight room and on the skill development side. Hopefully, athletes come prepared to train but if an athlete is under-trained or lacks exposure to certain stimuli, such as weighted balls or a consistent lifting routine, we have to take time to establish a base workload tolerance. An ideal strategy is to establish a high volume of work at submaximal intensities. From there, the periodization is primarily linear where the volume will decrease slightly as intensity increases over time. Once we have an athlete accustomed to handling a solid workload on both sides, then we start the balancing act as we drive them towards higher outputs. However, an obstacle that sometimes rears its ugly head in the process of improving the body's tolerance to high stress, is pain.

Let’s Talk About Pain

An important perspective to have when it comes to managing these athletes is to understand pain, and for this section I am going to stand on the shoulders of some pain science giants, David Butler and Lorimer Mosely and their book Explain Pain.

In the early stages, pain is an alarm system that’s worth paying attention to. Pain is extremely complex, multifactorial and sometimes downright confusing. In the context of this discussion, pain can be a warning that the body is experiencing a significantly greater amount of stress than it has been exposed to previously and to proceed with caution.

You can think about this alarm system in terms of having a threshold that has to be crossed before it is set off, and your chronic workload as what establishes that threshold. In many instances, an athlete experiences pain when their acute workload exceeds this threshold. It doesn’t mean they’ve injured themselves, but it may have triggered an inflammatory response in a tissue that wasn’t prepared for the stress it is now experiencing.

Think of the last time you did something highly active and abnormal from your daily life, like going on a massive hike because it's the first day of warm weather after snow season, and then your knee being puffy and bothering you the next couple days. You didn’t “injure” your knee, but it's definitely telling you to back off and that threshold for pain is now more sensitive than it was previously. This threshold is dynamic, and it can increase in order to allow the body to tolerate more stress before it is set off, but this takes time and repeat exposure to training that is within the threshold’s limit. Chronic pain and subsequent injury occurs when athletes, or coaches, don’t respect this warning and continue to blow past it day after day.

Physical stress is not the only consideration when addressing this issue. Stress is stress and everything counts from the physical, psychosocial, and occupational domains. While this less so applies in our setting, it may apply more in yours. For example, it has been demonstrated in D1 football athletes that injury rates are doubled during periods of high academic stress. You have to respect all additional variables from school and work to playing games to relationship trouble and do your best to manage the variables you can control like promoting sleep habits, quality nutrition, and modifying training demands appropriately.

Conclusion

Hopefully this brief dive into workload and pain response provides a more holistic lens to view your athletes through. If you want a deeper dive into any of these topics, I recommend surfing through the links throughout the article. In part 2, we will discuss more specifically the application of these principles in the day-to-day management of our athletes.