I’ve been thinking a lot about pain this week, mainly because I’ve been in a lot of it. In last week’s “Ode to my collarbone” I wrote about dealing with the immediate aftermath of a broken collarbone and briefly mentioned opioids, the very effective painkillers that can also carry a significant risk for abuse and addiction. Well, this weekend I’m back on those powerful painkillers following surgery to bolt my collarbone back together. However, my recent injury, research, and conversations with doctors and friends have led to an interesting conclusion about pain and painkillers:
For lifelong athletes, exercise can be both the cause and cure for chronic pain.
I have broken quite a few bones, and based on the comments, emails, and phone calls I’ve received, so have a lot of you! And even beyond broken bones, a lifetime of activity results in greater wear and tear on joints and more opportunities for ligament, tendon, and muscle injuries. Most of these injuries are relatively minor (thankfully) and only cause us to pause our active lifestyles for a little while. But in aggregate, over a period of 20-40 years, those acute injuries can add up to chronic pain.
A Brief History of Pain
Pain is remarkably difficult to measure. To make a comparison to athletic training, pain is essentially measured by perception, much like rating of perceived exertion (RPE). In sport we can correlate a subjective measure like RPE with objective data from power meters and heart rate monitors, but pain measurement is almost entirely subjective. And for a long time, physicians had effective ways to treat acute pain (anesthesia, nerve blocks, etc.) but far fewer options for treating chronic pain. As a result, people suffering from injuries or other painful conditions were often left debilitated, bedridden, unable to work or enjoy leisure time, and profoundly unhappy.
The emergence of prescription opioid painkillers like codeine, oxycodone, hydrocodone, and fentanyl provided physicians with highly effective medications for the pain management, and through both aggressive marketing and good intentions, the number of opioid prescriptions rapidly grew. People with debilitating pain experienced massive improvements in quality of life. They were able to complete activities of daily living with less pain or pain free. They were able to return to work, which was both fulfilling and lessened economic hardships. They were able to move more and be more active.
The addiction and overdose risks of opioids have been known for a long time. The prescription opioids you get from your doctor are not that far removed from heroin. And despite the fact the United States is in the midst of an opioid addiction and overdose crisis, the facts still remain that these medications are effective for pain management, most physicians prescribe them responsibly, and most patients take them as prescribed and stop taking them within a short period of time. And there are also doctors and patients using very powerful painkillers responsibly for long-term chronic pain, too. Personally, I am somewhat uneasy taking hydrocodone even for a few days, but Lord knows I’m grateful to have it this weekend!
The Athlete’s Response to Pain
Athletes are not masochists, but I think we have a different relationship with pain compared to non-athletes. Training is strenuous. Discomfort is normal, and some level of pain is expected. We know injuries – both small and large – are part of the bargain. But athletes also learn early on that movement is part of the healing process.
Training is about taking proactive steps to improve performance. Pain limits our ability to perform, so we take steps to address pain through movement. At the simplest level, going for a light spin or walk on a recovery day is a means of alleviating pain from a prior effort. To address more significant pain we use physical therapy, massage therapy, compression garments and pneumatic boots, and a long list of other modalities.
The medical establishment is catching on to this multi-modal approach to pain management. A report from National Public Radio describes “a biopsychosocial approach, [which] acknowledges not only the biological aspect of pain, but also recognizes that psychological and social variables contribute to how people experience pain.” The program at the Mayo Clinic seeks to help patients for whom pain medications are no longer effective, stating that opioid painkillers are neither recommended nor particularly effective for managing chronic pain. Instead of focusing on chemically blunting or blocking the pain, the focus is on regaining function so people can participate more fully in activities and relationships they find rewarding and valuable. The 40-year-old program has proven effective at getting many pain suffers off opioids by teaching participants to manage pain using multiple, non-pharmacological interventions.
Good Morale and Good Legs
When I was a young racer in Europe the old Belgian hard men used to say, “When the morale is good, the legs are good. When the legs are good, the morale is good.” As athletes, continuing to be active makes us feel good, and feeling good helps us stay active. My broken collarbone has been a good reminder that, while being an athlete has led to a number of injuries, being active has also kept chronic pain at bay.
In 1986 I broke my femur. It was a nasty break. I split the femoral condyle, messed up my patella, the works. To this day, my knee starts hurting any time I’m not active for an extended period of time. My good friend and NBA basketball legend, Bill Walton, is an even better (worse?) example. His career was cut short by repeated injuries to his feet, ankles, and spine. Standing and walking are painful for him every day. But put Bill on a bicycle and he’ll ride all day long. Next week he will ride down the coast of California, nearly 100 miles a day, during the Challenged Athlete Foundation Million Dollar Challenge (my recent crash is the only reason I’m not doing it with him). If you ask him he’ll tell you, “The bike is my gym, my wheelchair, and my church all in one.”
Without exercise, Bill Walton would be largely immobile. And while cycling is his form of exercise, in the larger picture it doesn’t have to be cycling. The point is that exercise keeps people moving, and moving keeps joints healthy. It keeps muscles, tendons, bones, and ligaments healthy. Exercise can prevent significant weight gain that leads to more joint pain and a host of other impediments to being active. And reduces cardiovascular disease risk as well as the risks of developing Type II Diabetes and hypertension. Perhaps most important – and a key point identified in the aforementioned Mayo Clinic program – is the psychological benefit being active imparts by enabling people to participate more fully in relationships, activities of daily life, and society in general.
An exercise program is not going to solve the nation’s opioid crisis or epidemic of chronic pain. But neither is the next narcotic painkiller. From where I (uncomfortably) sit, I believe it may be the culture of athletics – particularly the integration of exercise, diet, community, proactive recovery, and multi-modal therapies – that may provide the most promising model to inform and enhance the way the medical establishment tackles these public health crises.
CEO/Head Coach of CTS