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Can Avoiding Pain Actually Cause More Damage? With Greg Lehman

Episode 62:

Can Avoiding Pain Actually Cause More Damage?

Today we dig into several myths surrounding the role of pain in exercise. They include the ideas that: targeting specific muscle groups with strength workouts is always beneficial, clients should wait until pain subsides before returning to exercise, and finally, that losing weight will lead to decreased pain associated with knee osteoarthritis (OA). We interview physiotherapist, chiropractor, kinesiologist, and public figure Greg Lehman. Greg is also a published researcher who shares a passion for evidence-based movement practice just as much as Raphael and Cloe.

What You Will Learn:

  • Targeted vs general strengthening exercises: when is each type of exercise most appropriate?
  • When it’s okay and even helpful to ‘poke into pain’?
  • How movement optimism can be applied to people with knee osteoarthritis (OA)
  • The myths surrounding OA as a degenerative condition
  • Why losing weight does not necessarily decrease pain associated with knee OA

Do you really need to target specific muscle groups?

It’s a commonly held idea in the physio and fitness communities that exercise is most effective if it targets specific muscle groups. Greg offers the idea that in most cases, what’s most important for clients in any stage of recovery is just to get moving. However, there are some times when specific exercises are helpful, depending on the client’s goal. In order to see benefit from specific exercises, goals must be based on some motivation which goes beyond the pain itself. For instance, if a 30 year-old runner wants to start being proactive about bone health, they may explore exercises which address bone density. Whether specific exercise will help is largely dependent on how specific the client’s goal is.

Poking into pain

It’s no secret that clients are often discouraged from continuing their workouts by the possibility of encountering pain. There is a lot of misinformation circulating in the physio world about when to push through pain and when to back off. Greg discusses the potential damage caused especially when instructors avoid pain. He explains that current evidence does not support the idea that exercising makes pain worse and causes reinjury. 

Movement optimism for osteoarthritis 

The narrative instructors offer their clients is key when it comes to helping them realize their goals. Teaching patients and clients not to fear pain is critical to their success. Greg explains when it is beneficial to address pain and when it’s best to steer clear of the topic for the sake of progress. If clients have a negative narrative of their experience with pain, Greg recommends slowly introducing the idea of not worrying about pain in certain exercises. Movement optimism is very helpful in cases of knee OA, in which people are often convinced that exercise will actually cause further deterioration of their joints. Deconstructing the negative pain narrative so many people with knee OA have can help them find the strength to move with confidence through knee strengthening exercises.



Research and Resources Mentioned in This Episode:

  • Greg teaching his daughter to take a step here
  • There is more damage to medial PF cartilage even in knees with valgus alignment here
  • Running nourishes cartilage here
  • Predictors of academic success here
  • Moderate running seems to thicken cartilage here
  • Running knee cartilage systematic review here
  • Running is safe for people with OA or at risk of OA here

About Greg Lehman:

Greg Lehman is a practicing physiotherapist, researcher, and educator in Toronto, Canada with over 20 years of experience in the rehabilitation field. Greg’s background includes an MSc in Spine Biomechanics, MSc in Physiotherapy, and a Chiropractic degree. Greg has published more than 20 peer-reviewed publications in the manual therapy and exercise science fields. He has a special interest in the multidimensional nature of pain and injury and believes that simple yet comprehensive approaches are a cornerstone of the biopsychosocial approach to patient care. Greg has taught the popular “Reconciling Biomechanics with Pain Science” course for 5 years to 1000s of therapists throughout the world. The course is about fundamentals and finding the common threads of many rehabilitation approaches

How to Connect with Greg:

  • Find Greg on Instagram @greglehman
  • Find Greg on Twitter @GregLehman
  • Reconciling Biomechanics with Pain Science online course here
  • OA Optimism YouTube Channel here
  • OA Optimism online here
  • The Naf Physio Podcast here

About Raphael and Cloe:

Raphael Bender, CEO, Breathe Education

Raph believes everyone deserves the opportunity to transform into a better version of themselves. His main strength as a teacher and movement professional is the ability to distill complex research findings into a simple, science-based approach to help people move fearlessly, thoughtlessly, and painlessly. He LOVES running, weights, cycling, and Contrology.

Raph holds a Master’s degree in Clinical Exercise Physiology (Rehabilitation), a Bachelor’s degree in Exercise and Sports Science, Diploma of Pilates Movement Therapy, and STOTT PILATES full certification.

Cloe Bunter, Trainer, Breathe Education

With 8+ years in the industry, both teaching Pilates and nurturing new instructors, Cloe is passionate about empowering new and seasoned instructors to think critically and move fearlessly. Empowered instructors empower their clients, and in turn, change lives.

She finds great joy in building connections with clients, students, colleagues, and the broader movement and rehab community. Co-hosting the Pilates Elephants Podcast, with Raphael Bender, has provided an incredible platform to bust common Pilates, movement, and rehab myths whilst creating a worldwide community of critical thinkers who are elevating health literacy.

Cloe is fascinated by movement in general, and its ability to enhance our lives, at any age. Her own movement practice includes Contrology/Pilates, running, weights, and kettlebells. She has a Diploma of Clinical Pilates, Cert IV in Pilates, and Cert IV in Training and Assessing.

How to Connect with Raphael and Cloe:

3 Myths About Posture in Pilates eBook:

  • You can find the eBook here

Stop Faking It & Really Know Your Stuff Pilates Q&A:

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