CAUTION: LONG POST AHEAD!!
@Steve Freides - you don’t have to read this. There’s nothing mean in it.
There’s a lot of fascinating pain research happening world wide, much of it driven by the enormous impact of back pain.
To understand the applicability of any of this to strength coaching, you must understand “the Nocebo Effect”. We should all be familiar with Placebo Effect whereby patients experience improved outcomes from “sugar pills” or some other faux treatment that has no actual physiological effect, no mechanistic avenue to create an impact. The only remaining avenue is mental, psychological. The patient gets better because he *believes* he’s going to get better via this treatment. He believes as much due to the interweaving of a complex matrix of experience, belief, and context along with all the physical stuff.
The “Nocebo Effect” is the flip side of placebo effect. Nocebo effect is something beginning to hurt because you believe it should hurt. If I, as your coach, tell you that a 100lb Bench Press is the upper limit of where we can safely progress to, I have just inserted a danger trigger in your head. The trainee is now far more likely to begin to experience discomfort and even pain as we approach and attempt to surpass 100lb. If I tell a trainee that “at your age you should never train S&S more than twice a week”, the same thing happens if she sees another coach who tries to get her to train 3x per week. If you stop and think, the examples in “fitness” are nearly limitless. This is the Nocebo Effect - creating a belief that damage is being done or will soon be done because of the context in which the activity is taking place. Viewed through a more medical lens: what happens if you get medical imagery done for some reason unrelated to your spine. The doctor walks in and says everything looks fine. Then he asks “do you have a lot of back pain? I ask, because you have a lot of bulging disks and one of them might even be ruptured.”. He just “Nocebo’ed” you in a huge way. From now on, you’re very likely to be The Bad Back Guy. “I can’t do that!! Ferpitysakes, my doctor told me I have the spine of a 75 year-old!!” Walk in with no back pain and no fear of injuring your back; walk out as Bad Back Guy.
This segues nicely into the two current pain models. The traditional and still overwhelmingly dominant model is the Structural Model. Basically, something is wrong and it’s making you hurt. The something could be an injury, a “tight” muscle, a spinal subluxation, etc. But there is always a cause, a physical explanation, for the pain. The pain is created at the site of the physical defect and interpreted by the brain. Pain is an Input TO the brain.
The competing and much younger model is the Bio/Psycho/Social model of pain. In this model, sensory information is fed to the brain, the brain accesses experience, context, etc and through a grossly complicated process I won’t pretend to understand- decides how big a deal to make out of the situation. In this model, pain is multi factorial and is always an Output FROM the brain.
There’s a famous story of a Brit construction worker who stepped on a nail and drove the thing straight through his boot sole, his foot, and the top leather of his boot so that it was sticking out. In the emergency ward the guy was absolutely writhing in excruciating pain. Inconsolable. He had to be sedated in order to sit still enough for them to cut the boot away to see what they were dealing with. At which time they saw that the nail had gone between his toes, missing flesh altogether. But the pain was REAL. In the Bio/Psycho/Social model the pain is ALWAYS real because it’s an output of the brain, created after the brain has catalogued and contextualized a vast array of sensory, emotional, and experiential data.
As coaches, the implications inherent in each model are significant. If you are a Structuralist, a trainee experiencing pain must be treated by a medical professional and the underlying cause of the pain corrected before any sort of training is appropriate - or even responsible - because any physical activity could further disturb the physical malady that is causing the pain thereby increasing the pain. If you embrace the Bio/Psycho/Social model of pain, your goal becomes to reduce the perception of threat. Again, I won’t pretend to have a firm handle on how this is done. All I know about it is that the trainee needs to progress from “I’m broken and I hurt” to “I’m ten feet tall and bulletproof”. This is not compatible with Structuralism because the process of becoming ten feet tall and bulletproof might involve learning to ignore discomfort because you’ve developed a different way to catalog it and experience it.
There are unavoidable areas of overlap between the models. One important one I can think of is the Structuralist idea of neural facilitation which means that the neural pathway that brings the original sensory perception of an acute injury to the brain keeps getting better and better at carrying that signal, despite the reduction in the intensity of said signal as healing progresses. That’s physical, structural. Where it steps over into the BPS model is after the wound has healed and you’re still feeling excruciating pain. It seems likely to me that avoiding these triggers and returning the trainee to a state in which his pain perception is not hyper-sensitized is what drives Dr. Magill’s approach, which means a Structuralist is instinctively employing BPS methodology!
It’s a complex and fascinating area to study.