Military Health Expert Clarifies 'No Pain No Gain' Workout Myths

Injuries are the leading reason for military medical visits each year.

Department of Defense active duty service members require medical treatment for injuries almost 5 million times each year (for around 1.5 million individual injuries). Injuries cost millions of lost duty and training days, and billions of dollars each year.

"Some injuries are caused by acute trauma, such as from falling or a vehicle accident, but the majority of military injuries are cumulative micro-traumatic injuries, often referred to as overuse injuries," said U.S. Army Capt. Regis Pearson, a physiologist and chief of the Injury Prevention Branch for Defense Centers for Public Health-Aberdeen.

A recent military report shows that over 75%of all injuries to active duty service members are due to cumulative microtrauma.

"Most of these overuse injuries usually involve the musculoskeletal, or MSK, system which includes bones, muscles, tendons, as well as ligaments and other joint tissues," said Pearson. "A doctor may use a medical code for 'pain' in a specific body area if a more identifiable injury diagnosis is not determined. Because the pain is a result of damage to tissues in that body area, the diagnosis is still categorized as an injury."

In a 2019 study of three years of soldier medical data, almost a quarter of all the initial service members' injury visits were for a diagnosis of MSK "pain" to a body part.

"The back, especially the lower back, is a particularly common body area associated with injury pain codes," said Pearson. "The knee, ankle, and shoulder are the next most frequent body areas linked to pain diagnoses. Though somewhat less common, hip pain is also a problem, especially among female service members."

Pearson said the common physiological factor of these pain codes is that they usually are associated with the complex tissues of a joint, which is not the same as delayed muscle soreness.

"There are two types of muscle pain," he said. "Acute or immediate pain in a muscle felt during an activity is indication of a strain or tear that needs medical attention. Muscle soreness that develops a day or two after an exercise is typically referred to as delayed onset muscle soreness, or DOMS."

Like other forms of MSK pain, DOMS is a form of tissue damage that the body responds to by increasing inflammation, said Pearson.

"Unlike joint or bone damage, however, the body is often able to repair the microscopic muscle damage that is associated with DOMS in two to three days," said Pearson. "This is what inspired the phrase 'no pain, no gain.' Unfortunately, misunderstanding the "no pain no gain" concept can lead to more serious or even chronic injury-related conditions."

'No Pain No Gain; Myths

Pearson reminds everyone that this phrase doesn't apply to joints-such as the spinal area, knee, ankle, shoulder, or hip-and corrects some common misconceptions, including:

• Myth: Sudden sharp pain during an exercise just means you are pushing your body to improve.
  Fact: Feeling sharp sudden pain during an activity may mean an acute injury. Immediately stop activity to rest the body area and consider medical evaluation.
• Myth: A body will adapt to muscle soreness, so it is a necessary part of training. Not feeling any pain means you are not working hard enough.
  Fact: Delayed onset muscle soreness is the body's protective response to new or excessive exercise; it is not an indication of training effectiveness. Severe DOMS can even hinder a person's ability to recover efficiently if the muscle is too damaged.
• Myth: Delayed onset muscle soreness is a type of pain that the body will repair and recover from on its own.
  Fact: In severe cases of DOMS, the body's repair mechanism may be overwhelmed, especially if high exertion activity is continued. In many cases of DOMs, it is generally advised to continue using the muscles through low exertion activity for at least a day or two to allow time for the body to recover.
• Myth: MSK pain will go away over time.
  Fact: Continued pain, especially near joints, is a sign that the body is trying to repair some form of MSK tissue which, if ignored, may worsen the severity of the condition. This can lead to longer recovery periods or even long-term pain conditions such as chronic back pain or arthritis.

What Can You Do?

Pearson said though the long-term conditions that result from MSK pain are common and often unavoidable, their severity can be reduced.

First, reduce your chances of injury by addressing leading risk factors of injury:

• Maintain a healthy body weight and keep body fat percentage with the DOD limits. Evidence shows that personnel with excessive body weight and high body fat are at a higher risk for MSK injury. In addition, service members who are underweight are also more likely to get injured.
• Maintain a regular exercise routine to achieve fitness levels. Those who don't regularly maintain high levels of fitness are more likely to get injured. Exercise should include a balance of activities like aerobic conditioning and anaerobic training, such as strength, power, and balance activities. Service members can enhance their fitness through individual physical training but should balance the amount and types of exercise with unit training activities. The U.S. Army offers online guidance for safely training for its fitness test.
• Stop smoking or using tobacco products. In addition to increasing risk of MSK injury, tobacco is a leading risk factor for heart and lung disease and cancer. Tobacco use has been found to increase chances for hospitalizations, missed workdays and impaired vision. Cessation services are available to service members through TRICARE.
• Eat a healthy diet in addition to maintaining a balanced exercise regimen. The military is making it easier for service members to find high-quality foods and drinks to boost fitness, strength, and health as part of the Go for Green® initiative. Information and good food choices at dining facilities or galleys help service members make smart choices.

Second, seek medical evaluation of problematic MSK pain early on, and follow medical guidance for recovery time and restricted duty or activity. Otherwise, you may develop chronic pain.

Chronic pain, which is pain that lasts longer than six months, can impact your mood and make it difficult to work and participate in everyday activities. Some examples of chronic MSK pain are back pain, arthritis, and other joint problems.

Pearson said that maintaining a healthy body weight and fitness levels can increase your resilience against injury; it is critical to stay in tune with your body's pain feelings.

"Trying to 'tough it out' can make things worse in some situations," he said. "It is important to differentiate between mild DOMS and a more serious pain. Stop activity for more serious conditions and follow your provider's recovery guidance."

Additional information sources:

• Uniformed Services University, Human Performance Resources, Rehab, Refit, Return to Duty
• Veteran Administration, Women Veterans Healthcare, information regarding chronic MSK pain in women
• DOD Public Health Total Force Fitness, Injury Prevention
• Example: military walk-in clinic MSK treatment support

The Defense Health Agency supports our Nation by improving health and building readiness-making extraordinary experiences ordinary and exceptional outcomes routine.

NOTE: The mention of any non-federal entity and/or its products is for informational purposes only, and is not to be construed or interpreted, in any manner, as federal endorsement of that non-federal entity or its products.