Physical Pain: Places I've Had Pain

health , pain management , physical health

Physical pain has been a recurring teacher in my life. Each injury forced me to learn something about how my body works (and doesn’t). This page is the hub for my pain-related learnings, with dedicated pages for each area where I’ve had issues.

Places I’ve Had Pain
Key Concepts for Pain Management
Approaches to Managing Pain
Great Books For Across the Board Improvements

Places I’ve Had Pain

Key Concepts for Pain Management

Tightness is the signal/symptom it is not the problem.

Physical pain has a direct analog to mental pain — both use discomfort as a signal, not the root cause:

Mental Pain => Anxiety => Signal to Focus => Instead of asking why am I anxious, and what am I trying to control, how do I maximize my influence

Physical Pain => Tightness => Signal to Focus => Instead of asking how do I loosen, ask what is weak? how do I strengthen.

Negative Feedback loop - When you are tight.

Your body is designed to operate smoothly and symmetrically. However, we can also operate with mitigations, but those are of course increasing our injury risk. So if we’re tight on one side we compensate, and that puts us at higher risk of future injury.

Flexibility vs Mobility

These aren’t synonyms — they’re two different but related concepts. The distinction matters because it tells you what to train:

	Flexibility	Mobility
Definition	Passive ROM — how far you can be moved (by gravity, a partner, or strap)	Active ROM — how far you can move yourself under own control
Limited by	Tissue stiffness, ligaments, joint structure	Strength and motor control
Test	Can a physio push you into the position?	Can you get there yourself and hold it?

The key insight: The gap between your flexibility and mobility is a strength/control deficit, not a stretching problem.

Example: You might be able to touch your toes when you relax and hang (flexibility), but struggle to actively lift your leg to 90° while standing (mobility). More stretching won’t help — you need strength work in that range.

Practical implications:

If you’re flexible but not mobile → train strength at end-range (e.g., loaded stretches, isometrics)
If you’re not even flexible → address tissue restrictions first, then build strength
Chasing flexibility without mobility creates “loose but weak” joints — injury waiting to happen

The Tendon Problem: No Pain Until It’s Too Late

Tendons don’t have nerve endings. Unlike muscles that scream at you when you’re overdoing it, tendons can degrade, fray, and even partially tear without sending pain signals. By the time you feel tendon pain, you’ve often already done significant damage.

The Achilles heel is literal: Your Achilles tendon can rupture completely while running, with people describing it as feeling like someone kicked them in the calf. Same with ACL tears in the knee — the ligament snaps before you feel real pain. These structures fail catastrophically precisely because they can’t warn you they’re failing.

The paradox: Tendons need loading to stay strong, but can’t tell you when you’re overloading them. The answer is systematic progression, not feel-based training.

Why this matters:

Muscles hurt when you overwork them → you rest → they recover stronger
Tendons silently degrade when you overwork them → you don’t notice → they fail catastrophically
Tendinosis (chronic tendon damage) develops over weeks/months without symptoms
By the time you feel pain, healing takes 3-6 months minimum (tendons heal SLOWLY)

Form is non-negotiable for tendons

Because you can’t feel tendon stress accumulating:

Perfect form isn’t about looking good — it’s about not destroying your tendons
Bad form under load = invisible tendon damage compounding every rep
The shoulder impingement example: grinding your rotator cuff tendons every arm raise until they tear
Turkish Get-Ups without mobility: compensating in ways that silently damage shoulder tendons

Pacing and progression rules

The classic mistakes that destroy tendons:

Restarting too aggressively - “I used to run 5 miles, so I’ll start with 3”
- Wrong. Tendons decondition faster than cardiovascular fitness
- Your lungs might be ready, but your tendons aren’t
The 10% rule for running - Increase weekly mileage by no more than 10% per week
- This isn’t conservative, it’s the MAXIMUM safe rate
- After time off, start even slower
Ignoring early warning signs - “It’s just a little stiff, I’ll run through it”
- That stiffness IS the warning — you’ve already damaged the tendon
- Stop immediately, rest, and restart more gradually

Reminder to self on rebuilding running: Even if my ticker feels good, take it easy. My cardiovascular system recovers faster than my tendons.

Isometrics: How to Load a Tendon Without Moving the Joint

The Tendon Problem leaves an obvious question: if tendons need load to get strong but can’t warn you when you’re overloading them, how do you load them safely? Isometrics are the best answer I’ve found.

An isometric is producing force without moving the joint — the muscle fires, the angle doesn’t change. Two kinds:

Overcoming — push or pull against something that won’t move (pressing into a wall, pulling on a bar bolted to the floor).
Yielding — hold a position or a static load: a wall sit, a dead hang, the bottom of a squat.

Why they’re good for tendons

This is where Keith Baar changed how I think. He runs the Functional Molecular Biology Lab at UC Davis and is the tendon-and-collagen guy on the podcast circuit (Tim Ferriss, FoundMyFitness). His work: tendons adapt to load × time under tension, not to reps. Heavy, longer holds build tendon stiffness and drive collagen synthesis far better than fast, bouncy reps — the slow sustained tension is the signal the tendon actually reads.

Isometrics also reduce tendon pain, at least for a while. In Ebonie Rio’s patellar-tendon study, a single bout of heavy isometric holds dropped pain by nearly 7 points on a 0-10 scale and kept it down for ~45 minutes — and the effect showed up as reduced inhibition in the brain, not just the tendon. A hard isometric hold is genuinely analgesic. That’s the well-supported part.

A few more reasons they fit this whole post:

Joint-friendly. You load hard without traveling through a painful range — ideal for rehab and for training around pain instead of aggravating it.
Angle-specific. Strength carries over only ~15° around the angle you train, so they’re great for a specific sticking point.
Cheap and low-risk. Minimal gear, no momentum, less soreness and recovery cost than heavy eccentrics.

What makes them hard

They’re deceptively brutal. No momentum to help you, no eccentric phase to rest in, no rep to count toward — just sustained tension with nothing to break the burn. It only builds.

The mental side is worse than the physical. You’re pushing near-maximally against something that doesn’t move, with no visible progress and no clear point of failure. Nothing tells you you’re done, so it takes real intent to push hard — it’s very easy to sandbag and coast through the hold. Baar-style 30-second holds are their own flavor of suffering; the tension never lets go.

Baar’s protocol

Roughly:

Heavy holds, ~30 seconds, ~4 reps, ramping the force up and down slowly rather than jerking into it.
Space the sessions out. His lab found collagen synthesis saturates after ~10 minutes of load and then needs a refractory period — so ~6+ hours between tendon-loading sessions, and piling on more load in one block doesn’t buy more adaptation.
Gelatin + vitamin C first. ~15g of hydrolyzed collagen or gelatin plus vitamin C, taken 30-60 minutes before loading, roughly doubled markers of collagen synthesis in his 2016 study.
Be patient. Tendons adapt far slower than muscle — think months of consistent load, not weeks.

Honesty check: the analgesia and the core principle (load drives tendon adaptation) are solid. The exact numbers — 30s vs 45s holds, the 6-8 hour spacing, the precise gelatin dose and timing — are emerging science, built partly on blood markers rather than long-term tendon outcomes. I treat the protocol as a reasonable default, not gospel.

Using the 5 whys to understand pain

From our favorite COE process - the 5 whys:

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Why Pain?
- Tightness
Why Tightness?
- Body Protecting From Injury
Why Protecting From Injury
- Body feels instability in joints
Why unstable?
- Lack of muscular Endurance

This is what’s great about the mcgill big 3, it’s isometrics to build endurance, as opposed to strength. And it does so with the minimal amount of back load (which would worsen the injury)

Rotation for stiffness

OK, a very hard to read book “Becoming a Supple Leopard”, but a point which he hammers in that no one else does is the importance of external rotation, both in the hips and in the shoulders:

Becoming a Supple Leopard, 2nd Edition: The Ult...

Coaches talk about “bending the barbell”, or rotating your pits forward or screwing your feet into the ground. What they are “cueing” you for is to externally rotate your humerus or femur into the socket, this pulls the slack out of the joint making it stiff.

Note in the hips, when you point your feet out you have more ROM, but you lose tension, and that tension has downsides — being stiff gives you strength.

Shoulder external rotation was really hard for me, and also interesting since the way I do pushups is I let my elbows go perpendicular to my core (which is apparently not what you want).

Lack of shoulder external rotation meant I had really weak wrists and put extra strain on my wrists.

To have strength, you need stability or your body shuts off strength to avoid injury (hopefully). You have a few ways to get stiffness: one is stiffening random muscles, the other is external rotation.

So why do we do massage, and stretch

Because while that tightness is a symptom, it’s also limiting range of motion, and by loosening (even temporarily), we can be more effective at strengthening (again exactly the same as anxiety in mental pain).

Approaches to Managing Pain

Physio Therapy

Physio therapy is a great model for improvement. You go, they coach you, and then you have to do the work.

Critical because Practice makes permanent. See

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Massage, Stretch, Strengthen

Massage (aka Release) feels amazing, stretching feels good, and strengthening feels like it does nothing. Inconveniently, massage only lasts 20 minutes, stretching a day or 2, but strengthening lasts forever.

Self Release: Massage and Foam Roller, Tennis Ball

Foam roller and Tennis ball are mostly self massage, which is mostly less effective than an expert nailing it.
Remember this is not fixing the problem, it’s giving you a window to maximize your efficiency in fixing the problem.

Great Books For Across the Board Improvements

Rebuilding Milo - From the Squat University guy (Aaron Horschig). Focuses on diagnosing and fixing common lifting injuries (hip, knee, shoulder, back). Very practical with specific rehab protocols and movement assessments.
Built from Broken - Scott Hogan’s science-based approach to joint health and injury recovery. Covers the “why” behind pain and provides structured programs for rebuilding strength after injury. Good on nutrition’s role in tissue healing.