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Strength Training for Pain Relief (1 Key Brain-Based Approach!)- Episode 438

Video Highlights

- A quick neurology primer on the pathways for voluntary movement
- Clues for knowing if a client is a good candidate for extended unilateral training
- Programming ideas for clients who are concerned with becoming asymmetric

Hi, I’m Dr. Eric Cobb of Z-Health Performance.

Today we’re going to be talking about how to structure your training if you have a single-sided pain presentation.

This is going to have some brain science in it so stay tuned as we get through the rest of the episode.

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So today I’m going to talk a little bit about something that we see quite regularly that as a brain-based practitioner is super interesting and also important to address

Often we have people come in and they say, look, I’m having pain and then you ask them where.

Well, it’s my right shoulder. I have elbow tendonitis or tennis elbow on the right side as well.

My right knee hurts. And I have plantar fasciitis on the right.

As a human being, we are considered to be a contralateral biped in motion, which means my left leg and my right arm work together.

So usually when we see biomechanical, if you want to call it that, issues we will often see left side lower body issues and right side upper body issues.

But probably at least forty to fifty percent of the people that we see violate that rule. They will complain about single-sided, pain, issues or single-sided injuries.

If that’s you, one of the things that we have talked about in prior blogs is unilateral versus bilateral training because of how the brain works.

It’s a pretty simple idea. The right side of your brain, controls the left side of your body involuntary movement.

All right. So if I ask you to do a row, a curl, whatever with your left side, the driver for that is going to be the right side of your brain,
but very importantly, another job of the right side of the brain is that as you’re creating voluntary movement on the left, it should be stabilizing the right side of the body, in order to allow you to create force.

Additionally, what’s happening on the right side, is it sending signals down to your brainstem to control muscle tone so that your joints are stable.

And also, as a part of what’s called an anti-nociceptive system, which is basically a pain inhibition system.

So, what we often see in people who, let’s say, you’re having a lot of right-sided pain, if we test them, they have poor coordination on the left side of the body and/or poor strength on the left side of the body.

And as a result of that, they are lacking activation in the right side of the brain and subsequently the right brainstem isn’t getting stimulation.

So now all of a sudden, the brainstem that is supposed to inhibit pain on the right side is not doing its job and we start to see these types of presentations.

Now, the reason I’m talking all that through with you, is that often we see these people whether it’s a patient, athlete, whatever, we say what we want to start off with is six weeks of unilateral training and when they ask what that means, we’re going to say, we’re going to train the left side of your body for the next six weeks.

The number one thing we hear is, I won’t do that. I can’t do that. I’ll wind up asymmetric. So I always tell them, look, you’re already asymmetric. None of us are perfectly symmetric.

But right now will you have a neurological asymmetry, if you want to call it that that may be contributing to your pain, and understand

I’m oversimplifying all this for the sake of a YouTube video.

But having said that, a lot of people just simply refuse.

They’re like, no, there’s no way that I can do that.

And if that’s you, if that sounds like a very weird idea that you would just focus on training one side of your body, in order to help pain on the other side of your body for six weeks.

It simply then comes down to volume.

So if you are let’s say this person with all right-sided pain, know that you’re going to need to create a lot of left-sided activity.

So if you are still going to be in the gym, you’re still going to be doing exercise of some type, what we would then recommend is a 70/30 volume split.

Which means that if I’m going to do a lot of work and I’m going to refuse to not do bilateral work.

For three reps on the right side, you need to do seven reps on the left side.

It’s a very simple idea.


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Now, there’s nothing magical about this 70/30 rule.

It’s just having worked with thousands of people that seems like something that they will actually do as opposed to me saying, let’s do 6 and 4 because at that point we’re now getting almost equal amounts of load.

80/20 actually I think works better for many people. But again, just doing 2 reps versus eight makes people freak out.

So I just want to make sure that you have an idea that if you fit into this category of, “I’ve injured the right side of my body a bunch, I have pain on the right-side of my body,

The number one takeaway is you may need to spend a lot of time doing left-sided training.

Number two, you don’t have to only train the left side of your body forever.

Remember I said in the beginning we normally do a six-week workup.

But if that also feels extremely strange to you.

Just keep in mind the 70/30 volume split, you may find that it works wonders.

So what I want you to do is if this is you, right side, you’re going to train 70/30, focused on the left.

If you have left side only pain, you’re going to do a 70/30, the reverse, focusing on the right side. Try this before your training session.

Check your ranges of motion. Check your pain levels.

Warm-up, do a 70/30 training session, and then retest.

Notice if you feel significantly different than you would after one of your more standard training sessions, if that is the case, then this is probably something you need to stick to, as I said, for the next four to six weeks.

It may make a tremendous difference ultimately in your ability to rehabilitate the issues that you’re experiencing.

So give this a shot and let us know what you think. Thanks.

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