Barbell Lifting and the Biopsychosocial Model of Pain

Teaching ourselves that we can do hard things is key to building resilience. And barbell training is hard.

Introduction

Pain is a complex phenomenon. While it’s tempting to think of lifting injuries as purely physical, there’s more to it. Other factors affect the duration and intensity of symptoms. These include our overall emotional state, thoughts about pain, and social support systems.

Thankfully, that means we can use the same factors to benefit us. Two examples are positive self-talk and a robust training community. They can speed up your recovery process and make you more resilient to future tweaks.

In addition, lifting weights itself provides unique advantages. The act of strength training provides proof that we’re resilient and powerful. Add barbell lifts into the mix, and you can completely change the way you operate in the world.

In this article, I’ll cover this phenomenon rooted in the biopsychosocial pain model. I’ll discuss how I used it to overcome chronic pain.

My Early Injury Experiences

My first significant injury occurred during my first year of high school during an off-season basketball tournament. While driving to the basket, I landed awkwardly on an opponent’s foot, my ankle completely turning underneath me. It looked gruesome enough that my teammates and the crowd gasped.

A couple of volunteer coaches carried me to a makeshift office and called my mom in a panic. She picked me up and freaked out even more. We spent hours in the emergency room. Eventually, the doctor confirmed it wasn’t broken and sent us on our way.

This was back in the dark ages when physical therapy was rare. The conventional wisdom was that complete rest for as long as possible was the key to joint healing.

Fast forward a few months, and I was still on crutches. My successful stint on varsity seemed like a distant memory. I was out of shape while isolated from my teammates and my favorite activity.

I was far behind my teammates when I returned to the court the next season. Fueled by immaturity and frustration, I quit the sport altogether. I became even more de-conditioned.

For years afterward, I would suffer periodic sprains. These sparked all the panic, fear, and anxiety from the first incident, and I would respond with complete immobilization.

The injury followed me until it became part of my identity in my early 20s. I “wasn’t a runner” and quit pick-up basketball because “my joints were shot.”

In my mid-20s, I had two surgeries, with each doctor convincinf me that a simple surgical fix would work.

But that’s rarely the case. While the surgeons may have addressed an underlying biomechanical issue, I hadn’t adjusted my mindset and belief system. I listened when doctors recommended I stick to light cardio for the rest of my life to stave off total joint replacement.

I limped around, sure that there was no solution.

Until I found powerlifting. And then there was.

What is the Biopsychosocial Model of Pain?

Credit: European Pain Federation

Many people have had similar experiences. The details change, but the general context remains.

The events around injury dictate how badly we feel. Pain is as much an output from the brain as an input from the body. Seeing your coaches or teammates react in horror will send alarm bells screaming in your head. Hearing a doctor tell you to give up something you love will cause a major stress response.

It will be even worse if that thing is your source of community.

This scenario fits into a model known as the biopsychosocial model of pain.

Dr. George L. Engel developed it in the late 1970s (click here for an interesting overview). He wanted to challenge the idea that physical injury or damage is the only source of pain. Instead, he proposed that pain is a complex phenomenon. Biological, psychological, and social factors all play a role and often reinforce one another.

It’s important to note that “bio” is still in the word. Injuries happen and are real; the model does not claim that pain is all in your head. Instead, it lays out how other factors influence how much pain you might experience or how quickly you can bounce back.

Here’s an overview of the main biopsychosocial factors and weight-lifting examples.

Biological factors

Biological factors refer to the physical processes within the body that can contribute to pain, such as tissue damage. When performing a heavy barbell squat, for example, you cause micro-tears within the muscle that can lead to soreness.

You can also experience acute events, such as straining a tendon.

Psychological factors

Psychological factors encompass our thoughts, emotions, and perceptions. You will often hear athletes say that regaining confidence is the final part of rehab after healing an injury. Feelings of anxiety or fear can amplify our pain perception.

Say you pulled a hamstring while barbell deadlifting. After you’ve recovered, you will naturally be cautious when you try the lift again. This is a perfectly natural defense mechanism. Our brains are wired to help us avoid things that hurt.

However, if you’re overly sensitive to every muscle sensation, your anxiety may lead to feeling pain even if you’re physically fine. Or, you may avoid any hip-hinging movements for a very long period. That will make you weaker, leading to further delay in healing.

Social factors

Social factors come from many places. Our environment, support systems, and cultural beliefs affect pain. For example, lifting alone is a very different experience from lifting in a gym. Failing a barbell bench press in your garage can be very jarring if you set-up your safeties incorrectly.

If you’re working with human spotters, you won’t even register the experience. Or, you may get the rep because other lifters are psyching you up. These different scenarios may affect your mental state, which can influence pain perceptions in the ways described above.

How Barbell Lifting Affects These Factors

At some point, I became stubborn enough to ignore the advice of my doctors and pursue heavy lifting. I had a vague idea that powerlifting would improve my situation, even if I was unclear on the details. I was right, and I subsequently learned why.

Biological

Compound lifts are uniquely stressful (in a good way) to the body. These movement patterns engage multiple muscle groups and joints.

Think of the overhead press. In the starting position, you must first stabilize the body by standing slightly wider than shoulder width with palms facing out. From there, the lift requires you to coordinate different body parts throughout each phase of the lift. The shoulder blades are used differently at the bottom and top positions.

Since compound barbell lifts are potent stressors, you must create an intelligent program. Managing the load, for example, will help reduce the risk of injury.

But assuming that’s the case, the payoff is enormous. You’re increasing strength, lean body mass, power, and coordination. You’re also building body awareness, a crucial part of functional fitness. Knowing when to squat versus hip hinge will make a big difference as you wrestle a couch up three flights of stairs.

For me, I noticed a massive improvement in my ankle from squatting. Or, more specifically, from squatting more like a powerlifter.

Loading a low bar squat strengthened all the soft tissues, including the ligaments, tendons, and muscles. In addition, loading the ankle through dorsiflexion improved my overall range of motion. You can also reference this online guide for some specific mobility drills.

Psychological

Most strength training exercises work wonders, whether it's free weights or body weight.

Physical improvements from lifting heavy barbells are only one part of the story. The required mental resolve also changes our perception of our fragility and our resilience.

But something uniquely powerful happens when we lift heavy barbells. It’s primal to raise a bar made from iron right off the ground or fight up from the bottom of a squat.

In addition, barbells force us to realize we can do hard things. While you can be passive with a weight machine, even light weights on a squat demand full attention. And once the weight increases, you must act against any lazy instincts. Your body may say you’re tired, and your brain might flinch at crunching into a low position.

But you will do it and come to embrace your resolve and toughness. That’s where we fully acknowledge we’re not fragile.

Our bodies were made to withstand physical challenges. Pain is not what defines us.

This was the most significant factor in embracing a new identity as a lifter and athlete. Once I realized my capacity for grit, I internalized my ability to train through setbacks. I began rehabbing my ankle not just for powerlifting but also for running. The thing I said I could never do.

Social

We all crave human connection. And with barbell lifting comes the opportunity to find your community.

This can come in many forms. I’ve had new clients come to me with nagging or chronic pain and feel much better by the end of one personal training session.

Some of that is because of physical changes. But a much larger factor is personal experience.

As a strength coach, I take professional pride in actively listening to my clients. I can usually spot the lifting faults potentially causing pain or assure them that their form is safe. And perhaps most importantly, I promise them we’ll collectively work through the problem. Feeling more optimistic about their recovery influences their psychological perception of pain.

Conclusion

The biopsychosocial model proposes that several factors influence pain. Our physical, psychological, and social states often work together.

Barbell training offers unique benefits in the context of this model. By fusing fortitude and community, lifting changes our perception of pain, improving sport performance and quality of life.