When is it OK to exercise with pain?
By Dr. Gina Hahn, DPT, RKC
We all know that exercising regularly and eating nutritious foods are important for good health, but what if you have pain when you exercise? How are you supposed to get fit or stay fit if exercising hurts? Should you just "push through it"? The answer is it depends.
Pain is very personal. Some of us have experienced a lot of injuries in life from minor trips and falls, to more serious events like car accidents. Some of us have endured painful recovery from surgery or birth. All of your experiences are mapped on your brain and filed away as a memory.
PAIN IS PROTECTIVE
Pain does not equal tissue damage. It is not a one-to-one ratio. Pain is our body's natural protective mechanism. It serves to protect us from injury. Think of it as your body's smoke alarm: Imagine cooking bacon in the kitchen and the grease gets so hot that it starts to smoke. The smoke alarm alerts you of the smoke. You are present in your mind and body, actively cooking the bacon, so you know why the alarm is going off. The first steps you take (if you're like me) are to a) turn down the stove, b) open the window and c) fan the smoke away from the alarm. You don't run out of the house because you are well aware of why the smoke alarm is sounding.
Treat your pain the same way. If you are doing push-ups and your shoulder starts to hurt (rated a yellow on the traffic light) at the bottom of the push-up, then don't go as far down, decrease the range of motion of your push-up and feel if that decreases the shoulder pain. You know the trigger -- it's the bottom of the push up -- instead of stopping, try to modify the activity.
When pain rears its ugly head, our brain has to determine 'HOW BAD IS THIS?' And the way our brain makes that decision is by recalling past experiences and relating them to your current situation. This is not in your control, but what is under your control is what you do when you feel pain.
Here are a few questions to ask yourself if you're experiencing pain or discomfort with exercise:
Can I tolerate this pain for 2-3 more reps?
Does it hurt so bad that I'm considering (in that moment) taking pain killers or over-the-counter medication?
If I change my body position, does the pain reduce?
If I decrease the weight or resistance, does the pain reduce?
In healthcare we are taught to use a pain scale from 0-10 (0= no pain, 10= the worse pain). Although this scale is important, it often doesn't do your pain any justice because a number is just a number without meaning. A different way to think about the pain scale is to use a traffic light metaphor:
RED means stop if you think/feel: "Wow, I need to take Tylenol" or "I really need a break"
YELLOW means proceed with caution if you think/feel: "I have discomfort but I can deal with it"
GREEN means go if you think/feel: "I have discomfort, but I can ignore it"
This gives the pain more meaning and allows you to make appropriate decisions on how to proceed instead of just “running out of the house”.
WHAT IF THE PAIN IS CHRONIC?
Chronic pain is slightly different. When our body experiences unrelenting pain for months or even years on end, there are proven changes that occur in our brain. Our brain adapts to a new norm and becomes OVER-protective, and not as informative.
Let's take the smoke alarm analogy again; this time the smoke alarm is more sensitive. You are about to cook the bacon, so you turn on the stove and open the package when all of a sudden the alarm gets extremely loud because it detects the heat from the stove, nothing to do with an actual fire. You respond with intensity and run out of the house! The alarm system did not do its job well, it alerted you, but not for the right reason. It has lost its ability to gather the right information and has therefore failed in helping you to make an informed decision.
Your personal report of pain on the 0-10 scale and traffic light are likely going to be more sensitive, and that's OK! You will likely have to endure a little more discomfort (in the yellow zone) during physical activity. In order to re-acclimate your system back to "normal", and build confidence in your body's ability to adapt, it will take time, effort, and support.
WHAT IF I HAVE A HIGH TOLERANCE FOR PAIN?
For those of you that have a higher tolerance for pain, you have probably experienced a lot of minor or major injuries and accidents in your life, and so your system, too, has adapted. You likely have a larger library of memories of uncomfortable scenarios that you survived and came out the other side with more confidence about the strength and resilience of your body. Your system is not over or under protective, it's just right for you and your experiences. Both the 0-10 scale and the traffic light still apply to you. All pain is personal.
Pain is protective
Pain does not equal tissue or joint damage
You are in control, use the traffic light and be honest with yourself about HOW uncomfortable you are, don't push through red
If you can tolerate the discomfort, then you can proceed (with some caution)
Our brain adapts to unrelenting chronic pain by becoming MORE sensitive and LESS informative, if this is you, there is hope that you can overcome this but you will need to work with a professional to get the support and information you need to feel safe and confident with exercise
SAY HELLO! TO GREEN & YELLOW
You're here reading this because you have experienced some level of pain or discomfort with exercise, and you're wondering how to manage it in order to get the outcome you want (whether that outcome is injury rehab or trying to lose the "covid-19 pounds" it doesn't matter). The main takeaway is: Exercise is positive stress to the body, and the body might respond with a gentle alarm (green & yellow on the traffic light). You know your body better than anyone. Listen to what your body is telling you. Don't be overly cautious because sometimes in an effort to consciously protect yourself, you end up holding yourself back from progress.
The good news is that the human body is incredibly adaptable and responds well to small doses of new and challenging things!
WAYS TO PREPARE YOUR BODY FOR THE STRESS OF EXERCISE
Drink lots of fluids on a daily basis, and especially on days that you are exercising
Warm up! You have heard this before, but it really is important (read why below)
If you are trying something new (good for you!), move with a slower pace
Move and activate these common areas that get rusty from being in 1 or 2 positions all day (or night): ankles, hips, upper back and neck
Warming up is not just about getting your heart rate up, it's about exciting your nervous system, waking up your core, and getting your tissues more mobile before you put them under stress.
Most of you probably spend a lot of your day working on a computer. And even if you do a good job of switching from sitting to standing, you have still gotten "rusty" during your work day like the tin man. Now it's time to workout. Your body is hungry for movement!
The first thing on your agenda should be an active warm up:
stand up, march in place slowly
do a few mini squats
add arm and neck rotations
Rotate your spine from side to side
get on the floor and do some cat and cow poses
If able, perform a plank or side plank to activate your core
add some bridges
finally, stand up again and try balancing on one leg then the other
In total you just spent about 10 minutes actively moving. Not bad! Your nervous system is now more awake because you just asked a lot more muscles and joints to move than you have all day in a sitting or standing position. You probably got your heart rate up and can sense that you're breathing is a little heavier. Your blood is flowing to parts of your body that have been dormant for a few hours.
Your body is now more prepared for whatever is coming next. The movement preparation may allow you to get deeper into your poses during your workout or to go an extra mile. It also improves blood flow to your brain which can help mitigate some discomfort.
If you have pain that is keeping you from being as active as you want or need, please email or call Gina to schedule your FREE consultation. I look forward to hearing from you and helping you along your fitness and wellness journey!