Recent injury? Managing an old injury? Want to keep training but unsure if the pain you’re experiencing is okay? In this blog we discuss training when in pain
Firstly, it’s important to remember that pain does not always correlate with tissue damage and ‘hurt does not equal harm(1)’. A good example of this is when you have a hot shower after being sunburnt – it can really sting but doesn’t necessarily mean you’re doing more damage to your skin, it’s just that the skin is more sensitive. This same concept can be applied when we experience pain during training.
The great news is that whether you’re returning from recent injury or managing more persistent and ongoing pain, training with pain can be acceptable, even a good thing! A 2017 systematic review by Smith et al.(2) demonstrated that individuals suffering chronic pain (pain present for more than 3 months) who performed exercises with some level of pain present, reported lower levels of pain in the short term over individuals who performed completely pain-free exercises. Additionally, research demonstrates that movement and exercise is the best treatment strategy in managing hip and knee osteoarthritis and that mild pain during this exercise is acceptable(3).
Depending on the type of injury (such as a muscle strain, tendinopathy, low back pain), a similar approach can be applied to acute (or new) injuries.
A recent study conducted on hamstring strains by Hickey et al.(4) investigated if performing rehab exercises in the presence of pain resulted in faster return to play times, compared to those who completed their rehab completely pain free. Although it found a similar return to play time, it did find that those who performed rehab with some level of pain had greater hamstring strength when they returned.
Tendinopathy (i.e Achilles, plantar fasciopathy) is another condition that requires progressive loading, and research demonstrates that painful rehabilitation has no detrimental effects on recovery. Those who perform rehab with some pain report greater symptomatic improvements compared to those who keep their rehab completely pain free (5).
So how do you know what is an acceptable level of pain and when you may need to ease off?
We like to use the scale below, and giving the pain a score out of 10: with 10 being the worst pain ever for YOU, and 0 being NO pain. If you are experiencing 0-3/10 pain, then you may be OK to increase the loads. Pain between 3-5 is OK, but maybe keep the load the same. Experiencing pain between 5-10 is a sign you need to modify what you are doing.
It’s also important that your pain/symptoms quickly settle back to baseline levels within 24 hours. Other factors such as training frequency and duration may need to be modified if baseline pain levels are not being achieved fast enough.
Remember - the human body is resilient and adaptable. Loading joints and muscles when injured is critical in being able to return to full function and performance. If you train and pain is present, think of the pain as a stimulus for adaptation – you’re making your body stronger and giving it the best opportunity to recover. While pain should not be the only criteria in judging how well your recovery is going, it can be a useful guide in progressing your rehabilitation program.
Whilst the above information acts as a good guide, it is important to ensure that you get a diagnosis from your health professional to ensure your pain is something that can be exercised safely.
In summary, remember:
Pain does not correlate with tissue damage
Your body is strong and resilient!
Pain you rate as less than 4/10 is acceptable to continue to train through
If during an activity you rate your pain more than 5/10 , it’s time to modify (decreasing weight, changing position etc)
If in doubt, don’t hesitate to reach out to us at www.healthhp.com.au
References
Moseley G. Reconceptualising pain according to modern pain science. Physical Therapy Reviews. 2007;12(3):169-178.
Smith B, Hendrick P, Smith T, Bateman M, Moffatt F, Rathleff M et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. British Journal of Sports Medicine. 2017;51(23):1679-1687.
Brosseau L, Taki J, Desjardins B, Thevenot O, Fransen M, Wells G et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Clinical Rehabilitation. 2017;31(5):596-611.
Hickey J, Timmins R, Maniar N, Rio E, Hickey P, Pitcher C et al. Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy. 2019;:1-35.
Silbernagel K, Thomeé R, Eriksson B, Karlsson J. Continued Sports Activity, Using a Pain-Monitoring Model, during Rehabilitation in Patients with Achilles Tendinopathy. The American Journal of Sports Medicine. 2007;35(6):897-906.