You’ve recently started exercising, or you might have even been training for a while but have increased your intensity/volume or changed something in your usual program, but now you are starting to have pain. What should you do?

Firstly, this is a really common thing to experience, and is a normal thing, especially during the rehabilitation process from an injury.

Whether you are having pain before, during or after exercising, we commonly get asked a whole number of questions around this topic: ‘what should you do if you feel pain while exercising? Should you push through sore muscles? Should you stop working out if you feel pain? Are you supposed to be in pain when you exercise? Should muscles hurt during a workout?

This blog will hopefully provide you with enough knowledge and information so that you have enough confidence and knowledge to answer those questions yourself.

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A few important things you need to know first:

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•  Pain does not equal damage, pain is an experience based on various biological, psychological and social factors (I’d suggest having a read of our blog: “what is pain” if this doesn’t make much sense). Essentially, just because you are feeling pain doesn’t necessarily mean you have caused or are causing yourself damage, so it isn’t necessary to immediately STOP an exercise or movement just because you are experiencing pain. There are some circumstances though where this may be the case, but we will get into that a little later on.
• Injuries can occur without pain, and pain can occur without an injury. Because of this relationship, pain in isolation is a rather poor predictor of injury. Similarly, just because you feel more pain, doesn’t mean more damage or injury, think about how painful a paper cut is, but the amount of damage is rather small!
• Tissue damage may occur when load demands exceeded the capacity of body tissues. ‘A physical complaint or observable damage to body tissue produced by the transfer of energy experienced or sustained by an athlete during participation in Athletics training or competition, regardless of whether it received medical attention or its consequences with respect to impairments in connection with competition or training’ (Timpka, et al., 2014). Even though this definition was in relation to athletics, this can be simplified by saying, an injury is when the body is placed under a larger force than it is capable of withstanding or producing, which results in damage to body tissues.
• No singular exercise or movement is inherently dangerous or has a higher risk of injury. People often view something like the deadlift as a scary exercise, and if done “wrong” will cause any number of back injuries and problems. Keeping the above in mind, if your body has the capacity and ability to withstand a certain task, then the risk of injury is significantly less compared to a task where you don’t have the physical capacity to complete. By this understanding, if you have gained enough adaptations towards a certain task, you should have the ability to perform that task.

Example:

• Person A and person B both attempt the same task of lifting 100kgs off the floor 10 times.
• Person A has the ability to lift 150kgs with ease for more than 10 repetitions.
• Person B is only able to lift 50kgs for 8 repetitions.
• If person B suffered an injury from doing this task, is the movement dangerous? Or is it perhaps the demands of the task which person B is underprepared for?

Complete rest and avoidance aren’t the answer.

Just because a particular movement or exercise is causing pain or discomfort, doesn’t mean you should stop moving altogether. Usually there are other alternative movements, exercises or activities that you may still be able to do without significant discomfort.

One adjustment you can do is continue performing the same overall task, but decrease or change the demand required.

I.e. If doing a lunge is painful the solution might be to change your position, decrease the load required, or perform a variation of a lunge instead.

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Recovery between sessions is important for allowing for longterm sustainability/adherence to an exercise program and to improve your ability to perform. There are some circumstances where a short period of rest from aggravating activities is suitable, but this doesn’t mean you need to completely stop what you are doing. If we completely rest from all activities until pain subsides, we have the potential to lose the improvements and adaptations we have made, but more importantly, we disengage from activities that are meaningful and important to us. In cases of longstanding and persistent pain, we know that this behaviour is actually unhelpful (Zale, 2015).

By conditioning ourselves to avoid and stop activities whenever a painful stimulus occurs, we can decrease our tolerance, and our pain system gets more efficient at producing pain to protect us from something we have determined to be ‘dangerous’ to us.

Completely ignoring and pushing through pain isn’t always helpful either.

Overtraining is possible, and not allowing for sufficient recovery between sessions can decrease your ability to perform and can lead to overuse injuries such as tendinopathies and bone stress injuries or stress fractures (Warden, 2014). However, these injuries do not appear overnight or with sudden onset, if you have had pain brought upon by certain activities that you are not able to change or modify and you are continuing to persist with your training and you are having an increase in symptoms with activities, it is important to recognise this as a trigger to re-assess your training schedule or program.

Find your level of tolerance.

If resting for too long, and overtraining aren’t the answer, perhaps there’s a middle ground to these actions? As I mentioned earlier, it’s encouraged that you continue to engage in movement or activities. You might need to make some modifications but the overall aim is to gradually build and progress on this new starting point so that you are eventually back to the level you were before things became too much to tolerate.

If you are finding that it is taking you more than 3-4 days to recover from a session due to your symptoms being intolerable the following days, you may benefit from decreasing your overall intensity, or volume of activity, until you have the capacity for the level of activity you are currently doing. Everyone is different but as a generic rule, find the level of activity that you can tolerate and recover from within 48hrs. This is to allow you to recover adequately so you can continue to train and exercise without impaired performance or function, sustainable over a period of time.

You don’t have to be PAIN-FREE - read our blog on this here.

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But as a short summary, you don’t need to wait until you have zero symptoms, or you don’t need to only do exercises that do not cause symptoms. 

Similar to the above point, find your level of tolerance. Remember that pain doesn’t mean damage, and you can hurt but not be doing harm. Symptoms of pain and discomfort are normal experiences during the rehabilitation process from injury, and recovery from an injury is never a linear upward path without setbacks. Be patient, and progress yourself gradually.

What level of pain should be acceptable?

This is a highly individualised question, and given that pain is an experience unique to the person experiencing it, it is hard to give blanket generic statements to advise you on this. That being said here’s a very simple way of approaching pain during exercise:

1.    Is it tolerable and are you comfortable with this?

Yes – you are safe, continue on as tolerated!

No – go to 2.

2.    Does it settle or return to baseline with a short rest (minutes)?

Yes – go to 1.

No – go to 3.

3.    Am I able to change it in any way?

Yes – go to 1.

No – go to 4.

4.    Is it any less concerning when you try for a second-round/ set?

Yes – go to 1.

No – go to 5.

5.    Are there any other movements you can continue with instead before trying again later?

Yes – go to 1.

No – go to 6.

6.    Do you think you need some help?

Yes – You may benefit from seeking out some assistance

No – Reassess your program/schedule. Remember pain is multi-factorial, think about what other things could be causing what you are feeling right now.

Still unsure what to do?

If you have tried the above and feel like you are stuck… maybe you are unable to find alternatives or changes you can make, or perhaps you are still concerned with the symptoms you are feeling, you may benefit from seeking out some assistance from a health professional you trust.

Our team is always happy to help if you are unsure what to do, we will help you identify the potential barriers so that you can keep active and continue to work towards what is meaningful to you.

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References

Warden, S. J., Davis, I. S., & Fredericson, M.(2014). Management and prevention of bone stress injuries in long-distancerunners. journal of orthopaedic & sports physical therapy, 44(10),749-765.

Timpka, T., Alonso, J. M., Jacobsson, J., Junge,A., Branco, P., Clarsen, B., ... & Edouard, P. (2014). Injury and illnessdefinitions and data collection procedures for use in epidemiological studiesin Athletics (track and field): consensus statement. British Journal ofSports Medicine, 48(7), 483-490.

Zale, E. L., & Ditre, J. W. (2015).Pain-Related Fear, Disability, and the Fear-Avoidance Model of ChronicPain. Current opinion in psychology, 5, 24–30.https://doi.org/10.1016/j.copsyc.2015.03.014

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