Pain and exercise, Finding the right balance
Traditionally within the training, rehab and medical fields we have been taught to avoid pain with activity or exercise at all costs, this messaging is still echoed today by many doctors, trainers, physiotherapists etc. While it may seem intuitive to avoid movements and exercises that cause pain, avoiding movement all together can lead to a host of issues and also delay the healing process.
Our bodies are extremely adaptable, efficient and “plastic”. We hear a lot about “neuroplasticity” when it comes to psychology, neuroscience and changing behaviours, but the truth is our whole body and all of its tissues are “plastic” to some degree. When we talk about neuroplasticity we often hear the phrase that “neurons that fire together wire together” meaning that if we fire the same neurons in the same patterns, those connections will become stronger, which helps our brain to be more efficient. Changing these neural connections like deep seated behavioural patterns or bad habits can be challenging because these patterns can become so so engrained in our nervous system while choosing other habits, behaviours or reactions seems impossible because those connections/patterns are weak or non-existent. But over time and with enough repetitions we can create new neural connections; new habits and behaviours and make them stronger, while the old ones become weaker and whither away. This is the basic premise behind behaviour change techniques such as cognitive behavioural therapy.
When it comes to our tissues and joints the same rules apply. The more we move and use our tissue and joints, the more they will adapt and become more efficient at what we are trying to do. Anyone with some experience with weight training can attest to this. You start off with a weight that is challenging to lift, you do it for a while and the weight becomes easier. To become more efficient our body makes stronger neural connections so that our muscles our better coordinated, we gain more muscle, our tendons and ligaments become thicker, we create more blood vessels in the area and the metabolism of our cells becomes more efficient. When you stop training, the opposite occurs, your body adapts and you become less efficient at doing that certain task because, as the old saying goes; if you don’t use it you lose it. In this way we can see how our tissues are plastic and will change depending on the demands that they are experiencing.
This is why complete rest or avoidance of movement or exercise after an injury is not advised. The less we use an area of the body, the more deconditioned it will become, making the rehab process that much harder. The more you rest and avoid movement, the more muscle you will lose, your movement will be less coordinated, your cells will become less efficient at making energy, there will be less blood flow to the area and all the structures will become weaker. Not to mention our tissues and joints need lots of movement to help circulate blood, lymph and synovial fluid in order to transport nutrients to our cells and remove waste products, if we aren’t moving enough these processes stagnate and can contribute to feelings stiffness and soreness.
When recovering from an injury, It is true that we don’t want to push the area to the point where we are creating more tissue damage because this will only delay the healing process as well. The key to maximizing recovery during these times is to do just enough movement/exercise to create some positive adaptations while avoiding further tissue damage/inflammation. In order to do this it is important to have a system in place to know how much we should push into pain.
The key is to start off small and make gradual steps towards your goals while being mindful of how you feel during and after an exercise. During rehab it should be expected to feel some discomfort along the way, especially when trying a new exercise or making a progression. While discomfort is normal and expected we don’t want to do is cause a flare up after doing an activity, where the pain increases after the workout, into the evening or the next day and starts to affect other activities in your life. This would be counter productive.
What I like to use is a traffic light analogy for navigating pain during exercise/movement.
Green light - no pain or discomfort during exercise. No flare ups or increases in pain after. This exercise, movement or activity is safe to do. Try and do as much of it as possible, ex. Walking
Yellow light - some discomfort or pain during exercise. Pain is not overly intense and quickly settles down (within 20mins) of doing the activity. This activity is safe to do, but be mindful while doing it and don’t progress too fast
Red light - significant pain during activity and/or activity causes a flare up and affects other areas of life such as sleep. Scale back on this exercise or take it out of your program for the time being and come back to it later.
In this way we can start to create a list of exercises and activities that we can tolerate as we rehab an injury. If we do happen to push it too hard and cause a flare up, this gives us an idea of where our capacity is at the moment and gives us information as to how to proceed with rehab exercises. So while it may not be pleasant during the flare up, we can reframe it as knowing how much our body can handle at that time. The more we are able to move and use our bodies while avoiding flare ups, the better the body will be able to recover after and injury.
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