Is it wrong to exercise through pain?

There is no one-size-fits-all when explaining your pain; recovery is rarely linear, and sometimes exercise hurts! So many factors affect your pain, and it is important to remember that pain is normal, personal and always real.

One of the most common fears about exercising through injury is that it is painful and may cause more damage. Immobilising or taking pressure off an injury can lead to more severe long-term problems if we don’t move it.

When it comes to pain and tissue damage, both can exist without the other being present. This means that although there may be a pre-existing injury, the level of pain experienced is often a poor measure of that injury and is an unreliable indicator of the presence or extent of tissue damage.

What causes my pain? Pain relies on context and past experiences. It can be influenced by things you see, hear, smell, taste and touch; things you say, think and believe; things you do; places you go; people in your life and things happening to your body. Pain is a conscious experience that involves many brain centres and experiences across time.

Let us use lower back pain as an example.

As clinicians, we often hear, “I am afraid that bending and lifting will worsen my lower back pain.” This is often accompanied by a history of chronic lower back pain and scans with incidental findings. Although scans such as an X-ray, CT or MRI may occasionally be helpful, findings such as disc degeneration, arthritis and disc bulges are extremely common in the pain-free population - meaning they can be a poor interpretation of your symptoms.

Over time as your pain develops (maybe gradually or maybe from an original painful event), the stimulus that causes this pain will become highly sensitised. As a result of a prolonged pain response, muscles that stabilise will often switch off, causing altered movement patterns. The longer these muscles are switched off - the more strength you lose and the more deconditioned you become. Now that your body does not trust these movements that once caused pain (Let’s say you bent over to lift an object, now bending over can trigger this distrust), your new altered and uncontrolled movement patterns can increase your susceptibility to reinjury and re-initiate the pain response - and so the cycle continues!

This is a protective mechanism that has been turned UP. As humans, we are bioplastic; this notion suggests that the systems can change back, and it is biologically implausible to suggest that pain cannot change - what goes up must come down!

Exercising through pain can be scary. However, exercising within tolerable amounts of pain has been proven safe and beneficial. Current research describes exercising into tolerable amounts of pain as rating your pain out of 10; anything below a 3-5/10 is considered safe and tolerable for the individual. In addition, the pain should settle within 3-5 hours and will not worsen the next day. It may be painful to bend, lift, move and mobilise in general with chronic pain, and this is real pain, but developing mobility and strength to relearn these activities are extremely important in improving function, reducing the risk of recurrence and ultimately breaking the vicious pain cycle.

It is important to remember that pain is one of many protective outputs, pain can exist in the absence of any clear injury, and pain does not always represent damage!

All pain experiences are normal and real; learning about pain can be a great form of therapy. When you understand why you hurt, you may hurt less. Once you understand pain, you can make goals, explore different ways to move, improve your health and gradually do more. Knowing where to start when you are in pain can also be scary, but no one should be afraid to move, and sometimes, help is necessary. Physiotherapists are trained to help you understand your condition and the pain associated, so don’t be afraid to ask questions on your next visit!

References

Mosley, G.L. and Butler, D.S. (2017) Explain pain supercharged. South Australia: NOI.