Exercising Around Pain
The information in this post regarding injury is given in generality and is not to replace/provide medical advice. You should always consult with your medical providers about training around pain.
Getting injured sucks. There is no question about it, but in general, injuries should not prevent us from staying active.
I have helped every patient that walks through the door figure out how to stay active while injured. Here’s an example: I currently have a patient who is four days post-op from arthroscopic surgery, and she is already dying to get back into the gym.
My advice to her, let it rest roughly one more week so we can continue to strengthen the knee and improve your gait. Once we reach these goals, we can discuss how to train around your injury.
If you have pain, here is the advice I would give you:
1. Use Pain As Your Guide:
- If you have pain during, directly after, or within 24 hours of completing your workout - that tells me either the volume, intensity and/or exercise selection was too high and you must regress.
Example: If you ran 3 miles, and at mile 1 you had pain, you must decrease the distance you are running to below 1 mile to prevent any discomfort from occurring.
Why? If you are continuously overloading tissue into pain, you will continue to make your injury worse. This happens because you are not giving the tissues adequate time to heal and if the forces are high enough it can cause more damage.
You Are Allowed To Have Soreness
Any soreness in the area that was injured less than a 4 out of 10 soreness level means you are putting positive stress into the tissue.
Secondly, for this stress to be positive, the soreness should not exceed 48 hours.
If you were injury free, you could have soreness that lasts longer than 48 hours, but for healing tissue, this is an indicator of negative stress and poorly effects healing.
Don’t Rely On Previous Experience/Physical Activity Levels
When returning to exercise, don’t start where you left off. Remember every tissue has a limit for how much force can be applied before we experience pain.
If you return right away to your pre-injury activity level, you may still experience pain.
When our patient above is ready to return to her active lifestyle, we will start her off easy (this will be as early as next week!). We will get her on the bike, and find a routine that allows her to continue strengthening her core, upper body, and non-affected leg, all while maintaining the integrity of the joints above and below the injury (the hip and ankle).
During the process, we will be using the three points above to ensure that we are allowing proper healing of the meniscus, and ensure that we are progressively loading the knee enough to make a positive adaptation.
If you didn’t have surgery and thought you didn’t need to abide by these rules, let’s take my experience with low back pain as an example.
Two and a half years ago I hurt my back. Every time I started to feel better, I would get back into deadlifting because it is one of my favorite exercises.
Before the injury, I was able to deadlift 350 lbs, so it was safe to say that 225lbs wasn’t necessarily heavy to me. So this is the weight I would start with every time I was ready to return to deadlifting. Each week I would increase the load, but for some reason, without fail, once I hit 275lbs my back would go into spasm.
This is a case of loading tissues too fast. My body was not prepared for 275lbs, so my nervous system would set off the alarm and create a painful stimulus. The proper thing for me to do in this situation is to train higher volumes at slightly lower weights (that were pain-free) and prepare my body for the jump to 275lbs. For a while, it was hard for me to put my ego aside, but eventually, I took my advice. I haven’t deadlifted for the last nine months, not because of pain, but because my coach hasn’t programmed them for me. But with all that said, the other day I deadlifted 275lbs by accident as I was coaching a client. The best part about it was that it felt pretty light, and there was no pain afterward.
We must respect pain, and injury - yet we should not be fearful of getting back into the activities that once caused pain. If we follow the rules above, we can all desensitize tissue, and get back to the living life the way we once did.