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Pain And Exercise


What Can We Classify As Exercise?


Exercise doesn’t need to mean training in a gym, going for a run, doing a Pilates or yoga class. Exercise can simply be doing something that requires physical exertion above what you typically perform in daily activities. This might include any of the following:


- Walking

- Running

- Swimming

- Yoga

- Pilates

- Weight training

- Skipping

- Bodyweight exercises

- Hiking

- Gardening

- Playing outside with your children (kicking a ball, jumping on a trampoline, throwing a Frisbee)

- Cycling

- Dancing

- Martial arts

And more..

Some of you may have a job as a tradie, or a courier, a teacher. Your job may require you to lift, carry, walk, stand for long periods. Even though these activities may require physical exertion, it is physical activity you are conditioned to, or it isn’t continuous or strenuous enough to have an adaptive effect on your body. If you push wheel barrows around all day, demonstrate dance moves, ride a bike as an Uber Eats delivery person, these are exceptional examples. However, most of our work roles are not strenuous enough to pass as ‘exercise’. Choose something that requires you to expend energy you wouldn’t otherwise be expending.

Hurt Doesn't Always Equal Harm, Pain Is Not Always Equal To The Level Of Damage


Our nervous system is……incredible. From our amazing brain that has the ability to produce complex thought, emotion, movement patterns, memories etc. To its ability to detect where your limbs are in space with your eyes closed, and discriminate between sharp, dull, hot cold….


As amazing as it is, it can also be prone to over-reacting. Pain is a sensation produced in our nervous system AFTER it has received and processed a multitude of stimuli feeding in to it. Sometimes the end result of that processing is the need to produce an intense sensation of pain to ‘protect’ a body part from damage or further injury. Sometimes, instead, your brain may determine that the stimulus it is receiving is not a threat and therefore not worthy of the need to ‘alarm’ you of any potential danger or damage, and little or no pain is produced.


Let’s imagine stubbing your toe on a piece of furniture. Your brain interprets the intensity of the impact, where on your toe you hit, whether it believes there has been tissue damage….But it also is taking into account your fatigue level, your mood, previous experience of stubbing your toe, stressing about whether this toe-stub is going to affect your performance in the half marathon tomorrow, or whether you’re in a hurry to get out the door because you have more important things to do than worry about a sore toe…



All of these factors (and more) taken into account may lead to a severe sharp pain in your toe that lasts for a few days, or may result in a sore toe for a minute, which you’ve forgotten about by the time you’re out of your driveway.

The level of pain you experience is often not equal to the amount of damage you have sustained. (pain of holding a hand over a candle flame, getting a paper cut, pulling a hair from your nostril, popping a pimple on your lip…. These are all quite painful, but all very minor, or not harmful at all.

This is the same with many muscle, joint, ligament, bone, and nerve injuries. You may have intense, nagging, sharp pain in your knee, but there may not be any significant damage. Just as you can have intense low back pain that makes it hard to get out of bed in the morning. This doesn’t mean your back is severely damaged, or even damaged at all.

Quite often your nervous system just over-reacts. Think of it as an overly protective parent


Should You Be Exercising?

You may be unsure if you can exercise at all with your current pain or injury. If you haven’t consulted with your G.P., Osteopath, or other allied health provider this should be your first step.

It is important to first identify the likely factors contributing to your pain or injury. Some injuries such as fracture, inflammatory conditions, bursitis, muscle tears, and more, can be aggravated or worsened with loading or stressing the tissues too much, and if this is the case then exercise would not yet be recommended.

Your health care provider will take a history on the injury or pain, perform a physical assessment, and determine whether your pain or injury is something that needs rest, or avoidance or certain activities, or whether you are clear to exercise.

Fortunately, situations requiring rest and avoidance of exercise are arguably few and far between. Most muscle, tendon, joint, nerve, and ligament injuries are safe to exercise with, and often exercise is beneficial in recovery of the injury.

So if you haven’t yet had it assessed, do that first.


Benefits Of Exercise


Regardless of whether exercise DOES specifically help your pain or injury, there are numerous health benefits to exercise:


- Improved mood

- Improved energy

- Reduces cardiovascular disease risks

- Helps to manage weight

- Improves blood pressure and cholesterol

- Weight bearing exercise is good for reducing or preventing bone density loss

- Decreased risk for some cancers and metabolic diseases

- Improved sleep


https://www.betterhealth.vic.gov.au/health/healthyliving/physical-activity-its-important

So even though you may not reduce your healing time with your exercise, there are many other benefits to being regularly active and participating in regular exercise. These benefits can often help many of the factors that may be contributing to you pain, or help reduce or eliminate factors that are inhibiting your recovery.


Choosing Your Exercise


Once you get to this point you should have an understanding of whether you are clear to exercise with your injury or pain. So the next step is to choose what you want to do for exercise. The answer… Something you enjoy.

If you don’t like walking, don’t decide to start walking. If you don’t want to go to the gym and lift weights, don’t take up weight training. The exercise needs to be something you enjoy, or something that has meaning to you, otherwise you won’t keep it up. Consider something you used to enjoy doing, or something you’ve wanted to take up. Or even something you previously thought you shouldn’t do because of your pain or injury (once you’ve been given the all-clear).

Once you’ve chosen your exercise, do it regularly (most days of the week). If it is something strenuous it is probably best to give yourself a rest day between each session. Once you are used to doing it frequently or consistently, you will see more results, and it will become more of a habit, and therefore easier to maintain.


Is Pain During Exercise Okay?


Now that we know pain does not always indicate the level of injury or damage, we know that not all pain with exercise is bad.

Below is a pain scale I like to use when discussing ‘tolerable’ pain:


The green zones are our 'acceptable' pain zones.

It’s okay to be aware of the ‘injured’ or ‘painful’ region when performing exercise, but we want to avoid pushing into uncomfortable territory.

Now, this scale is completely dependent on your pain tolerance, and discomfort to one person may be a tolerable ache to someone else. However, even if you believe you have a high pain tolerance, we need to avoid sensitising or aggravating the tissue or nervous system. So there’s no point in toughing it out or pushing through because you “can handle it”. You’ll only aggravate it and prolong your recovery.

No or ‘some’ discomfort is okay, but not what you would (honestly) consider ‘pain’.

Any discomfort during exercise should ideally remain mild, decrease throughout the exercise, or not persist for more than 24 hours after the exercise.

Some discomfort the next day can be expected, especially if you haven’t done much exercise recently, or if the activity you are doing is relatively new to you. This soreness may simply be what is called ‘Delayed Onset Muscle Soreness’ (D.O.M.S), and is a result of minor tissue damage, causing low level inflammation in the tissues. This typically resolves within 48 hours, and isn’t anything to be concerned about.

Pain persisting for more than 48 hours, or pain that is severe or worsened after exercise indicates likelihood of aggravation, and you should let it settle before recommencing your exercise.


Progressing Your Exercise And Keeping It Varied


Once you’ve returned to, or begun your exercise habits, it is a good idea to progress over time. This may mean running a bit further, swimming another lap, Increasing the weight you’re doing, attempting more challenging yoga poses.


Your body is very good at adapting, and overtime what you currently may see as strenuous, heavy, or difficult, will eventually become easier and in order to become stronger or fitter you will need to progress.

Progression should be done gradually, and allow for recovery and tissue adaptation, which is where you may want to get a program designed for you by a trainer or coach.

It is also a good idea to keep your exercise varied and novel.

Every now and then change up what you are doing, try different exercises, use different equipment, or take a different class. This will keep it interesting, but also challenge your body to adapt to a new movement or activity.


In conclusion, pain during exercise isn’t always bad, and yes, you can definitely exercise with an injury or pain. Just have the injury assessed by your allied health care provider or G.P. before you engage in exercise, to ensure there isn’t a need for rest or avoidance of certain activities.

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About Me

I'm an Osteopath, Strength and Conditioning Coach, and Remedial Massage Therapist. Passionate about helping people function at their best, and build stronger, more resilient bodies.

 

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