I want to give credit for this piece to Mike Israetel PhD, Jordan Feigenbaum MD MS, Greg Nuckols, and Michael Ray DC. These four tackled this topic, and much more in a roundtable discussion regarding pain and injury (linked at the bottom). The central issue was how we should think about pain and its relation to injury during activity. The context for this discussion was strength sports, but the principles apply well to many other situations. Most participants in the discussion provided much insight, but Dr. Israetel’s portion was somewhat more memorable. His recommendations were so simple, reasonable, and easy to implement that I mainly wanted to share what he came up with. I will be discussing other ideas and topics covered in the video, and adding my own opinions, and integrating it all how I think makes the most sense.
This one should not surprise anyone. If you have a diagnosed, acute injury that is still painful you should almost certainly not push through pain during activity. Follow the instructions of your healthcare provider in this case, and/or seek the help of a healthcare provider with knowledge of injury rehabilitation.
Suspected injury/acute trauma
If you have experienced a physical trauma or done something recently that you think caused an injury, then we have another red light for pushing through pain. Seek the advice of a professional in this case. Maybe they will tell you that you can return to activity right away, but it is better safe than sorry.
Chronic pain, not worsening
This is probably the most complicated situation. I will keep it short and sweet. If the pain is not much of a concern to you, and was not caused by any trauma or acute injurious event, you probably do not need treatment. You may want a coach or kinesiologist to determine if your technique is on point, and your programming is put together properly. If these things do not help, the next step might be seeking the help of a healthcare professional with an understanding of the aggravating activity.
Chronic pain worsening with activity
If you have had a nagging pain from an activity such as lifting weights or running and it is consistently getting worse it is time to take action. In this case you could try resting or decreasing your volume and intensity for a week or two. If that does not provide adequate relief, you should see someone with a deep understanding of the activity in question. It could be a coach or healthcare provider, depending on your level of concern. This situation is likely a load management issue (doing too much too soon), but may also have to do with your technique. It may, however, need treatment so it is probably a good idea to see someone that can diagnose and triage properly such as a physiotherapist, chiropractor or a sports medicine doctor.
New pain without trauma
You get to the gym, start your exercise and you suddenly have a new, probably sharp pain, but you have not done anything out of the ordinary recently. What should you do?
If you start a moderate or high intensity activity without a warm up, stop the activity and warm up properly before continuing, then continue the activity if it can reasonably be considered safe.
- If the pain improves to a point where it is no longer a concern, proceed with activity.
- If the pain is not improving but not worsening, try changing your tempo, range of motion or other technical variable. If it continues but is not concerning, and there is no good reason to suspect injury then it may be alright to continue.
- If the pain is worsening even after modifications, either switch activities/exercises or take a rest day. Try again after one or two days, if worsening continues it is time to get professional help.
The root of this discussion is in pain science, which is extremely complex. While the evolutionary origin of pain sensation seems to be for the detection of physical damage (nociception), the development of higher brain functions in humans has made pain a much more complicated phenomenon. Hopefully the information provided in this post will give you some piece of mind during some situations in which you might find yourself.
Here is the video with the discussion:
Disclaimer: This post is for informational purposes only. The content of this blog is not intended to be medical advice, nor should it be regarded as a replacement for medical advice or treatment. The use of information contained in this blog, or any of the information from the links is at the user’s own risk. Note that no doctor patient relationship has been formed.