When someone comes to physiotherapy, it can be for one of two reasons. Either someone is in pain doing an activity and can no longer do it, or they can do the activity, but believe that with specific treatment and rehabilitation, they can do it better. With respect to these two issues, one must ask themselves, ‘‘Do I need to be pain-free?’’.

A big differentiation often needs to be made in exercise and sports. ‘Am I in pain, or am i injured?’. The difference between these two is whether you are causing damage to something, or whether you are going through the normal sensations of high performance and exercise.

‘Injured’

When someone has an injury, it may be acute after a single incident, or it may be a gradual process. Injuries can present with swelling, stiffness, pain, inability to perform daily tasks, or even apprehension around certain end ranges of motion. Injuries are normal in someone’s lifetime, but pushing into an injury can make it worse. Injuries often either reduce your ability to perform an activity, or stop you completely. An example of an injury is a stress fracture. These are often gradual onset, and can either make walking or running painful, or stop you completely. In the presence of a stress fracture, you will make it worse by running on it. This injury requires an element of rest, and rehabilitation of the tissues around the stress fracture site.

A partially torn rotator cuff muscle is another example of an injury. In this case, if you continue to do the activities that caused the issues in the first place, you may make the tear worse. Rehab of this injury will include modifying how you do things in the gym to let it settle, applying appropriate load to the muscle with things like isometric loading and other specific exercises. As the injury improves, we can gradually increase the loads that we are putting through the shoulder.

Normal Pain

An element of discomfort is often expected when we push our body. An example of this is Delayed Onset Muscle Soreness (‘DOMS’ as it is commonly known). DOMS is the soreness felt in muscles when we have applied a significant stimulus on them such as a long run, or a game of rugby, or lifting weights in the gym. This is painful in some people, but a normal characteristic of strengthening your body. Rather than resting the muscles until pain is completely gone in this case, we aim to recover well, train other muscle groups in our next session, and continue with our training program.

If training for a marathon, a runner may begin to get some knee pain, or ankle pain during a run. This may increase over the weeks as the mileage begins to increase. Although this can be scary for some, a small amount of discomfort is often expected when you are challenging your body to do something that it is not used to.

So how do I know how much pain is too much pain?

When I discuss pain with clients, I usually discuss two terms with them: intensity, and timeframe.

1. Intensity - We have all been asked by a physio or a doctor ‘what’s your pain out of ten?’. Now although this scale is a little arbitrary because everyone’s pain is different, it is very reliable for you to measure your own pain against your previous experiences of pain. Whether someone is training or rehabbing an injury (should look the same in my book), we are realistically looking for pain to remain at a 4/10 or below, and not rise above that. There are some exceptions such as stress fractures, or an acutely torn tendon or muscle.

2. Timeframe - Some discomfort or pain is expected with rehab and training, but we don’t want it to last for longer than a 24hr period. Pain lasting for several days may be a sign taht you have done too much, and need to reassess your training load and volume. Next time your muscles or a joint have some discomfort the day after training, keep telling yourself ‘this is normal’.

‘But my physio promised to make me pain-free?’

A problem with some healthcare professionals is that they sacrifice physical performance for comfort, or making things ‘easy’. They will have their clients doing underloaded exercises that aren’t getting them to their goals under the guise that the exercise is pain-free. With this mindset, frustration can set in as you’ve seen your physio for 15 visits, and still aren’t back to your activity. The skill in physiotherapy is applying a stimulus to the body that causes an adaptation to build a stronger individual. We respect the pain experience, but we must also consider that pain is normal, and that high performance and pain can be in the same room at the same time.

I’m not trying to advocate beating your body down, and causing injuries to lift an extra 5kg, but I don’t want people to have unrealistic expectations of what is required to get faster, stronger, fitter, and healthier. If you train because you enjoy exercise, then it is ok to dial back your exercise if you feel some pain. However, if your sport or activity means a lot to you, then sometimes it is necessary to work with someone who can guide you in knowing what level of discomfort is safe to achieve your goals.

If you have any questions on whether physio is the best option for you, or you have any questions about MVMNT in general, feel free to contact via email.

- Jay Towolawi, Specialist Sports Physiotherapist and MVMNT Founder.