You’re mid-way through a training session when you feel the onset of a small amount of pain. The decision whether to keep on pushing or to call it quits is a difficult one to make. The phrase “no pain no gain” – although motivating – is not one to live by as training through an injury can only exacerbate it and potentially lead to longer recovery times.
Pain is an indication that trauma has occurred to your body, caused by chemical stimulation to neuroreceptors within your body’s tissue. Neurological signals then travel to the brain where they are interpreted by the frontal lobe and cerebral cortex. So believe it or no, pain is more of an emotion. Hence, we can have good pain (massage or foam rolling) and bad pain. When making a decision to continue or to cease training a few factors need to be considered.
The Intensity of the Pain
Rate the pain out of 10, with zero (0) being no pain and 10 being the worse pain imaginable. If the pain is above four then stop, the pain is simply high enough that moderate to severe tissue damage has occurred. If the pain is either a 3 or 4 stop rest and reset. Attempt to exercise again, after a few minutes, if the pain increases e.g. from a 2 previously to a 3, then stop. If pain stays the same consider the type of pain (discussed below)
A rating of two or less should be ok to continue with a session. Though look at modifying the session with either a decreased intensity, longer recoveries or a change in activity.
Type of Pain
The type of pain is important as it gives us clues as to the structure damaged.
Ache or discomfort – this would be considered the lowest level of pain. Mostly likely to be muscular or ligamentous. As long as the pain intensity is within set limits than training should be ok to continue. Due care needs to be taken by the athlete to ensure that further damage does not occur.
Sharp – this is higher and often an indicator of greater damage and often with an acute onset. Any sharp pain with an acute onset during a session, should trigger immediate cessation. Rest is then recommended for 5-10mins before re-attempting at a lower intensity. If the pain is then still present, I’d recommend ceasing all activity for that day, and look at getting the area assessed by a professional.
Pins and needles or burning pain – this is often an indication of nerve pain and neural irritation. With the onset of this pain activity should stop immediately, with the recommendation of seeking further medical advice.
Dr Nick Miller treating Niwili White Forest. PHOTO CREDITS: Mike Hurst
Chronic Pain
Ideally all training should be pain-free though a previous injury can create long term pain, particularly while exercising. Similar guidelines as above for the cessation of a session should be considered for chronic pain. If the pain is still presenting after an injury, a few factors may need to be addressed.
Is the initial injury fully recovered? The return to sport from an injury needs to be guided and monitored to ensure healing is optimized. The commencement of activity too soon or levels of intensity greater than tissue ability can impact healing timeframes. For many athletes the return of exercise and the intensity at which to do so is dependent purely on the presence or absence of pain. Since pain is a poor indicator of tissue recovery, other factors such as range of motion and strength need to be considered.
Are the demands of the exercise greater than the current tissue strength? Scar tissue is often less elastic and not as strong as the initial tissue. This is why one of the predisposing factors for any injury is a previous history of one. Perhaps what needs to be focused on is strengthening the injured tissue or improving stability around the area. For example, the rehabilitation of recurrent hamstring tears in runners can benefit from a combination of glute activation work as well hamstring eccentric loading. This can be concurrently done with tissue manual therapies to ensure correct directional healing of tissues and elasticity of tissue.
Is the pain localised? If the pain is consistent for a particular movement pattern (e.g. Pressing overhead) when every time you train pain is elicited in an area seeking a professional opinion is highly recommended. If this is occurring than dysfunction is occurring surrounding a joint and needs to be corrected.
The choice whether to train with pain is a difficult one to make, as a professional my decision are balanced between preventing further injury and allowing the body to adapt to physical demands and loads for complete healing. A variety of factors needs to be considered as discussed, though when in doubt stop and seek further advice. Although pain may stop a scheduled session, the session doesn’t have to be a waste. If the pain does stop training, the focus can be switched, e.g., Upper to lower body, allowing for the focus on low-intensity activity (e.g. technique, mobility or stability). The areas covered above should give you some basic insight into what to consider and look for when making this decision.
By no means is this extensive or the only factors, but they are some major factors I consider with my training and with getting an athlete back to full participation.
Dr Nicholas Miller
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