As you leisurely proceed with your morning jog and suddenly experience a twinge of unease in your calf, your thoughts drift to the old worn-out T-shirt tucked away in the depths of your closet bearing the motto “No Pain, No Gain!” However, this contemplation is interrupted by the advice shared in your Facebook running community: “If there is discomfort, CEASE!”
So, which perspective is accurate? Well, as a physiotherapist, I can affirm that it is neither.
While pain may seem like a straightforward, passive sequence from A to B—where I flicked your hand and you felt pain—it is, in reality, a much more intricate, active process. When I flick your hand, it triggers an input that enters the nervous system and undergoes filtration by the brain based on various factors, such as past experiences, current emotional state, focus, and more.
An interdisciplinary review article published in 2013 in the Cognitive Science journal depicted pain as “a personal, subjective encounter influenced by cultural knowledge, the context of the situation, attention, and other psychological factors.”
Such complexity renders pain an unreliable indicator of internal happenings in the body. Chronic pain can persist even in the absence of observable structural or mechanical alterations. Consequently, adage models of “no pain, no gain” or “if you experience pain, stop” are inadequate. The existence of a significant gray area necessitates a more refined approach to address the issue.
“We aim to educate [athletes] on differentiating between pain and soreness—the distinction of whether a workout elicits discomfort solely during the session or if the discomfort lingers posteriorly to the activity,” shared Gerry DeFilippo, a strength and sports performance coach who is the proprietor of Challenger Strength in Wayne, NJ. “If a baseball player exhibits general forearm soreness that persists throughout the day and not specifically during throwing, it suggests an underlying factor rather than throwing being the primary concern.”
Tom Goom, a physiotherapist and running expert at Body Rehab Studios and the mastermind behind running-physio.com, further dissects this process. “I often advise that mild discomfort during activity (up to three out of 10) is acceptable as long as it subsides within 24 hours and the individual demonstrates improvement over time,” he elaborated. “However, circumstances may change, such as if I suspect a bone stress injury or when additional signs and symptoms are present, like swelling or instability.”
Goom employs a traffic light analogy to facilitate his patients’ comprehension of this range of discomfort levels: If the pain is severe, rating at six or above out of 10, that merits a red light and signals a cessation. A level of four or five is bearable and warrants a yellow light, while three or below merits a green light to proceed with the activity.
“The reality is, much like other medical scenarios, the response to the dilemma of what to do when encountering pain or unease is: It varies,” as stated by Shounuck Patel, DO, FAAPMR, a non-surgical pain specialist at The Patel Center for Functional Regeneration in Arcadia, CA. “If patients persist in performing regular activities despite experiencing pain, they might be perpetuating the actions that led to their injury in the first place. Conversely, if patients grow apprehensive of movements that could trigger discomfort, they might develop abnormal movement patterns, ultimately resulting in the perception of pain even during routine movements.”
In essence, fear of movement can trigger compensatory pain and injuries, to the extent that movements which were previously painless could now evoke discomfort, perpetuating a destructive cycle.
Considering the insights from these three experts, alongside my own encounters as a physiotherapist, and integrating the foundational principles of pain and movement science, I devised a four-question checklist to guide individuals in managing pain and determining when it is safe to continue and when it is advisable to take a step back.
1. Is the discomfort escalating to a five out of 10 or higher?
The visual analog scale employed by medical professionals is regarded as a reliable and valid tool for gauging acute (new) discomfort: On a scale of zero to 10, a patient gauges their discomfort level, with zero indicating absence of discomfort, five portraying moderate discomfort, and 10 marking the most severe discomfort. I perceive five as a discomfort level that noticeably alters your emotional state.
2. Is the discomfort exhibiting radiating and/or electric characteristics? Are sharp sensations present constantly?
Radiating discomfort refers to a sensation where the discomfort appears to extend from one body area to another, almost as if it is shooting towards a different region. Electric discomfort entails a stabbing and burning sensation that is sharply demarcated, nearly traceable with a pencil if prompted.
If either of these descriptions resonates with your situation, or if the discomfort is steady and sharp, it suggests a more critical issue that necessitates prompt attention from a healthcare provider.
3. Has the discomfort persisted beyond 36 hours?
If the lingering discomfort or unease from your physical activity extends beyond approximately a day and a half, it is highly probable that you exerted yourself excessively, and your body requires additional recovery time before engaging in strenuous activities once more. Even if you are merely 24 hours post-activity and experiencing discomfort, allow another 12 hours to pass to assess any changes; the repercussions of intense activity can sometimes persist beyond that one-day mark.
If you are experiencing inexplicable discomfort (indicating no specific activity as the cause) that lasts 36 hours or longer, this serves as a significant warning sign that merits immediate attention.
4. Is the discomfort intensifying progressively?
Observe the trend closely: Is the discomfort gradually advancing from a two to a three to a four, diminishing, or stabilizing? A consistent increase over time indicates a crucial sign of sustained overuse and strain without adequate recovery.
Interpretation of Your Responses
Responding negatively to all four queries signifies that you are managing your activity level appropriately. Proceed, but remain conscious of these considerations.
However, if the response to any of these questions is affirmative, then adjustments to your training intensity are imperative. I suggest scaling back your activity level and monitoring the subsequent alterations in your responses. If you are experiencing sharp or radiating/electric pains, or reducing activity fails to elicit a change, it is time to consult a medical professional.
Keep in mind, discomfort is a signal, albeit a multifaceted one. Pay attention to the cues and heed them.
