When Is It Okay To Ignore Pain?

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All of you who like getting injured, please raise your hands.

Right. No one does.

If you’re active, you’re always on the edge of getting hurt. Comes with the territory.

And a question I’m asked often – by students, clients, friends, family – is pain a bad thing? Should I stop what I’m doing if I hurt somewhere in my body?

I suspect most people think of pain as “bad” or “abnormal”. I’ve had clients tell me that they expect to never hurt; that they should be able to do whatever they want and never have an ache or pain.

The conversation usually goes something like this.

Client: “I just don’t think I should hurt when I do stuff. I should be able to exercise and do other things and not end up hurting or really ever hurt. I just think that’s normal and pain is a bad sign. Something’s wrong when I hurt.”

Me: “I see. And why is that?”

Client: “Well, because, well…it’s just how your body is supposed to work right? I mean pain is a bad thing isn’t? Doesn’t it mean I’ve damaged something or something is wrong?”

Me: “Sometimes yes, that’s true but not always.”

Client: “So, you’re saying that my pain could be normal?”

Me: “Yes, maybe so.”

And at this point in the conversation, we’ve entered new territory – that some pain is normal, okay.  Not ominous. Not doom and gloom.

Client: “But how do I know if it’s okay or not?”

Me: “I would like you to do something for me. As your sitting there in the chair, take your right hand and place the back of your hand on the seat next to you so your fingers are pointing toward your leg and your palm is up.”

Client: “Okay” – and she places her hand in the position.

Me: “Now, lean onto your hand slowly and tell me what you feel.”

The client leans onto the back of the hand which forces the wrist to bend and increase pressure in the joint and surrounding tissues. Eventually, if you continue to increase the pressure, something will hurt.

Client: “Uh…my wrist is hurting. Should I keep going?”

Me: “No, go ahead and stop. Now, what did you feel?”

Client: “Well, my wrist hurt I guess.”

Me: “Okay and tell me what you think of that?”

Client:” Uhhh…well, I guess not much. I mean, I’m fine.”

Me: “So, is all pain bad then?”

The Fifth Vital Sign

Pain is sometimes referred to as the fifth vital sign. Vital signs – blood pressure, heart rate, respiratory rate, and body temperature – are indicators of your body’s function. But, they have to be interpreted within a certain context.

For example, if I take your heart rate and it’s 120 beats per minute (BPM), without knowing why your heart rate might be that high, I could arrive at a false conclusion. If you said that you had just run up two flights of stairs, then a heart rate of 120BPM seems reasonable. If however, you had just walked in to the office and your resting heart rate was 120 BPM, I would be much more concerned.

Pain requires the same kind of interpretation. And the general rule is this (and I’m speaking of musculoskeletal aches and pains): if the pain alters your ability to function, then you should stop the activity and monitor your symptoms closely for 48-72 hours. If the symptoms are still present and your function is still compromised, it’s time to get help.

Let’s take an example.

You go for a run and notice some pain in your knee afterward. It’s mild but something you’ve not had before. You can walk fine, get up and down from a chair, climb stairs okay. But, you’re wondering if you should run or not; should you ice the area? Take Advil?

Instead, you decide to wait and watch. The next day, you feel okay but choose not to run for two more days. You go out after three days of not running, and complete your usual routine. To your surprise, you feel fine. And the next day and the next day, you still feel fine.

Contrast this with a slightly different scenario.

You go out for a run, notice knee pain afterward and just shrug it off as “over doing it”. You have a run scheduled with a friend the next day and are determined to do it. After all, you feel fine walking around, going up and down stairs.

The next morning, you meet your friend and take off together for a three mile run. But, 10 minutes into the run, your knee hurts. And by the end of the run, you notice it hurts a little to walk. But, by the time you get home, walking is okay.

So, the next day you go out for a run and now you hurt almost as soon as you start running. And you have to stop. And walking hurts. And stairs hurt.

Two different outcomes from different choices.

How To Interpret Your Pain

I am not immune to this problem of pain and activity and, from time to time, I’ve had less than great judgment in the past but have gradually improved my decisions.

In a recent training session for my dunk again project, I noticed that both of my legs felt “heavy” and mildly painful the next day. Not a I-did-too-much muscle type of pain but more of a overall fatigue sensation. They didn’t feel “right”.

While I could walk, bend, lift, etc, I noticed that my pattern of motion was not normal; I was favoring my legs and avoiding bending at the knees, for example, when I bent down to pick up something from the floor. And when I came back up, I grunted. This caught my attention.

Based on this, I decided to take two days off from my Elements and re-assess my training. The next day I felt a lot better. No heavy sensation; mild fatigue. So, I decided to use a session of Steady State Endurance to gradually introduce activity again.

When I looked at the training, I noticed that I had increased my loads for Back Sliders and Squats. The routine calls for higher loads and lower reps than what I was used to. So, the “symptoms” I had were likely in response to the new loads and the fatigue was not just muscle fatigue but soft tissue and joint fatigue. I was on the edge of a more serious injury. By taking the extra time off, I allowed my body to “catch up” even though inside, I was battling the “I shouldn’t have to deal with this” mentality.

Pain is a sensation laced with emotion. When you hurt, you hurt physically but your emotions act as an amplifier. The more distressed you are about it, the worse it gets. Pain impulses travel on the same nerve network as itching. Do you routinely think of an itch as a “bad” thing? It could be. Some serious diseases have itching as a symptom but itching doesn’t carry the emotional intensity; the worry and wonder that pain carries.

When you hurt, consider these principles:

  • Remind yourself that not all pain is bad. Sometimes, it’s the body reacting to stress, and it’s just letting you know about it.
  • Wait and Watch. If you have symptoms – pain, stiffness, aching, etc – that alter your movement or posture (form), stop the activity for 48-72 hours. Wait and watch. This doesn’t mean you can’t do other types of activity; just avoid activity that reproduces symptoms. If after 48-72 hours you feel okay, then resume your activity but with a mindful eye.
  • Get help. If you still have symptoms after 48-72 hours, it’s time to get help.

The most common mistake I’ve made and seen other people make is not taking a 48-72 period off to let your body catch up. And what I’ve discovered is that the more deconditioned you are, the longer it takes for your body to rebuild itself from the physical overload. So, in your enthusiasm to get healthy and fit, for example, you go full tilt, hurt some joint or muscle or tendon, think you just over did it but choose to keep going anyway. It’s at that moment, the choice to keep going, is where the problems escalate.

The truth is, at some point in your life, you’ll bump into pain. When you do, look at it as a message and ask yourself what you can learn; how can you adjust to it. Give your body time to adapt.

How about you? How do you interpret pain?


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About Doug Kelsey

DK_bball_post Doug Kelsey is a physical therapist and healthy lifestyle “guru”. Doug is formerly an Associate Professor and Assistant Dean for Clinical Affairs at the University of Oklahoma Health Science and is the owner of Sports Center Physical Therapy in Austin, Tx. He writes on how to “actively age” – how to get healthy and fit over your lifetime and take charge of your health. He and his brother Joshua created the ActiveAge Blueprint.

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