Is Pain During Therapeutic Exercise Okay?

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Pat was a client who was experiencing some pain with her self care.  She was concerned that the pain might be making the condition worse so she stopped doing the self care parts that were causing pain, but she wasn’t sure if that was the right thing to do.


This happens all the time.  There are two main reasons that a person falls off with doing their self care exercises.  The first is that they don’t see any direct relationship between what they’re doing and a positive effect on their area of concern.  The second, and the one I wanted to talk about today is that sometimes it seems like your exercises might actually be hurting you. It’s a valid concern. Lets see if we can come up with some guidelines that might help you decide.


Pain…it’s not just in your body.


Pain is not just a physical phenomenon, it’s not just coming from the tissues in the body where you feel the pain…and because it’s not just a physical phenomenon you can change your experience of pain by changing how you feel about pain.  Let me say that again.  You can change the pain, by changing how you understand it.  Pain is at least as much a psychological phenomenon as it is physical.  Speaking as someone who has had pain bad enough to make me cry, I know I wasn’t just crying because of the physical sensation…but because of the frustration, the fear, the uncertainty about the future and the sense of helplessness.  These feelings are part of pain and make pain what it is.  The good news is that you can regain some control of the situation by changing how you understand and react to pain.


Basically, you need to move the area.


Not moving the area is where the bad stuff happens…like tissues not getting nutrients and not getting pulled on. It’s important that tissues get pulled on so that they know how they should mold and align themselves relative to other tissues. Without that pulling you end up with a mess.


But how should you move the area? Moving it certain ways hurts and makes you feel like you might be causing problems…making it worse.  So here are some guidelines for how to tell if its a safe movement and an okay kind of pain that’s not hurting you:


1) Pain doesn’t always indicate tissue damage.  Sometimes it’s just your body’s way of telling you to watch out, but there’s really no damage actually taking place. Try to keep the area relaxed as you’re moving it. You want as much suppleness and movement in all the little bitty inside tissues as possible, so keep it soft and loose…and teach your body that it doesn’t need to tense up when it finds a bit of pain in there.


2) When the pain decreases during the exercise then it’s okay pain.  An example of this is: find a tight muscle (hamstrings) and put it into an intense stretch (seated or standing forward bend) it will feel intense…you might even say painful. It might even shake a bit. But if it’s something you can keep breathing through, then as you sit there without moving farther into the stretch the intense feeling will go down.  It’ll still feel like a stretch, but the edge will come off of it.  That might take 2-3 full minutes. and then if you keep sitting with it without trying to push farther into the stretch it will become ho hum and you’ll get bored and start thinking about something else.  So, you can go from something feeling super intense to ho hum by just keeping it in that position for a few minutes.  Some pain and tenderness works the same way.  Hold it in a tolerable position for three minutes without trying to make it go any farther and wait to see if the intensity of the sensation decreases.


3) If it hurts less the next time you do the exercise then that’s an okay pain.  Something to watch here is that sometimes the hurt is the same, but if you look at how far you can move the area you’ll see that your range of motion has increased. If you can move it farther, even if it still hurts, that’s improvement.  You can test this by using a stationary object as a marker or doing the movement in front of a mirror.


And the other kind…?


Those were some markers for kinds of pain that you can comfortably experience without worry but, what are some kinds of pain that should be a red flag? Below are examples of pain that may be a reason for you to stop the exercise until you’ve checked with your care provider about it:


1) When the movement makes an unproductive, icky feeling kind of pain during the exercise and leaves an irritated, unpleasant feeling in the area for an hour or two afterward.


2) When it hurts bad enough you can’t do the movement without clenching your teeth.  That is to say when it’s too intense to breath through it.  In this case you can try to do a little less and see if you can get it to an okay level.


3) When each time you do the movement it becomes more painful and/or your range of motion goes down.



The road back to activity.


As you retrain your body to overcome it’s particular limitation continue to work with curiosity and gentleness.  Your self care is practice for your daily activities.  That’s where it becomes meaningful.  Eventually the transition between self care and living becomes seamless.


I hope this has been helpful.  Please share your thoughts with me.

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