Moving While In Pain
I have a client who recently had a full knee replacement surgery. She spent one night in the hospital, and then had physical therapy for her knee the very next day before she was discharged. She’s had two physical therapy sessions a week since she came home from her surgery. The first two sessions involved the PT manual forcing her knee into extension (straightening it out) and into flexion (bending it). He had her walking on it, and pushing against him with it, and stretching it out. She just had an invasive surgery, was in pain, and yet began treatment immediately. This is actually a normal and effective protocol for knee replacements. She’s been actively walking a couple of miles a day, riding her exercise bike, and doing strength training with me. Six weeks later, her surgeon told her that her knee looks like it’s at the 3 month stage of recovery. (Oh, and she’s 77.)
Oftentimes, we’re afraid to move when we’re in pain. The underlying fear is usually that we’re afraid of causing damage or more damage than there already is. However, in the example above with the knee surgery, she was definitely in pain and clearly had tissue damage, yet was undergoing intense rehab anyway.
Pain is an alarm system to get us to change our behavior, it is not a solid indicator that we’re causing physical harm to ourselves. In the context of musculoskeletal aches and pains that show up gradually and tend to linger, it’s quite common that there either is no damage, or that the damage isn’t actually the direct cause of the pain. Once we understand pain as our body’s way of asking us to pay attention rather than the result of damage, we can begin to feel safe exploring movement even while we’re in pain. This isn’t about ignoring our healing process, abiding by a no pain no gain mentally, or pushing through against our body’s will, etc. It’s actually about aiding the healing process by increasing blood flow, strength, and confidence, all while monitoring our pain symptoms and reviewing other factors in our lives that might be contributing to our pain.
While rest is super important (sometimes when a painful area is flaring up, resting the area for a few days up to a couple of weeks could be the right option) in general, waiting for pain to just disappear by moving less doesn’t actually address the issue at hand. If your wrist hurts, and you just stop moving it, sure, the pain might go away. But is that a functional long term solution? Probably not, because you need to use your wrist eventually!
The reality is you likely have to move it, and strengthen it, even with some pain, in order for it to get better long term.
So then, how do you know if you’re helping or hurting yourself? The general protocol is this: on a pain scale of 1-10 (1 being barely any pain and 10 being extremely painful) staying within the 1-6 range while doing a movement or exercise is usually ok. (Obviously this is very subjective, as no one is in charge of those numbers but yourself.) If the pain level stays the same or decreases 24 hours after the initial exercise, you made the right move! If the pain increases after 24 hours, you might have done a little bit too much at this moment in time. That doesn’t mean you caused more damage! It only means that you challenged the painful body part a little more than what’s ideal for your nervous system to help you handle recovery at this stage.