Working Out with Pain: A Plan to Push Through
The past few weeks we have been going over how to stop pain while still working out. It’s often best if the movement that’s causing the pain be put off limits for a while. But what happens if a patient absolutely needs to be able to perform that movement? We have to have a progression to getting them back there.
Pushing to restore this movement might cause some apprehension, and that is totally understandable. So, there has to be a plan in place for each patient. Below is a flow chart that has been incredibly helpful for safely progressing someone back into a movement that previously provoked pain (http://physiopraxis.co/).
Whatever the activity, we can use this chart to judge how the progression is being tolerated by the body. I wouldn't have a patient start using this type of tool until I felt the body has healed and the tissues could handle it.
During the initial step, we are choosing the safest—and hopefully the most successful—entry point. An example that is very common with my patients would be to get a runner to try 10 minutes of low-intensity, zero-incline running. If they are successful with the run, they can progress to the next portion of the flow chart, while we continue to monitor them for the next 24-36 hours for symptoms. We will either continue to advance them or, like the flowchart says, reduce/stop the movement.
It is not always comfortable getting back into a movement that has been causing pain. The body can go through some mild pain during the process, but if the tissues can handle the movement and it doesn’t continue to irritate the problem, a positive adaptation is happening. If we have gotten a patient to this point, it becomes all about having a smart plan to increase intensity or load in order to reach their next goal.