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Exercise and Pain: Teaching Clients to Follow the Signs

Jul 08, 2019

Jim Heafner, PT, DPT, OCS, earned his Doctorate of Physical Therapy from Saint Louis University. He is a certified Orthopedic Clinical Specialist (OCS) and is trained in the Selective Functional Movement Assessment (SFMA), Functional Movement Screening (FMS) systems, and is Dry Needling certified. His educational and clinical background have made him an expert in manual and manipulative physical therapy as well as pain management and exercise prescription. Jim opened Heafner Health Physical Therapy, a cash-based physical therapy clinic in February 2016. He is author of the pain book, Making Sense of Pain.

Learn how to determine when it’s safe to continue a workout and when to stop exercising if pain arises, so you can help your clients do the same.

Until recently pain has been thought to be an indicator of the amount of tissue injury present in the body. The belief is that a high amount of pain equates to a serious injury, and a small amount of pain equates to a minor injury. However, through extensive research, we now know that pain has surprisingly little correlation to the amount of tissue damage present. For example, it’s estimated that 40% of people without any low back pain have at least one “bulging” disc on a lumbar spine MRI. Instead of pain acting as a barometer for tissue damage, it should rather be thought of as an alarm system, warning you about actual or potential threats to continuing a workout.

When is it Safe to Continue Exercising?

Since pain does not equate to tissue damage, does that mean you can exercise past the point of pain without any consequences? “No pain, no gain,” right? Not quite! As mentioned above, pain is an alarm system meant to alert you to potential danger. In the case of exercising, the danger may be caused by a specific movement or a specific weight machine. However, just as alarms can misfire, your internal protective mechanism can do the same. Factors such as fear, stress, anxiety, lack of sleep, overactivity, poor nutrition, and many others can influence your alarm system’s perception of danger. When exercising, do not underestimate the importance of these factors.

In my clinical practice, I always tell patients, “respect the pain and evaluate the symptoms you are feeling!” If the pain persists, stop exercising. If the pain decreases by modifying the exercise, warming-up the muscle, or simply desensitizing the movement with a few repetitions, it’s likely okay to continue exercising!

What are the Signs to Stop Exercising?

As you learn to calibrate your internal pain-alarm system, there are a few general rules to follow when exercising. My top three warning signs to stop exercising include: sharp pain, nerve-related numbness or tingling, and/or increasing pain.

SHARP PAINS

Sharp pains may indicate that a muscle, ligament, or joint is actively getting injured or overstressed. These pains quickly catch our attention because they travel along fast-moving nerve cells to warn us something is not in balance.

NERVE-RELATED NUMBNESS OR TINGLING

Numbness, tingling, or sudden muscle weakness may indicate that a nerve is getting angry because the normal amount of oxygen around the nerve has been altered. In my book, Making Sense of Pain, I discuss how the nervous system is highly sensitive to changes in oxygen levels. The nervous system weighs only two percent of our total body weight yet requires 20 percent of our total oxygen supply. When a nerve becomes tensioned or compressed, its oxygen flow is altered, often resulting in numbness, tingling, burning or aching.

INCREASED PAIN

Finally, pain that continually increases is a good reason to stop a workout. Increasing pain may indicate that the aggravated tissue is repeatedly getting over-stressed. This can lead to an overuse injury, which could require you to stop exercising for several weeks. To avoid this training error, it’s important to understand the concept of graded exposure, too much or too little stress can negatively impact your workout and recovery.

In Summary

  • Pain is like an alarm system designed to keep you out of danger.
  • Numerous factors such as nutrition, sleep, stress, and fear turn up or turn down the sensitivity of your internal alarm system.
  • If you experience pain during a workout, stop and evaluate the symptoms to determine if further exercise is safe.
  • If the pain decreases by modifying the exercise or further warm-up, it’s likely okay to continue exercising!
  • Sharp pain, nerve-related numbness or tingling, and/or increasing pain are all reasons to temporarily stop exercising.

How to Talk to Clients About Pain

Pain is a unique, individualized experience that must be artfully discussed to avoid sending the wrong message to your clients. In my clinical practice, I have found that using stories is one of the best ways to convey this message because it uses relatable language without the weight of scientific language. All of my favorite analogies on movement, posture, and tissue training are in my book, Making Sense of Pain.


OPTP Pain Education

Fitness Journal, Volume 16, Issue 7

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