A few weeks ago, I was working with a female runner who asked me, “Will I ever run pain-free again?”…
If you’ve read any of my work about pain, you might have a good framework on its complexity. If you haven’t read any of my work on pain, I’d encourage you to start here.
Knowing when to stop pushing through pain with exercise can be complicated. Pain, for many people, is frightening after all. My hope is to simplify things a bit so that people feel more confident about when to stop pushing through pain with exercise and when it might be OK to continue.
One of the reasons many people have persistent pain — and I see them everyday in my practice as a physio — is because they believe or have been told that it’s dangerous for them to exercise or to “keep pushing through pain” when exercising. Sometimes, they are even told to halt activity completely.
The truth is that when it comes to musculoskeletal issues, most of the time it is not dangerous to keep pushing through pain with exercise if that’s what you choose to do. The danger in doing so is largely dependent on the individual and their level of pain tolerance and self-efficacy.
In my professional opinion, it is not my job to decide for anyone what is appropriate to do with their body in pain and what isn’t. It is, however, my job to “do no harm” and ultimately help a person be free of suffering, understand risk factors, and find joy and fulfillment in the activity they choose. If pain is interfering with that, we might consider our options to adjust.
In most pain experiences, particularly those involving the musculoskeletal system, exercise needs to persist in some capacity to maintain a person’s overall health, well-being and quality of life. Movement is queen when thinking about how to manage an acute injury and persistent pain .
For example: if I tell a person with a sprained ankle to stop exercising completely because of pain, I’ve done them and their injury a huge disservice.
Exercise and gradual return to full capacity is essential to healing and health following injury.
Would I expect that they’re torturing themselves with pain during exercise? No.
We now know enough to know that when a person stops exercising altogether, for ANY reason, their health quickly declines. As a physiotherapist, this means that there are two aspects that I need to address when working with a person in pain.
First, we need to work in order to reduce the risk of further injury or harm. Second (and just as important), we also need to maintain some level of physical exercise while injured or in pain, in order to reduce comorbid conditions.
We know that when we start to avoid activity because of pain, it becomes difficult to reintegrate back into that activity, as well as can lead to disuse and sometimes more pain . As long as life-threatening pain states aren’t at play, continuing to move and stay active in spite of pain can be really valuable. And yes, even pushing through it at times can be appropriate, and safe.
With that however, there are circumstances where it would be advisable to consider halting exercise because of pain and in my opinion, there are three scenarios where we would want to cease activity for a period of time as a result of pain:
This is a no brainer: cardiovascular (CV) events are life threatening. There’s no reason to mess with this type of pain when you are exercising and it calls for emergency care. Knowing what to look for is critical, and understanding risk factors is extremely valuable to prevention.
Before I touch on the painful signs and symptoms of a CV event, I feel it is essential to provide some information about this to give you a framework for how important it is, particularly for women.
As it turns out, the number one killer of women in the United States is cardiovascular disease (CVD), where one in three women will die of this disease each year . Many of these deaths occur in black and Hispanic women, who unfortunately also have the lowest awareness of the risk factors . Black women are more likely to die of heart attack than any other racial group .
So what type of pain are we looking for here? According to the American Heart Association, signs of heart attack in women are not the same as what you would expect in a man, specifically when we start to consider the symptoms of pain that are associated with heart attack. These include the following .
As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea or vomiting and back or jaw pain.
Any of the symptoms of pain described above are cause for immediate cessation of physical exercise and activity, as well as emergency care . Remember that medical clearance from a physician is required before a person with known or suspected CVD can engage in exercise.
Severe or disabling pain can be indications of more sinister conditions that require activity modification or rest. Of course, this absolutely depends, but it’d be silly to continue suffering if pain is at this state.
Let me use an example: I work with a lot of runners and when I think of situations where I need to pull the plug on a runner, one of the only situations where I might consider pulling the plug completely is when a bone stress injury could be at play.
A bone stress injury will present with severe, often progressively worsening pain with running. My job, as a provider of health and wellness, is to work to reduce this risk and keep a person moving. If something like this leads to fracture we have a problem.
Bone stress injury can also be an indication of other more serious conditions, such as the female athlete triad, which is an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density, relatively common among young women participating in sports .
If I think of other types of athletic activities, severe, disabling or progressively worsening experiences of pain are signs that an evaluation by a professional is warranted. In most instances, after a thorough evaluation, there will be opportunities to continue to exercise under modified load or training, but will depend on all the factors associated with why that pain is happening for that particular individual.
After an evaluation, as long as exercise has been deemed safe, returning back to activity is valuable.
The last circumstance where I might pull the plug on exercise because of pain would be if a person’s painful experience is diminishing the joy and fulfillment found with exercise. In this case, we need to consider a person’s pain-related suffering, wherein suffering extends beyond unpleasantness .
When it comes to pushing through pain with exercise, one person might have a higher capacity to tolerate pain than another. Part of the reason why is because each person’s tolerance to pain is unique. In fact, research on this has demonstrated that a person’s pain tolerance level will differ significantly based on social, cultural, and even gender backgrounds [8,9].
As I mentioned earlier, my duty as a physio is to do no harm. This means taking into consideration the complex issues involved in each individual’s experience of pain, as well as how my influence, as a provider, can negatively impact a person’s life if I tell them to stop exercising.
In my opinion, it is detrimental for me to tell a person to stop exercise because of pain in most circumstances. I emphasize most for reasons already discussed above. Choosing activity modifications instead may help reduce a person’s pain or pain-related suffering during exercise, as well as foster their recovery, resiliency and continued health habits.
I believe wholeheartedly in the ability of our bodies to adapt, for better or for worse. This means that for me, pain is not inherently dangerous. What is dangerous is our response to it.
So don’t stop exercising. Keep moving. Trust the body. And if you need help, find a person to help you do just that or provide you with the information you need to continue to do so with peace of mind.
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