A Traffic Light Guide To Exercising With Pain

One of the harder parts of the rehab process from the practitioner side, and what makes rehab sometimes more of an art than science, is knowing when we accept pain during the rehab process. While we do have general guidelines, such as saving eccentrics for the later stages, or not progressing weights too quickly, we are working with human beings who are dealing with the experience of pain. The problem though is, pain is not always a reliable experience. The challenge then becomes when do we trust pain and when do we not? Or maybe a more relevant question is, when is it okay to work through pain? We’ve all experienced the “no pain, no gain” mentality in some form, but this may not always be the best approach depending on your injury.

The short answer is yes, it is okay to work through some pain, but with a bit of common sense. Of course context matters, so we’ll break it down a bit further, but knowing when to push and when to tweak or even hit pause can have a big impact on your recovery.

This is an important concept to address because pain is a complex, individual and multifactorial experience, meaning that everyone experiences it differently and there can be many factors influencing your pain. Pain is also contextual— we (patients and practitioners) seem to accept pain when we’re providing hands-on treatment. I lost track of the number of times someone would ask for more pressure during a massage despite them wincing in pain, or who thought that more would mean a faster recovery. But then when it comes to exercise, we tend to quickly abandon an exercise if the patient experiences any pain with it. So why do we accept pain in some cases, but not others (rhetorical question for the purpose of this blog).

Just know that pain doesn’t always mean damage during the rehab process. The tissue can still be sensitive to loading without resulting in further damage or reinjury.  When it comes to pain that develops through overuse or pain that lasts beyond the typical healing time, that’s when pain can be a bit more unreliable, and is still more about sensitivity than damage. Staying active and mobile can help with recovery, provided it is within reason. Being unsure of what is safe or not can certainly cause a dilemma with your recovery - if you back off you might be under-loading yourself, but if you keep going you might be overloading yourself. Neither of these are ideal. But there is a simple analogy you can use to help better gauge your pain and add some clarity to the decision to work through pain during your rehab— the traffic light.

Green Means Go!
In these cases, the pain is mild— I usually consider this to be a self-rated 4/10 or less on the pain scale. This pain generally settles down fairly soon after exercise, or at least within 24 hours, and during the exercise you’re still moving well and feeling confident. This is a good space to work in. The pain is there, but it is not modifying how you perform. You might feel a twinge or ache, but you’re not doing any harm, and your body can handle this. This doesn’t mean that we’re in the clear to go crazy, but it does give an indication that we’re in a good spot with the loading. You should still continue to monitor the pain though, because that leads into…

Yellow Means Caution (and Adjust)
This is when the pain increases to a 5/10 or 6/10 on the pain scale, and usually the pain lingers longer than 24 hours before subsiding. Movements might feel a little forced or you might feel guarded, hesitant, deliberate, or cautious during activity. We may not be causing physical damage yet, but we’re certainly starting to push the limits of what the injured tissue can tolerate, and we need to adjust accordingly. The good news is we can still continue some form of exercise, and there are many ways you can adjust to get back into a green light— changing the movement or reducing the weight are just a couple of examples.

Red Means Stop (For Now)
I don’t like having patients stop their exercises, and there are always some unrelated activities they can do to remain active, but sometimes stopping an aggravating exercise is needed. These are cases when the pain is a 7/10 or more; the pain sticks around at that level for longer, or even worsens, and you’re uncomfortable or hesitant to move. This is your cue to rest or scale back to simpler movements that calm the area down, rather than push through and hope for the best because we are at a higher risk of injury. It may seem like we’re losing progress, when really it is just being smart—short-term sacrifice for long-term gain.

It’s okay to feel some pain during the rehab process— tolerable pain doesn’t mean something is injured further. In fact, some studies show it leads to better outcomes than completely avoiding pain (maybe the point when you feel pain is the lower end of the stimulus threshold to cause adaptation, so by avoiding pain you’re not providing adequate stimulation). There’s no need to panic, but it is still worth paying attention to to see how it changes. Maybe it is just a one-off thing because you didn’t sleep very well the night before or maybe it’s a sign that you are not tolerating the exercise well and an adjustment is needed.

Staying active helps the healing process, as long as we are respecting that process and respecting where your body is at.