Do I Need to Avoid Painful Exercises?
Pain is a complex subject. It’s our body’s way of telling us something is wrong, and we should 
stop doing whatever we’re doing to avoid injury. This is beneficial in the short term, but what about pain that has been present for weeks, months, or even years? Should we always avoid painful activities?
Before we dive into whether to avoid painful exercises or not, if you think you are injured, talk to your physical therapist or physician; but in short, no, we probably don’t need to avoid all painful exercises, especially for chronic pains. Let’s take chronic low back pain for example. It’s not uncommon for people to tweak their back and continue to have low back pain for up to a year, sometimes longer! Standard tissue healing takes anywhere between 2-4 weeks for a mild strain, 4-16 weeks for moderate strain, and up to a year for a complete muscle tear (which is uncommon). So, if most heal in under 16 weeks, why do so many people continue to have pain well beyond that timeframe? I wish it was a simple answer, but unfortunately there are dozens of factors that come into play. The factors range from severity of injury, history of injury, underlying conditions, exercise programming, and even our own beliefs about the injury. There seems to have been a huge shift in the physical therapy management of chronic pain over the past 1-2 decades (and mostly for the better in my opinion). Physical therapists are taking psychosocial factors into account and tailoring rehab protocols around them. We are also seeing an increase in true strength training when individuals with chronic pain. It’s not just 2 sets of 10, hot packs, rest, and ultrasound anymore! Believe it or not, we’ve found complete rest is one of the worst things you can do for chronic pain.
We have a lot of research showing that exercising through pain is safe when done properly. This is where an experienced clinician comes into play, because knowing which pain is fine and which is not can be tricky. In general, lower levels (below 5/10 on the pain scale or no more than moderate pain) dull aching, and chronic pain is usually okay to train through. Some things to consider when training through pain are, “is this tolerable,” “does the pain return back to it’s original level after 24-48 hours,” and “is the pain going up or down week by week.” If you find yourself hitting 7-8/10 and feeling worse for 3 days after a workout then that’s a good sign you’re doing too much.
So, what would it look like if you came to our clinic experiencing pain during movement or exercise. The first thing we’ll do is a thorough physical exam. Determine what’s going on and if physical therapy is appropriate for you; and if not, we’ll get you where you need to be. Next, if deemed safe, I 
like to watch you perform the painful movement. This could be squatting, benching, overhead lifting/pressing, etc. Then we’ll perform some therapeutic modalities such as dry needling or perform some soft tissue mobilization, and then come up with some modifications to reduce pain during the exercise, determine an appropriate level of pain to work through (if needed), create a home exercise program, and a schedule to get you back to your prior level of exercise. We also like to work with any other health care worker or fitness professional you’re working with. This will allow us to communicate an individualized plan to keep you in the gym while you go through your rehab journey!
If you have any questions or want to find out if you need physical therapy, you can reach me at
Joe@collegehillpilatespt.com