WHEN TO PUSH THROUGH PAIN

WHAT DO PTS DO? THEY IDENTIFY THE WEAK LINKS 

By Vincent Hanneken, PT/Owner

 One of the unique consequences of receiving physical therapy at Full Potential PT is having a physical therapist identify the important factors behind why you’re having pain and limited ability doing a particular motion, task or repetitive activity. We could call these factors the “Weak Links” that contribute to the perpetuation of an orthopedic problem. Behind many orthopedic painful conditions are reasons why stress and pain are building into a knee, back or shoulder. Those reasons relate quite often to some deficit in motion, strength and endurance. 

Ultimately, we find muscle weakness as a primary initiator of reactions in joints and tissue that contribute to a painful and ongoing situation. As a result, at some point in the rehab process strengthening will become a major focus of care. At this point many patients ask “When do I push through pain, and when do I hold back?” This is a great question, and the root of the answer is that the expertise of the therapist will guide you through governing the right amount of stress to achieve the ultimate goal of care (like returning to a vigorous walking routine, being able to lift a grandchild or handle the usual yard chores). 

A person can gauge their quality of life by how much they feel able to live their lifestyle. Some of you have high expectations of your body and engaging in physically demanding activities is not only satisfying but needed to fulfill one’s responsibilities. When we talk about maintaining or increasing one’s physical ability we are often talking about strength and using that strength efficiently. 

This is what the therapists at Full Potential do well, we are experts at applying overload to progressively stress muscle in order to perform at a higher level. Inherent in this process is judging how much pain or soreness is therapeutic and helpful to reach your goal, and how much is too much. Each of you has unique needs and that is why we stress one to one consistent care from the same therapist. In doing so, the rehab process moves along productively by being able to gauge your response. 

Our feature article dives into the concept of overload and soreness. Read on and become more acquainted in why overloading and strengthening are key to long lasting results, and why it is good for you to be able to judge what is helpful exercise stress and what is too much. 

When do I push through pain and when do I back off?

By Dr. Luke VanderZouwen, Doctor of Physical Therapy 

Determining when to push through pain and when to back off in order to reduce pain in a sensitive area or to promote healing can be a difficult conundrum. One might think, “If it is painful at all, I should probably stop.” It is not always this simple. True, in certain situations pain should be taken very seriously and activities should be stopped immediately. The situations most often include situations that could potentially be very serious like a potential fracture, possible nerve damage, or immediately following surgery (just to name a few). Most of these situations are accompanied by a clear mechanism of injury and are relatively easy to rule out either by common sense or by a medical professional. Especially in more longstanding or unexplained painful situations, knowing what to push through with regard to pain can be a much trickier situation.  

Our connective tissues (muscles, tendons, ligaments, bones, fascia, etc) require appropriate stress or strain in order to heal and/or become less sensitive. If all stresses or strains that cause any discomfort are avoided, sometimes this does not provide the right inputs to make that area healthy and able to handle more in the future. Especially in cases where an issue has become chronic (lasting longer than 6 months), pain is not always the best indicator of what we should or shouldn’t do in order to improve. On the flip side, just pushing through pain that does not improve or intensify with activity can also simply irritate already aggravated body areas. So if you have a long term issue like chronic back pain, a shoulder strain, or a painful arthritic knee (just to name a few), what are you supposed to do?  When do you persist through some symptoms and when do you avoid an activity because it makes your body area sore?  The following rule provides some insight into what might be helpful.  

I call this rule the Sharp Symptom or 24-Hour Rule. This rule allows certain symptoms to be worked through, while also allowing the opportunity to occasionally avoid activities in order to promote healing and generally feel improvement in the long term. The Sharp Symptom portion of the rule is fairly straight forward. If an activity is performed and symptoms are sharp or intense, that is probably a good clue that they should be avoided or limited when possible. For example, if raising my arm over my head causes sharp or searing pain at the tip of my shoulder to the point where I might even have to wince, I should probably try to at least temporarily avoid that motion if possible. Sharp symptoms are a good sign from our body that an activity might be dramatically irritating a situation and should probably be avoided. 

On the other hand, the 24-Hour Rule is not always quite as straightforward. This rule allows for pain to be persisted through in a couple of scenarios, while still monitoring how the body is handling an activity in the long term. If symptoms arise that are painful, but only mildly so (activity is able to be performed with some pain/soreness, but without having to drastically change the way you move) it is probably alright, assuming that within 24 hours of experiencing the increased symptom, the pain eases to its relative norm. This is probably activity that is otherwise safe and provides good, healthy stress to a sensitive body area. If symptoms do not calm down within 24 hours, but instead persist beyond 24 hours, it is usually safe to say that whatever activity was being performed as symptoms increased, should be limited in the future when possible.  Not all pain is bad.  Pain is our body’s way of telling us that there is a threat of some sort. Just because there is a threat, does not mean I have to shut down and avoid all activity, especially when that activity might be helpful in the long run by promoting strength, mobility, and allowing me to get important things done in my life. If you are having trouble juggling these rules or knowing when to push and when to back off due to a painful situation, a physical therapist may be able to help. At Full Potential, we provide free consultations to discuss just these types of situations! 

Call us at 616-537-2864!