Should I Exercise if it Hurts?
Should I exercise if it hurts?
Probably not. While it seems to be badge of honour for some, exercising in the presence of pain probably isn’t the best idea if you want to progress in your health and fitness or make an old injury go away. I’ll try to explain my thoughts below. First I’ll briefly define pain, discuss what happens then a solution.
At this point in civilization, pain is understood to be produced by the brain to motivate you to protect your body. It also gets other systems of the body involved to put up the good fight, including hormones like those that deal with stress, the immune system and the muscles, which affects how you move (or maybe you can’t move because it hurts). Disclaimer: just because pain is produced by the brain it doesn’t mean pain isn’t real. It’s real and if you’re in pain it can hurt like a little son of a B. Come to think of it, my grandmother used to call me that when I was being a pain in her backside. But I digress.
Back to pain and protection, when it comes to the muscles and movement, there is an abundance of science showing that, in the event of perceived danger, in an effort to protect ourselves, the brain does things like reduce strength in some muscles so you’re weaker, make muscles tight or stiff, limits how far you can bend or move and even changes the way that you move (e.g. you get a limp, hold yourself differently). There are also a lot of changes happening in the brain itself but that’s another story.
While these strategies may be helpful in the short term, in the long term it can cause problems. Muscles can get smaller, particularly those that detect the position of your body so you may lose some sense of controlling your body or not able to “feel” where your body is in space (brain also contributes to this), weak or tight muscles around a joint can accelerate problems with the joint, changes can happen in the muscles or joints on either side of the original injury (knee pain with hip and ankle above and below) and entrench some of the altered movement strategies like how you walk, hold yourself or generally move differently. Evidently the longer the new movement behaviours are in place, the longer it can take to reverse.
So given all of the above, as for strategies, I would say that based on all of the above, if it hurts don’t do it. That’s probably the easiest solution. While you can push through it and the pain may go away, the reality is likely that you’ve adapted and not addressed the original problem. In other words, rehabilitation should be determined by the functional outcomes as opposed to only the presence or absence of pain. This is because the pain may go away but all of the changes to the muscles and movement I mentioned above may stick around even after the sensation of pain is gone. So as an example, in the case of shoulder pain, has full range of motion and strength been restored? Have you addressed any movement faults in the context of loaded or unloaded movements?
The second strategy (and it should be first) is to have an individualized assessment and exercise program that meets your goals and your current abilities. If you have pain during your training now or while doing other daily activities and you are training, your training program is contributing to your problem rather than enhancing health. A good assessment will pick up on potential injury mechanisms and weak links, like old injuries and movement patterns that you didn’t even know were hanging around, and an individualized program will be designed to help you progress pain free over the long term. Generic programs will produce generic results at best and get you injured at worse. If your goal is health don’t chase performance.
*I want to clarify that I’m discussing specific mechanisms of pain that are more mechanically driven for folks that exercise. If you have pain that is worse with stress, you’re afraid of moving, your environment is stressful, you don’t sleep well, you’re using opiates or other chemical means, and/or you eat like shit, then those are also threats that must be addressed but the process is a little different.