Sunday, May 24, 2015

Exercise and pain: Why rest isn't always the answer

My clinic sees a lot of athletes, and one question I ask every patient on their initial evaluation is, "What have you been doing at home?" The most common answer is, "Nothing."

Exercise and pain: Why rest isn't always the answer


My clinic sees a lot of athletes, and one question I ask every patient on their initial evaluation is, “What have you been doing at home?” The most common answer is, “Nothing.” 

Many people tell me that when they felt pain, weeks and even months ago, they just ran or exercised through it until it got bad enough that they could not do their sport anymore. So they rested for two weeks, four weeks, two months, then they went back to their sport and the pain came back. Sometimes, the pain comes back worse. No matter how long they rested, the pain returned and sometimes worse and in more spots then it was before they took time off.

Why doesn’t the pain stay away after a period of rest?

The truth is that unless it was a traumatic injury, like an ankle sprain where you can pinpoint exactly when and what caused it to hurt, rest is going to do very little for the pain on a long term basis. There is a reason that you were having pain. This could be muscle imbalances in the body, it could be inflammation, and it could be—and most often is—a combination of factors.

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Having pain in a joint means that there is a problem in the body and unless it came from a traumatic situation, then rest will not solve the reason that it got there in the first place. The reason for the pain must be identified and treated, not just the fact that you have pain. Treating the pain does not treat the injured area.

Why does it feel better after I rest but then hurt again?

Most often, when there is pain there is inflammation or swelling. Even though you may not be able to see a marked increase in fluid to the area, there may still be swelling. Rest allows the swelling to decrease. It allows the painful stimulus to subside. It allows any compensation patterns to diminish and it gives your body a break. The first couple times when you start back in, it may feel good. But over time you return to the old compensation patterns and you begin to experience the pain you once felt and sometimes even worse.

While you rested and did nothing, the remainder of your muscles began to weaken and this has made for a more precarious situation then you were once in. Not only are you dealing with an injury but now you are starting to have de-conditioned muscles.

So do I just exercise through it?

NO. The answer is simple, no. Pushing through it could cause you to damage something further or create a catastrophic injury from what was a simple compensation injury. But you cannot go and see your health care professional with every ache and pain either, otherwise you could be in there almost every day. The first step to take—and this goes only for injuries with unknown causes (commonly called non-traumatic injuries) is to ice.

  • Apply ice to the area for 15-20 minutes.
  • Make sure there is a cloth or a towel in between the ice and your skin.
  • Elevate it if you can. Do this every day for two weeks.

If you feel no change in pain or the pain is getting worse then you go and see your health care professional. Anti-inflammatories do not take the place of ice. Popping a few Advil does not have the same benefits as ice. Ice needs to be applied to the area, there is no substitution.

But I am in pain, isn’t it just best to stay off it?

The answer may be yes, to a certain extent. While it may be important to give your body rest from the pounding or the cutting of your every day exercise, it is very important to keep the muscles strong. Taking two weeks off and not doing anything can be just as detrimental as exercising through the pain. There are many ways to take the pressure of a painful area but still continue to exercise. It is important to see someone who understands athletes and how to keep the body active while allowing healing to occur.  Making sure that you seek professional help early can help you stay healthy and active for a long time. 

Read more Sports Doc for Sports Medicine and Fitness.
Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

J. Ryan Bair, PT, DPT, SCS Founder and Owner of FLASH Sports Physical Therapy, Board Certified in Sports Physical Therapy
Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Justin D'Ancona
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Brian Maher, BS, CSCS Owner, Philly Personal Training
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Gavin McKay, NASM-CPT Founder/Franchisor, Unite Fitness
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Producer,
Tracey Romero Sports Medicine Editor,
David Rubenstein, M.D. Sports Medicine Surgeon, Rothman Institute
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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