Sunday, March 1, 2015

Pain during exercise: How much is too much?

The topic of "no pain, no gain" is one that arises almost daily. Is pain during exercise appropriate? When is it too much, leading to muscle strain and injury?

Pain during exercise: How much is too much?

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The topic of “no pain, no gain” is one that arises almost daily in my practice. Is pain during exercise appropriate? When is it too much, leading to muscle strain and injury?

We tend to follow a simple pain number scale (0-10) for determining the “allowable” amount of pain with exercise at my office. If you consider the exercise pain free, you score it a 0, moderate pain is a 5 and excruciating pain is a 10. For a healthy, pain-free population, exercise should not elicit pain other than the sensation of burning due to muscle fatigue. This is a normal sensation and indicates minor muscle “damage” that enables muscle growth, strengthening and repair with the appropriate rest between workouts. This type of pain goes away within seconds of stopping the exercise.

During rehabilitation of an injury where there is baseline pain present prior to initiating the workout, we allow up to moderate pain but no greater than a 7. For anyone, if the pain is described as sharp or shooting, it is suspect for impending injury. At that point, the exercise intensity (weight) should be reduced. If pain remains still, the exercise should either be modified to a smaller range of motion or stopped altogether. Similarly, if pain intensity increases more and more with each repetition, the exercise is not being done properly or the intensity is too high.

Another “normal” pain you may feel occurs 1-2 days after your workout. In the medical community this is termed DOMS, short for delayed onset muscle soreness. This muscle pain creeps up 12-48 hours after performing a strenuous activity and that lasts a few days. DOMS is a normal response to increased exertion to which the body is not accustomed. Once your muscles get familiar with the movement patterns, the same activity at the same intensity will no longer result in soreness. Although the soreness is, well, sore, it is not a cause for concern and it serves as a reminder of the great workout your body had!  It can also be perceived as the same type of “good hurt” you may have experienced after an intense deep tissue massage. Both allow you to feel muscles that you never knew you had!

Pain is the body's warning signal that injury is occurring or about to occur so it should never be ignored. It is important to become familiar with identifying the “good pain” associated with muscle growth and strengthening or healthy stretching and differentiating this sensation from a “bad pain.” Our bodies are pretty amazing and will tell us what we need to do; it's up to us to listen.


Read more Sports Doc for Sports Medicine and Fitness.

Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
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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
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
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
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
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
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Tracey Romero Sports Medicine Editor, Philly.com
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
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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