Does It Hurt?

This is another of my previously published pieces reprinted for your reading pleasure:

I get asked rehab questions all the time. I have rehabilitated athletes in almost every major sport who were told they were “all done” by a doctor or a team trainer. Because people know my background, they often ask for advice.

Most of the time they ignore the advice because the advice does not contain the answer they want. They say “it only hurts when I run”, I say things like “don’t run”.

A famous coach I know once told me “people don’t call for advice, they call for agreement or consensus. If you don’t tell them what they want to hear, they simply call someone else”. His advice to me, don’t bother wasting your time with advice.

Here I go again wasting time.

If you have an injury and are wondering whether or not a certain exercise is appropriate, ask yourself a simple question. “Does it hurt”? The key here is that the question ‘does it hurt?” can only be answered yes or no. If you answer yes, then you are not ready for that exercise, no matter how much you like it. Simple, right? Not really. I tell everyone I speak with about rehab that any equivocation is a yes. Things like “after I warm-up it goes away” etc. are all yes answers. It is amazing to me how many times I have asked people this simple question only to have them dance around it. The reason they dance around the question is that they don’t like my answer. They want to know things like “what about the magic cure that no one has told me about?”. What about a secret exercise? I have another saying I like, “the secret is there is no secret”. Another wise man, Ben Franklin I think, said “Common sense is not so common”.

If you are injured and want to get better, use your common sense. Exercise should not cause pain. This seems simple but exercisers ignore pain all the time and rationalize it. Discomfort is common at the end of a set in a strength exercise or at the end of an intense cardiovascular workout. Additional discomfort, delayed onset muscle soreness, often occurs the two days following an intense session.  This is normal. This discomfort should only last two days and should be limited to the muscles not the joints or tendons. Pain at the onset of an exercise is neither normal nor healthy and is indicative of a problem. Progression in any strength exercise should be based on a full, pain-free range of motion that produces muscle soreness without joint soreness. If you need to change or reduce range of motion, this is a problem. Progression in cardiovascular exercise should also be pain free and should follow the ten percent rule. Do not increase time or distance more than ten percent from one session to the next. I have used these simple rules in all of my strength and conditioning programs and, have been able to keep literally thousands of athletes healthy. I’m sure the same concepts will help you.

27 Responses to “Does It Hurt?”

  1. […] want to take my word for it, legendary strength coach Mike Boyle wrote an article years ago called Does It Hurt? that opened my eyes to to an obvious solution to this problem. Read it and listen to his advice, […]

  2. mboyle1959 Says:

    I think everyone needs blanket statements. Yes there are obviously exceptions to every rule but to tell coaches and trainers that it is OK to ignore pain during exercise is clearly wrong. I also happen to believe that it is wrong in 99% of rehab cases. Your focus is the one percent, mine is the other 99.

  3. Cubos, yeah, I think the main issue is blanket statements don’t work when it comes to pain. I don’t think the settings/clients are apples to oranges. Whether I’m working with a patient post operatively or whether I am working with a young athlete who is doing preventative work, I keep all aspects/factors of pain in mind and apply the research out there to meet the individual’s needs.

    Nelson, this part of your comment is somewhat true, but not necessarily: “I agree that we should not have anyone move in pain. The brain is highly predictive and associative. Moving in pain is literally teaching your brain “movement is painful”

    If you look at some of, I think, Moseley’s work, people with chronic back pain can just think of doing a certain activity, like say picking a 30# object off the floor and during the thinking process can have significant differences in the active pathways in their brains (as noted with fMRI). You can then take those same people and educate them about pain. Not have them do a single exercise or do any movement pattern. Just talk and educate them – engage them in understanding pain. The research findings are that those same people after an educational session will have almost normalized brain process just thinking about picking a 30# object off the floor (as noted by fMRI). If I recall correctly, I believe, through other research, education can change function, but doesn’t necessarily eliminate reports of pain.

    Again, I can’t support a blanket statement of not having anyone move in pain. That kind of thinking is distorted when it comes to pain. There are millions of people in pain in this world and if they all followed that blanket statement, we’d have a lot of people sitting around doing nothing and having their butts carted around by something or someone.

    The real response to whether or not it is okay to exercise in pain is, “it depends.” I mentioned in previous posts the multiple factors that should be considered prior to determining if the pain experience is okay or not okay. If we perpetuate thoughts that people should not move in pain, we basically increase fear levels and immobilize people… as fear levels increase we have more societal costs due to diagnostic spending to define the reason for the pain.

    Again, I appreciate the discussion. It is interesting hearing different views.


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