Archive for December 17, 2009

Painful Exercise?

Posted in Injuries, Low Back Pain, Random Thoughts, Training on December 17, 2009 by mboyle1959

I got a bunch of interesting responses to my Does It Hurt post. One reader said:

“What about situations where ‘no pain’ may not be indicative of ‘no problem’ or more precisely ‘a problem is brewing’?”

I think this is why I wrote articles like Should Women Run? and why I always recommend interval training on a bike. The truth is that Does It Hurt is really simple advice but, not all inclusive.

More interesting are the questions and responses that followed. Numerous PT’s who seem to specialize in pain management stated that painful exercise was OK. I strongly disagree in almost all cases. One PT actually went so far as to describe manual therapy as placebo. I have to tell you the dialogue is interesting. Make sure you go back and read not only the post but the responses.

Below is an excerpt from an article I wrote for StrengthCoach.com called My Ah-Ha Moments. Lots of this info is contained in my new book Advances in Functional Training.

Ah-Ha#2-. Soft tissue work, whether for chronic muscle strains or for tendon issues, is like weight training. Treatment is actually a stimulus. In effect what the therapist is doing is irritating the tissue to produce a chemical response. The chemicals produced are what begin the healing process. This why soft tissue work is often painful and can leave you feeling similar to a workout the next day.

Ah-Ha#2B- Soft tissue work goes by many names. The names don’t matter, the treatment does. Physical therapists use the term soft tissue mobilization. Chiropractors usually use ART or Active Release Technique. Massage therapists just called it deep tissue work. Just remember, the magic is in the hands, not the names.

Ah-Ha#5 It May Be Ok to Do Painful Exercise

I have always said “if hurts don’t do it” and “does it hurt” is a yes/no question. I still believe this in almost every case. However, my studies with Dan Dyrek have again shown me the error of my ways. In rehabilitating or reconditioning ( boy do the PT’s get bent if they think I’m doing rehab) a client or an athlete with a tendonitis/ tedinosis condition  it may be necessary to endure some tendon pain to produce the proper remodeling effect. Just remember this is the isolated exception to the rule. The painful stress to the tendon acts much like soft tissue work to initiate a healing response.

The key is the type of pain. Acceptable pain is localized to the target tissue, and the tissue is painful to touch. There should be no swelling and no motion restrictions. The pain should follow a DOMS like pattern and be gone in 2-3 days.

My point is that Does It Hurt? in my mind applies in almost every situation, the exception being the two above. I have trouble believing that having a client or a patient do an exercise that causes them discomfort is benefitting them.

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