Painful Exercise?


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.

9 Responses to “Painful Exercise?”

  1. Nice writing style.I noticed your blog from Bing and thought it rocked. Have you been writing for long?Not long ago I recently set up a blog on my own and its been a very fun process. I’ve met some interesting friends since then although it is tough sometimes! Once more, thanks a ton for your blog post!

  2. mboyle1959 Says:

    As I have said previously, you are obviously bright and educated. Thanks for making this one of the most read threads in the history of this blog.

  3. Mike, Mike, Mike… Whoa… ouch… I believe you took my comment out of context. In whole, what I basically stated was that manual therapy either worked because a) the manual intervention itself provided some type of spinal inhibitory mechanism or b) by virtue of education and creating expectations/perceptions a placebo effect occurs. There is no direct research that answers the question. And, yes, I admittedly said it is kind of a slap in the face to think the manual aspect is all placebo. I will admit, I do think there is a definite component of placebo but the key is in moving the patient forward during the window of time inhibition occurs.

    If you are referring to pain during treatment of a Achilles tendinosis with eccentric exercises, I’m not sure why the pain occurs, but it does. Apparently, microscopically, the Achilles tendon in tendinosis situations happens to have a large influx of neurovascular structures. Somehow with eccentric training, the amount of neurovascular abnormality is substantially reduced and basically correlates to a reduction in daily functional pain. To my knowledge, current research hasn’t quite explained how the abnormality occurs or why eccentric training reverses the abnormality.

    If you don’t have a background in pain education, don’t understand pain and don’t understand neuroplasticity, then I would suppose it is better to not have a person you are working with experience pain. It really isn’t abnormal for patients to report pain. The key is in asking the right questions to understand the current pain experience. I’m not saying every patient experiences pain with exercise, but yes, sometimes they do. Even as Andy shared, McKenzie extension exercises can definitely increase low back pain. I would assume most physical therapists communicate and the patient has no fear and expects the change in their symptoms. Since Andy didn’t respond (or I didn’t see a response), the outcomes in research for directional preference exercises is pretty good. Treatment based classification systems definitely enhance physical therapist outcomes.

    I assume our training, background, research, clientele are huge variables in why we will need to agree to disagree on pain and exercise. I just had to put my thoughts in because fear and anxiety really make my role difficult. I’d love to nip fear in the bud… pain does not always equal harm. Fear immobilizes the general public…

    ~Snippets

  4. Vincent Brunelle Says:

    Mike,
    the other A ha should be when one has pain (outside of injury) it is a message from your body. Check your posture and assess the gravitational lines. If your sore the odds are you are fighting against gravity and your effort is taxing.

    Vin

  5. mboyle1959 Says:

    Well said

  6. mboyle1959 Says:

    Interesting question. I want full pain free ROM to play. However, you know in hockey there is pain and sore. I don’t like playing either way but, I am also a realist. If pain compromises movement, no chance they play unless it is at a critical juncture in the year. There are always the “it depends” answers.

  7. Peter Roberts Says:

    Hi Mike
    Love your insights and your information is gold, the best thing probably about you is that your prepared to admit a misstep. I think it’s so easy to keep blasting away with the old thought processes even with the best intentions to no avail. As you said quite a lot of Physios and PT are loath to mention remedial therapy etc, I think a hell of a lot of this is down to professional jealousy. Back in the day a lot of Physios were very hands on then the machines came along to make their lives easy, and they don’t want to go back. I perform soft tissue work and it does sometimes pay a heavy price on your hands, but the results are wonderful. the human contact element is a huge placebo not to be discounted too. I have been treated on the Physio production line 4 people being treated simultaneously, it’s lazy and weak. I work as an exercise professional too and PT’s are loath to send people your way least they seem flawed. To refer is the right choice if what your doing isn’t solving the issue, because it’s the client that matters not the ego. To improve each day is the higher choice and to reflect imperative, if we can chose to do this then we take the higher road.

  8. Would you allow your athletes to play in pain?

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