Most people understand that in order to recover from an injury well, they need to train their muscles to get strong. They understand that adding resistance to their movements, such as by carrying a dummbell while performing the movement, will increase the level of difficulty and cause the muscle to undergo a series of reactions* that, ultimately, make it stronger.

For some people, this is enough to assure them that they will heal and be back to normal in the near future. For others, however, they don’t realise that something else was damaged when they hurt themselves and that needs to be repaired too. That is, their confidence. They’ve been shaken and they’re not sure how things are going to go. Pain worries them and makes them think they’re doing more damage. That makes them do less exercise or only at a very low intensity, which slows down their healing further and prevents them from getting to appropriate strength levels before trying to return to their sport.

I’m here to share some good news: pain does not always mean damage and indeed damage does not always signal pain. The classic example given is from a study done on cervical spine imaging. (1) They took 1211 healthy, pain-free people and performed MRIs on their necks. The results showed that even for those in their 20s, there was a high percentage (<73%) of disc bulges that could be seen. However, patients had no symptoms!

Another study (3) showed very similar findings:

Disk and Fascia DegenerationImage 1. Incidence of Spinal Degeneration in Asymptomatic Populations Source: https://simplifaster.com/articles/why-most-people-are-wrong-about-injuries-and-pain/

The second main point I’d like to make is that though the old thinking used to be to never go into pain during exercise, the more recent thinking is that a bit of pain is OK, once it’s at an acceptable level to the patient. Smith et al (2017) did a recent systematic review on chronic pain and rehabilitation with exercises that may cause some pain. They found short term pain levels were better for those that exercised with a bit of pain, compared with those that didn’t, and that medium and long-term results were similar for both groups. Function and disability were unaffected by either exercising with or without pain. (2)

So, to sum up, if you get injured, don’t believe you are stuck with a ‘disability’ forever. You simply need to break down some barriers, have confidence in your rehab and don’t fear pain – use it as a tool to guide you to the right levels during exercise. Too much = pull back, just a little = A-OK, none at all = push on! One caveat: be most careful with acute injuries (broken bones, torn ligaments, post-surgery, etc.). Do what you can while they heal and once they’re healed fully as confirmed by your doctor push yourself using the guidelines above – WITH the help of a professional of course. 😉

*For an explanation of the full mechanism, that will require an entirely different post.

  1. Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine(Phila Pa 1976). 2015 Mar 15; 40(6):392-8. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25584950
  2. Smith BEHendrick PSmith TO, Bateman M, Moffat F, Rathleff MS, Selfe J and Logan P. (2017) Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis
  3. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J.A., Avins, A.L., James, K., Wald, J.T., Kallmes, D.F. and Jarvik, J. G. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR. American Journal of Neuroradiology36(4), 811–816. http://doi.org/10.3174/ajnr.A4173 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/