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Pain: What’s normal and what’s not

As I scroll through social media today, the day after the Broad Street Run, I see a ton of posts about not being able to move. This is my favorite one:

Pretty funny,  but I definitely can relate to the sentiment. I’ve run the Broad Street Run 5 times now and consider it a mini miracle to come out of it pain free. It also got me thinking about how to explain what normal pain is, what injury related pain is and how to know whether to enlist the help of a medical professional.

We’ve heard time and time again “No pain, no gain.” It can be very confusing to try to decipher the difference between “good pain” associated with making gains in strength and endurance and “bad pain” associated with injury. Knowing the difference between these two conditions is crucial. Understanding the difference can can assist in making you a stronger athlete and save you from avoidable injuries.

Pain

Pain is a neurological signal that there is actual or potential damage to the structures in your body. It’s your brain telling you, “Hey! Something is WRONG! You better look into this.”

Location, Location, Location

Just like in real estate, location is EVERYTHING when it comes to deciding whether pain is normal or not.

Good Pain

Normal or “good pain” is  ALWAYS going to be located in your muscles and NEVER in your joints or ligaments. “Good pain” is technically called “delayed onset muscle soreness” or “DOMS.” DOMS typically occurs 24-48 hours after exercise and lasts 2-3 days. It’s a diffuse soreness that you will feel with activity. You won’t typically feel pain at rest with DOMS.  It’s caused by microscopic trauma to your muscles after an activity that overloads them. It’s a sign that weaker muscle fibers are tearing. Though it sounds bad, it’s actually a good thing! After a muscle fiber tears, new muscle fibers form and make adaptive changes that anticipate the heavier loads you’ve been placing on them. Your body is basically saying “our current muscles aren’t strong enough to handle all that exercise. Let’s make some new fibers that can handle it.” It’s a beautiful thing! Repeating the process of tearing up old muscle fibers and rebuilding with new ones is how we get stronger.  It’s how bodybuilders put on mass. It’s how runners and cyclists get faster. Our bodies are constantly making adaptive changes when you exercise to make you stronger and more efficient. After a long run, you may feel DOMS when walking up and down stairs or getting up from a chair. This is normal and will eventually go away in a few days. The best way to get rid of DOMS is to drink a lot of water and to move. It stimulates the lymphatic system-the drainage system in your body.

Bad Pain

Pain in your joints (the space between bones), tendons (the connective tissue between muscles and bone), and ligaments (the connective tissue between bones) is NOT normal. You should never “push” through this pain. Pain in joints, tendons, and ligaments is a sign of injury. When it comes to distance or endurance events, it’s often a signs of overuse. If you’ve fallen or experienced some sort of traumatic event, it can be a sign of a more serious injury. Swelling and pain at rest is often a sign of “bad pain.” If you are experiencing bad pain, you should stop the activity that’s causing it. If you are running and you have bad pain, then WALK. There is no benefit to your body to toughing out this type of pain. It won’t make you stronger or faster. It may actually lead to more down time if you don’t take the time to address it. If an event has occurred where you’ve fallen or torqued a joint and can’t put weight on it, definitely seek medical assistance right away. Otherwise, it’s ok to just to back off.

I have bad pain. Now what?

REST. ICE. COMPRESSION. ELEVATION. (RICE for short).

Rest

Rest doesn’t necessarily mean that you need to take time off from exercise, but it does mean you need to stop doing any activity that replicates your bad pain. If you experience pain when running, but lifting weights is pain free, then go for the weights. I always like to say, “let pain be your guide.” This means if it doesn’t hurt, then it’s ok to do. If it hurts when you do it, then stay away. Try taking at least a week off of the pain causing activity and make sure you have no pain, swelling, or tenderness before trying to resume that activity again. Make sure you don’t resume an activity at the same intensity as the time of injury. Dip your toes in the water before you dive in, so to speak. Only try a few minutes of an activity and wait a day to assess how it made you feel before you return to a training regimen. Remember that most injuries happen when you over train or ramp up your training too quickly. Your body needs time to adapt, so don’t rush it!

Ice

Ice is a great way to slow the inflammatory process in the body without having to take medication. Although temporary, it also numbs your nerves so you don’t feel pain. Try icing 1-2 times per day for 10-20 minutes.

Compression

Wrapping an injury can help take down swelling. You want to wrap looser as you move distal to proximal. This means you should start slightly tighter at the end closest to your extremities and loosen up as you move closer to the center of your body. But don’t wrap too tightly! Loss of sensation or discoloration is a sign the wrap is too tight. Use a material that is flexible, like an ACE bandage.

Elevation

You can help your lymphatic system out with the use of gravity. If you’ve injured a limb, keep it elevated above the level of your heart to help drain things towards the center of your body. Use pillows to keep an injured leg elevated while you are lounging.

It’s been a week, I’ve used the RICE method and the pain isn’t any better.

Time to see a medical professional. Your family doctor or a physical therapist is a good place to start. Physical therapists with direct access licensure (like us!) can evaluate and treat an injury without a referral from a doctor. If your therapist suspects a more serious injury that requires medical imaging or surgery, they can assist you in with finding the appropriate medical provider. Otherwise, physical therapy can help the vast majority of orthopedic conditions.

 

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