Training with Pain
Pain is many things; complex, multi-factorial, and most importantly — subjective. It’s not just a yes or no scenario, and subjectivity usually surrounds someone’s “tolerance” and the quality of their pain. I’m sure we’ve all heard someone say “I have a high pain tolerance,” to which I usually ask, “compared to what?” Let’s go ahead and have a little conversation about pain and go over some tools to use in understanding how hard you should push it.
Rather than looking at pain as a tolerance, I’ve started looking at pain as more so a relationship. This is typically determined by a person’s history in sport/activity, as well as how much said sport/activity has beaten their body up. A novice mover, or more sedentary person, may find stretching painful simply because it is a novel stimulus that their nervous system has not experienced. Whereas, it is not uncommon for ultra marathon runners, folks who push their bodies to the limits every day, to try and run through stress fractures.
Experience is our best teacher when it comes to understanding when to pause or push through pain.
Measuring pain and knowing when (or not) to train
In healthcare, we use the Visual Analog Scale (VAS) to assign a general, objective marker to someone’s pain level. This is our typical 0-10 scale, with zero being no pain at all and 10 being the worst imaginable pain. In between that pendulum we will typically classify a 3-4/10 as “nagging” or “uncomfortable pain” — in other words, it doesn’t necessarily change how you go about your day but you’re definitely aware something is going on. A 6-7/10 on the pain scale is getting a little more intense, and will likely force you to adjust how you go about your day — as well as impact your mood and demeanor.
Once a patient has identified their number on the pain scale, the next step is to determine when we should train, when we should slow down, and when we should prioritize rest. The stoplight analogy comes in handy here:
- Green Light = Your pain is from a 0-3; train like normal. Don’t worry about modifying movements or decreasing the intensity.
- Yellow Light = Your pain is 4-6; we should make some modifications. This might look like modifying movements or changing the volume (reps) or load (weight) of a workout.
- Red Light = You’re dealing with pain that is 7 or greater; your workout should be heavily modified, replaced with single mode aerobic work, or shut down completely.
After a handful of ‘“yellow light” workouts, if improvement isn’t made or noticed, it may be time to call up your chiropractor, physical therapist, or massage therapist to get some trained eyes on you.
The stop light analogy is simple, but damn if it isn’t effective. If nothing else, it’s a great place to start in determining an appropriate training stimulus. There are two more considerations to make during and after your workout to hone in the skill of training with pain.
Be one with your feelings
Your quality of pain is another aspect that is heavily weighted in a healthcare setting. The quality of one’s pain is mostly just simple descriptors like ‘“achey”, “sharp”, “stabbing”, “dull”, “shooting”, “tight”, et cetera — being able to describe the quality of your pain helps me, as a healthcare provider, to understand the intensity of your pain. If you would describe your pain as sharp, stabbing, shooting, or are experiencing any numbness/tingling I would recommend you err on the side of caution and dial back a little more than the stop light may suggest.
Lastly, after you train through or around your pain, how do you feel? Did the pain increase? For how long? Did it go away? Did it boomerang back? As corny as you may feel, these are the moments in which a training log or journal becomes incredibly helpful. Beyond just tracking your fitness and wellness progress, logging how you feel during, and how you feel after a workout from a pain management perspective is huge in developing a sound strategy for movement improvement. If post workout soreness/pain (not the soreness associated with those gainz) increases for more than 60-90 minutes it is advised to make changes to the next training session. Decreasing volume or load would be great modifications to following workouts.
This may be an unpopular opinion, but I’m not sure a life without any pain at all is a realistic goal, especially if you are active. Having a good understanding of what pain means and when you should be concerned is an integral skill to develop in order to maintain your health and your fitness.