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How to exercise with pain: A guide to getting stronger

Are you wondering if it's okay to feel some pain when you work out? Maybe you're trying to get back in the gym, but you're not sure if you should be completely pain-free. Well, today, we'll talk about just that!

In this article, we'll explore how you can exercise safely, even if you're dealing with persistent pain. We'll learn about what is considered normal pain during exercise, how to handle pain while working out, and whether feeling sore after exercise is a bad thing. So, let's dive in and discover the answers to these questions!

Dealing with pain during exercise can be scary, but there are steps you can take to minimize pain flare-ups and avoid re-injury. Before we get into the details, here are a few important things to keep in mind:

1. Get Medical Clearance: It's essential to get the green light from a physician or Doctor of Physical Therapy before starting or returning to exercise, especially if you have an acute injury.

2. Delayed Onset Muscle Soreness (DOMS): Some soreness after a workout is normal, and exercising through it can actually help reduce it. Typically, DOMS makes you feel sore roughly 24-48 hours after you’ve done your workout.

3. Persistent/Chronic Pain: This article is primarily for those with ongoing pain issues once major structural problems have been ruled out.

Think of improving your pain tolerance as similar to getting stronger in the gym. Just like you have to add more weight and train frequently to get stronger, you need to gradually increase your pain-free activity.

Three Approaches to Pain and Exercise

1. The Deconditioned Group: If you don’t use it, you lose it. Have you heard of this one? If you stop being active, your body becomes weaker, and your pain threshold goes down. So, it's not a good idea to avoid all activity when you're in pain. There are ways to train around your pain because let’s remember that movement is medicine.

2. The Fanatical Group: Some people push too hard, go beyond their limits, and end up causing major pain flare-ups. Taking several days to recover is not the way to go. Think of this group as the on-a-whim weekend warriors who love to go from 0 to 60 without much preparation.

3. The Play It Safe Group: These folks have found a balance between activity and pain. They may be active, but they often stick to the status quo. However, there's a risk of stagnation in this group, and they might not achieve their fitness goals. Plus, they tend to adopt the notion that pain is present all the time so that’s just the way it is.

How to Safely Increase Your Pain Threshold

To improve your pain-free activity levels, you need a strategy that allows you to push yourself past your pain threshold safely. I use a strategy of a stop light. On a scale from 0-10, with 0 being no pain and 10 being the worst pain imaginable and you’re already in the ER, rank what your pain is that you experience.

If you are from 0-3, I consider this a green light to continue the activity because sometimes when you’re working hard, there does come slight pain or discomfort with it.

If you are from 4-6, I consider this a yellow light and to monitor the activity you’re doing.

If you are a 7-10, I consider this a red light and understand maybe this isn’t the best exercise for you now—not forever—but right now.

Pain During Exercise: What's Acceptable?

Now, let's talk about what's an acceptable amount of pain during a workout. When you exercise, you might experience different types of pain:

1. Pain-Free: If you're pain-free during your workout, that's a good sign, and you can consider increasing your activity level next time.

2. Pain at the Beginning: If you feel pain right when you start an exercise, there are a few things you can do:

- Check your technique.

- Try the next set; your body might warm up to the exercise.

- If it still hurts, a rule of thumb I use is to decrease the intensity (weight, reps, sets, speed) or the range of motion.

- If that doesn’t clear it up, try the exercise again in a future session to see if it was just a one-off bad day.

3. Pain in the End Sets: If you experience pain towards the end of your sets, don't panic. It's likely due to fatigue. You can stop the exercise at that point because you don't want to push past your pain threshold.

4. Pain in Subsequent Days: If you feel pain after your workout, ask yourself how long it lasts. If it's around 24 hours or less, it's considered normal, similar to delayed onset muscle soreness.

- Keep the volume and intensity the same for the next session.

- If you don't experience pain in the next session, it's safe to increase difficulty.

- If pain lasts significantly longer than 24 hours, make minor changes like reducing weight, rep number, or choosing an easier exercise.


So, there you have it, fitness seekers! You can safely exercise, even if you're dealing with some pain. The key is to gradually increase your pain tolerance and use pain as your guide. Remember, you don't have to be completely pain-free to work out; you just need to find that middle ground where you can push your limits safely.

To sum it up:

- Improving pain tolerance is like any other adaptation; it requires pushing your limits.

- Pain at the beginning might be due to warming up or technique issues.

- Pain at the end of sets is often a sign of fatigue, and you should respect it.

- Pain that lasts less than 24 hours is normal, like muscle soreness.

- For pain lasting more than 24 hours, make minor adjustments and keep experimenting to find the right balance.

And, if you’re still not sure, you can always schedule an appointment to help you overcome any pain symptoms you may be experiencing.

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