IS THERE TOO MUCH OF AN EMPHASIS ON PAIN?
With rehabbing an injury, the goal is often to get rid of the pain and get back to 100% as soon as possible.
The issue I find with the measure of short-term success based around pain resolution is that it often falls on passive interventions such as rest, manual therapy etc. Yes, these can temporarily settle the pain quickly, however, despite being in much less or no pain, we have not increased your capacity for work and in fact often it is reduced. The absence of pain gives a mental ‘green light’ to crack on and I find leads individuals to ramp up activity to pre-injury levels quickly. Unfortunately, then there is a cycle of rebound/recurrent injuries or flare ups due to this cycle.
I propose instead, that although none of us want to be in pain, we choose to accept that in the course of rehab, there will be some pain. The severity, frequency and nature of the pain can guide us to progress, consolidate or regress our loading strategy. This pain should not be ignored, but can help guide the progress, along with a logical and graded progression.
Guide to acceptable pain:
1. Manageable pain that is not constant, keeping you up at night or affecting your gait.
2. Must not progressively worsen throughout an activity.
3. Must settle within 24hours of activity.
4. Must not be progressively worsening week by week.
If the pain is not staying within these parameters, instead of stopping completely, can you regress your program by a week or consolidate the current week and see how it responds.
This can be a much more proactive approach and less frustrating in the long term. Especially in injuries such as tendinopathies that can take many months to fully resolve and be pain free.
Have a plan that means you are not progressing entirely on presence of pain or not but a logical progression of loading. If you need help with this, let us know.
There are of course exceptions to this and this blog is not a substitute for medical or clinical advice, so if you are not sure, seek out the advice of a health professional.
Written by Sophie Tabor, Physiotherapist
Having an in house Physiotherapist has been transformative to the service that we can provide our clients at SFE. Our S&C and Physio teams can work in synergy to ensure the client gets the best outcome possible.
We all know that injury is rarely a linear path with it’s natural ebb’s and flow’s, yet we are able to manage setbacks quickly and effectively, giving you the support, guidance and accountability that is needed.
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