Some of you may know that I suffered a fractured rib while snowboarding over a week ago if you follow my Instagram page @thefitwanderluster or my Facebook page. And if not, get on that! Unfortunately, not much can be done and bones takes 6-8 weeks to heal. As a physical therapist, my advice to myself is to listen to my pain levels and not push through. Also being an athlete training for a marathon in April, I counter my professional advice with “no pain no gain”. But how do we know what pain won’t produce more damage and when should we rest?
What are the signs of good pain?
Most people beginning a new workout regime or those in training will experience some sort of discomfort. For muscular improvement, the muscle has to endure increased stress resulting in the perceived burn during activity. This is otherwise known as good pain that should be temporary and resolved upon completion of the activity.
Fatigue is also a sign of good pain when demonstrating you are exerting tissues beyond rest. However, this should also be short-lived following exercise. Fatigue that lasts for days may be a sign that the energy supplies are taxed and that one might be overtraining.
There are times, especially for those who are under-conditioned, to experience delayed onset muscle soreness for 24-48 hours following activity. This is a result of micro-tears to the muscle but it is not necessarily a bad thing. However, this should not go beyond the 2 days and you may need to seek medical advice if the soreness accompanies bad pain symptoms as mentioned below.
What are the signs of bad pain?
There are several other structures surrounding joints which include: muscles, tendons, ligaments, cartilage, and bones. They respond to stress gradually and if the process is too rapid or excessive in a short amount of time, the tissue may fail. Bad pain can objectively be defined with edema (swelling), loss of motion, tenderness to palpation, pain with functional movement outside of exercise (like climbing stairs or getting up from a chair). To prevent failure, it is recommended when starting an exercise program that you begin slowly and build gradually. As a general rule: Take the amount of exercise you think you can do and cut it by one third the first few times you do it.
A side note that is more apparent to the naked eye in regards to bad pain is, of course, injury from trauma which can create tears, fractures, hematomas (bruising), and the feeling of weakness, numbness, and tingling, etc. Seek medical advice immediately.
How can this bad pain be treated?
Rest or decrease the activity that is causing the problem and try low impact cardiovascular training like walking, swimming or biking. Ice the painful area for 10-20 minutes at a time or until the skin gets pink and repeat a couple times throughout the day. Maintain range of motion with light stretches and pain-free motion and consider over-the-counter medicines, with the advice of pharmacist or physician, to treat pain and inflammation.
When should I be concerned?
Pain should be short-lived following exercise. Pain that alters performance, does not go away with rest, affects function or sleep, does not improve with treatment, or the pain increases over time is not normal and you should consider seeking medical advice.
My injury, in particular, produces intermittent pain. It was really bad in the 8-hour bus trip 2 days after the injury but on the 3rd day of the injury, I was able to run my long run of 14 miles with only mild discomfort (on a scale of 0-10 where 10 is the worst pain, I was experiencing 3-4/10). I thought, “No problem, I can still run”. I was able to do my interval training as well but found sprinting definitely felt worse than a steady pace (pain 6/10). I continued my cross-training but I found pushing weight through my left arm and trunk rotation to the right increased my symptoms (back to 7/10). As soon as I stopped the motion I felt fine. Besides these two motions, sneezing and sleeping were the only times I felt bad pain. I felt my activity didn’t create any hindrance in my rehab.
Regardless of the fact that I have a post-doctoral degree in healthcare, I was being stupid. I know injuries are in the acute phase for 14 days, which means lots of swelling and edema, probably resulting in some lack of range of motion which probably changed my gait. So when I attempted my long run of 15 miles this past weekend (8 days after the injury) my body finally told me to give it a break after 9 miles. I had searing, sharp pain into my left breast that was a 9/10. I couldn’t take one more pounding step without feeling like a knife stabbing me. Breathing was difficult, the crying began, and frustration and fear crept in. “What if I can’t train?” my brain screamed! After this 5-minute anxiety attack of realizing I wouldn’t finish my run, I came to the realization the “bad pain” was no longer “good pain”. I came back to my senses that I have a week and a half old injury, that I’m STILL in the acute phase, not even the remodeling phase yet which is really when healing begins. No wonder I am STILL in pain and will be probably for the next 2 weeks. DUH!
So by finally seeing the light on this injury, yes it hurts, but I don’t have to stop everything. I can find ways to stay low impact, wear compressive clothing to help support the swelling and pressure, and just give myself a break the next week or two. Will I still attempt running? Yes, because I’m crazy. Will I let my pain get over a 5/10? No, because I’m a health professional and I experienced the worst of it so far and I don’t want that to happen again.