The “No Pain, No Gain” Philosophy Is Flawed
As a physical therapist, I’ve heard patients come up with some pretty entertaining alternatives for the abbreviation PT, including pain and torture and even physical terrorists. Now, these patients were, of course, speaking in jest; but, in truth, there can be elements of pain associated with rehab.
Let me elaborate. Pain is never something that a therapist strives to create, but it may be an unfortunate side effect of certain treatments. We make sure that we are up front with our patients about what to expect in terms of discomfort or pain during various therapeutic techniques. For example, when we are helping a patient gain full range of motion at his/her knee following a total knee replacement, there will likely be discomfort at the end of the range. The same can be said for shoulder surgery. The majority of shoulder surgeries can cause significant discomfort when attempting to gain full motion because of how small the region is and the amount of muscles and nerves that must pass in the often swollen area. Another example of a treatment which may cause discomfort is electrical stimulation. Certain forms of electrical stimulation are intended to create an electrical pulse that causes a muscle to contract and the intensity of the pulse may not be comfortable for all people. As PTs, our goal is to help our patients regain function with as little discomfort as possible, but discomfort cannot always be avoided.
Two important things to understand are that not all pain is the same and no two people react to pain in exactly the same way. Pain may be described as achy, sharp, dull, throbbing, pinching, burning, etc. depending on the cause of the pain. Additionally, even if two people have the same surgery, one may have extreme pain and the other may have very little or no pain. Depending on a person’s condition, a PT may choose to minimize focus on that patient’s pain, because focusing on it can actually increase awareness of pain and therefore the intensity of pain. Other patients may need focus to be placed on pain because they could damage their tissues if they ignore their symptoms.
I have some patients that halt all activity at the slightest inclination of discomfort, while others are constantly trying to push themselves past their bodies’ limits. Neither of these philosophies are necessarily good ones. Pain is very subjective and often needs to be explained in terms of what is expected and what is abnormal. Muscle soreness is a natural result of increased muscle activation. When you perform new exercises, your muscles produce lactic acid. This lactic acid is the root of the soreness or discomfort felt following new exercises. If the soreness lasts for an extended period of time (ex. 3+ days), however, then your level of activity/exercise may have been too high and needs to be reduced. Stretching is another activity that may cause discomfort that is misconceived as harmful pain. When you are stretching you should feel pulling or even a slight burn in the muscle belly. If this burn becomes excessively intense or turns into a sharper pain, then the stretch is likely being performed too far into the range and needs to be reduced.
Exercise should not be painful while you are performing it. There are some exception with regard to various surgeries and chronic pain conditions where pain cannot be avoided during activity; but as a rule, exercise should not be painful. The “no pain, no gain” philosophy is flawed. Pain is your body’s natural defense mechanism. If you ignore it, then you are likely causing damage to your muscles, ligament, nerve, or other structures in the body. I cannot count the number of patients I have seen due to overuse injuries or who continued to exercise improperly despite pain. Pain can be complicated and very subjective, so if you are not sure if your fitness routine is causing potential damage, then call your physical therapist for a consultation.