Pain Explained. Recovering from Injury.

by Joshua Bruner, PT, DPT, CSCS

We’ve all heard the phrase “No pain, no gain.” When taking part in rehab to come back from an injury, is there really any truth to the saying?

In the United States, chronic pain has become more prevalent over the past few decades. According to the National Institutes of Health, nearly 50 million adults have significant chronic or severe pain. Pain alone has been shown to affect more people in the U.S. than diabetes, heart disease, and cancer combined. Chronic pain can affect one’s daily lifestyle and become disabling. It makes one wonder if the phrase “No pain, no gain” is even relevant in treating an injury in physical therapy? To begin to answer that question, let’s first look at how pain works.

Nerves are the primary source for sending signals throughout the body when pain is experienced. The nervous system plays an important role in the body’s response to pain and acts as a protective mechanism for the human body. The best way to explain the nervous system is to compare it to an alarm system in a house. When something triggers that alarm system, it sends a signal to the main monitor, which alerts the household. The same thing occurs within the human body. When an individual steps on a nail, for example, the nervous system receives a stimulus that sends a signal to take the foot off of the nail. Once the stimulus is removed, the pain resolves and the nervous system returns to normal.

With an acute injury, one’s nervous system receives a stimulus that results in pain. If the nervous system is not reset to its resting level after the injury, the nerves around the injured area can become extra sensitive to movement and result in persistent pain. Extra sensitive nerves take less stimulus to generate further pain, which is why simple and safe movements can produce pain despite causing no physical harm to the body. Imagine the alarm system in the house again. If no one is there to properly reset the alarm after a brick goes through the window, the system may become more susceptible to going off to less dangerous threats, such as a neighbor’s dog walking in the yard.

Someone with a shoulder injury, for example, may have pain with simple and safe movements such as reaching overhead, but may not be causing physical harm to the shoulder itself. The same situation can occur in patients following a surgery. The trauma from the surgery can cause the nerves surrounding the area to become extra sensitive. This explains why gentle movement of the surgical area can be very painful even though the movement may not be causing harm to the actual surgical site.

Now, does this mean that we should technically “push through the pain” since we are not causing physical harm? Not necessarily, because too much pain can cause the nervous system to become more sensitive and allow the pain to linger. So, how do you know when the amount of pain you’re experiencing is normal? The best way to determine this is by answering four simple questions:

1. Does the pain return to baseline while at rest?
2. Does the soreness from prescribed exercises resolve within an hour?
3. Does the pain slowly resolve when performing the prescribed exercise or movement multiple times?
4. Does the activity or treatment that causes pain lead to a decrease in symptoms afterwards?

If you answered yes to any of these questions, you are most likely experiencing an acceptable level of pain with rehab.

Experiencing some pain in a controlled manner, such as during physical therapy, is normal when recovering from a surgery or injury. In rehab with a physical therapist, safe and controlled movements that produce little to no pain help reset the nervous system by decreasing the sensitivity of the nerves. The nervous system must relearn what stimulus is a true threat to the body rather than consistently producing pain with safe, harmless movements.

A professional physical therapist can help people gradually reduce pain through safe movements that help promote healing of the injury. If your pain experienced during rehab does not follow the rules above, it’s important to talk with your therapist, so they can make adjustments to the treatment plan. The goal of physical therapy is to produce no pain, but occasionally mild pain is needed to help reset the nervous system. A physical therapy session should not end with the patient leaving in more pain than they arrived with. If one feels a slight increase in soreness, it should resolve within an hour.

“No pain, no gain” doesn’t apply when rehabbing from an injury. One should not completely avoid all movements that produce pain because the nervous system can actually become more sensitive with bed rest and immobilization. Under a therapist’s supervision, no one should be afraid to perform gentle, controlled movements that produce mild pain, especially when the pain experienced stays within the limits described by the four rules. For help in recovering from an injury and learning movements that help an injured area heal safely, see a physical therapist at Southwest Health. We’re trained and available to help our patients overcome injury and prevent persistent chronic pain.