My rehab exercise hurts, should I keep doing it?

 

 

Have you stopped your rehab with a health professional because all the home exercises hurt?

 

Maybe you’re worried the exercise is doing more harm than good?

 

We’re here to tell you it is ok! But we have some helpful guidance for you.

 

 

If it hurts have I done more damage?

 

The short answer: Unlikely.

 

Medical research on pain has progressed rapidly in recent times.

 

We used to think all pain was because of tissue damage.

 

WE WERE WRONG.

 

The International Association for the Study of Pain recently updated the definition of pain to: "an unpleasant sensory and emotional experience associated with actual OR POTENTIAL tissue damage.”

 

English please! It is possible for you to feel pain when your body thinks tissue damage could occur.

 

Think of pain as the most advanced home security system money can buy, but for your body.

 

What’s that got to do with your rehab exercise hurting?

 

Naturally, your body is quite protective of a healing tissue. So, it makes sense that your body will warn you (pain) when it thinks you MIGHT make things worse.

 

 

Does it impact my rehabilitation if the exercise is painful?

 

Yes. When prescribed correctly you can expect BETTER outcomes if you exercise in pain.

 

You read that correctly!

How do we know this? Well, we see it time and time again with our patients, and there is lots of research to support it!

 

A recent study looking at hamstring strain rehabilitation found that the participants who trained within a set pain threshold were stronger and had better muscle development when they returned to play compared to those who rehabilitated pain free (Hickey et al., 2019)

 

Sounds alright, doesn’t it? Some pain during rehab to come out bigger and stronger at the other end!

 

 

How much pain is normal with my rehabilitation exercises?

 

There are two pain threshold systems I use, depending on the person and their situation.

 

If you have relatively low or no resting pain, then this system will work better for you.

 

THE PAIN TRAFFIC LIGHT SYSTEM:

 

GREEN: Your pain intensity is 0-3/10 during the exercise, and:

  • It settles quickly after the exercise
  • Your resting pain is similar 2-4hrs later AND the next day.

 

All good! Your body’s security system is working well, there’s no need to worry. You can safely progress next time you do the exercise.

 

YELLOW: Your pain intensity is 4-5/10 during the exercise, and:

  • It takes a little while to settle after the exercise
  • Your resting pain is back to normal the next day.

 

All good! Your body’s security system is working really well, there’s no need to worry. The exercise on the money, but you’re not ready to progress yet. Get in contact with your Physiotherapist if you’re concerned!

 

RED: Your pain intensity is >6/10 during the exercise, and:

  • It takes a little while to settle after the exercise
  • Your resting pain is back to normal the next day.

 

All good! Your body’s security system is on full alert, but don’t worry! The exercise is probably too hard for you right now, no stress!

You just need to adjust the exercise. Try reducing the number of repetitions, weight being used, or the range of movement. Get in contact with your Physiotherapist if you’re concerned!

 

If your resting pain levels change a fair bit, then this system will work better for you.

 

THE RULE OF 10.

(Credit: Ben Cormack, Physiotherapist from the UK)

 

Warning, some maths required.

 

Look at all of your exercises, give each one a score of difficulty from 0-10

(0 = Easy; 5 = Moderate; 10 = Hard). We call this a Rating of Perceived Exertion (RPE)

 

When it is time to do your rehabilitation exercises rate your resting pain from 0-10 (0 = no pain, 10 = worst pain imaginable).

 

Here’s the maths part. Your Pain score and RPE score can’t add up to more than 10.

 

So, if your resting pain is 4, you can do all the exercises up to an RPE of 6.

 

Had a bad day and the pain is a 7? No worries! You can do all the exercises up to an RPE of 3.

 

 

We’ve had huge success using these methods, and so can you!

 

If you need more detailed guidance on how to modify your rehabilitation plan please get in touch!

 

Mark Walters
Mark Walters
Principal Physiotherapist (APA, DPT) B. Ex. Sci, D. Physio Mark thrives on helping people getting back to the activities they enjoy, and aims to do this with fun and engaging rehabilitation. He also has a passion for injury prevention and performance, as well as helping people age strong.