I recently read an interesting article by arthritis rehabilitation researcher Ewa Roos from the University of Southern Denmark. The title for the article is the perfect discussion point for something that we have been discussing in the clinic, ‘If your knee hurts, keep exercising’.
This may sound insensitive, however pain is as suggested, a symptom. The brain makes an evaluation of the perceived threat or damage to a tissue and based on the context and the previous pain experiences of the person, their brain decides how much pain they should experience. Now this may seem strange, however this has been shown over and over by a fantastic Australian researcher, Lorimer Moseley and his team in Adelaide. The finding is consistently that pain evaluation is individual and not related specifically to the stimulus applied.
This does not mean that someone’s experience of pain should be discounted, however it does mean that just because somebody has pain, they may not necessarily have significant damage to a tissue. Two examples highlight this. The first is a number of patients that I have seen that have significant low back pain during daily tasks, but developed during participation in exercise at a high level. However after getting a scan, the findings were essentially blank. The counter to this was a patient that ruptured a tendon in their hamstring, requiring surgery, but other than the initial pain at the time of the incident, had little to no pain when doing daily tasks.
So what does this all mean?
It means that we should be aware of pain and particularly changes in pain, however the experience of pain does not discount someone from continuing in the rehabilitation or exercise setting. If their pain is stable, then effort should be made to continue to progress their function during exercise towards the goals of sport or rehabilitation. The article by Roos gives a rough guide for arthritis patients and that is, if pain is between 2 and 5 out of 10 and is staying stable during or after activity, then it is safe to continue. If it goes above 5 out of 10 then it may mean you need to alter the exercises that your perform, but should not stop exercising altogether.