How much pain is too much?

"It's a waiting game..." - Will Ferrell

This is not medical advice. See you doctor or therapist first.

This subject is hard to quantify as there are so many variables to consider. It is important to learn about pain, to protect yourself from injury, and to progress through rehab or fitness. It is important to think about pain from many different angles and perspectives.

Firstly, pain is relative to each person, and people perceive pain on different levels. It’s interesting that the patient’s who were not prompted to tell me that they had a high pain tolerance, were usually the people with the lowest tolerance for discomfort. There are studies confirming that a placebo pill is just as effective as aspirin at relieving pain. That says a lot about pain perception and the human brain. There was even a study where patient’s were told that the pill was a placebo, and their pain was decreased. Either people didn’t understand what a placebo is, or the mind is that powerful at pain perception.

Remember that saying about relieving pain by hurting another area? Our system is also wired that way. The pain gait theory describes how our bodies will allow certain pain signals through, and others are blocked.

Physical Therapy type people have always joked about pain and “hurting people.” Usually the patients are also joking, as sometimes pain is required for progress. My softball team 25 years ago was named the “Physical Terrorists.” For a group of fitness people, sadly we weren’t very good.

Ultimately, pain is a message or a way for your body to communicate with you on how to proceed with activity. How you choose to use, or interpret that message, can be the difference between injuring yourself, or progressively getting stronger. When you perform resistance training or weightlifting, you teach yourself how to differentiate between “good” and “bad” pain. Muscle pain, fatigue, or soreness can be a good thing, that is beneficial for getting stronger. A gradual onset of tendonitis or bone pain can make things worse.

There are times in rehab when you are asked to tolerate pain. If you have surgery and are lacking range of motion in a joint, you must gradually increase that range of motion over time, or your joint could become frozen with scar tissue. If this happens, you are unlikely to get that motion back. So stretching, and some tolerance for pain, becomes extremely important.

How much should you trust someone about to increase your pain? I would ask why is it necessary. That person should be able to explain why pain is needed or necessary for recovery.

Shoulder stretching can be extremely painful, yet the cause is important for progress. If you feel the stretching in the armpit, you are likely ripping scar tissue, and full joint ROM in the future will likely decrease you pain. If you have referred pain from the top of the deltoid, you might just be making impingent worse as the rotator cuff continues to pinch. This differentiation is important for progress. If you are consistently gaining ROM, then putting up with the pain will be worth it in the long run.