Top 5 Fridays! 5 Rules for Exercising People in Pain

A big misconception within the therapy world is that all exercises should be pain free. It is easy to assume that when an exercise is painful, you might be causing further damage or disrupting the healing process. However, that is almost never the case, especially with lower loaded interventions.

First, we know that pain and damage are not highly correlated. Pain is an experience that consists of a multitude of central and peripheral mechanisms in which the relationship between pain and the tissue becomes less predictable the longer pain persists.

Second, for individuals managing persistent musculoskeletal pain, the literature supports a small, but statistically significant benefit of painful exercises over pain free.

General Rules of Thumb when allowing pain with exercise by Cameron Faller

This does not mean that as clinicians we need to be preaching “No Pain; No Gain.” But what it does suggest is that we are able to reconceptualize pain-related fear through exercise.

In order to set up success for your patients, these are general rules of thumb I describe and establish early on to guide us through the recovery process.

1. Pain Must Be Tolerable
2. Pain Should Return to Baseline, or Diminish Upon a Determined Time
3. Avoid Increasing Symptoms More than 2 Points on a 0-10 Scale
4. Avoid Reaching Levels Where Moderate Swelling is Noticed
5. Avoid Reaching Levels Where Sleep Becomes Disrupted More than Usual

These rules are left fairly vague so that you can individualize all the parameters towards each patient you work with. Some patients are comfortable reaching higher levels of pain and some are able to show quicker recovery times.

Allowing pain with exercise is a process and not something you will have figured out the first time. With this, it is important you continually discuss with your patients about what they have noticed has improved, and what remains challenging.

Participating in shared decision making, keeping functional measures as a primary objective, and being willing to modify these rules based on each patient’s response will help guide you towards success.

Posted with permission from Cameron Faller's Instagram

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This article was originally posted on Modern Manual Therapy Blog

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