IS PAIN IN REHAB BAD?

Pain in rehab is a controversial topic. Some physical therapists say it’s part of the process and something you just have to deal with, others say it is something to be avoided.

With so many different opinions it can leave you in a scary place of not knowing whether you’re doing too much, too little, and unsure what to do next.

My goal with this article is to give you simple guidelines that can help ease that uncertainty based off what I have found to be beneficial with the athletes I work with.

In the first month or two following ACL surgery pain may be unavoidable, but the further into your recovery you get the more I see that as a red flag that you have something going on that needs to be addressed.

As a general rule I want to avoid pain in the rehab process as much as possible.

That does not mean we stop what we are doing, however. The key is to get as close as we can to those movements that cause us pain, but in a way that is 100% pain free. This is more of an art than a science, but is one of the defining characteristics of how I train my clients.

A mantra I instill in them from day 1:

Training should be hard not hurt

I don’t want athletes to push through pain because, more often than not, it actually makes things worse.

That’s because pain is, usually, a signal from our body telling our brain that something is off, that we are doing damage rather than stimulating growth.

A simple way to explain this idea is by thinking about the basic science behind exercise and muscle growth.

When you go to the gym to lift weights you actually are damaging your muscles, but you allow them to rest and recover and they grow back stronger (you deliberately take 1 step backwards in order to take 2 steps forwards).

Pain on the other hand means you are doing more damage than your body can recover from. It’s like taking 2 steps back but only getting one step forward in return, so you’re actually going backwards.

Then you try to push harder, to catch back up, cause more damage, and find yourself caught in a vicious cycle of pain, frustration, and setbacks that can be very difficult to break.

This is why we want to be very careful about distinguishing between the kind of pain you feel from a good workout (what I would call ‘hard’) vs. the sharp discomfort of actual pain.

It’s a fine line (and makes the language we use to communicate with each other very important as well) but one that I monitor very closely with all of the athletes that I work with.

Not crossing that line in training is one of the key markers I use to monitor intensity with my athletes so we can be sure the training we’re doing is building them up rather than breaking them down, even when challenging them with advanced training protocols.

The trick is that even though we don’t want to push through pain, we don’t want to change our entire workout plan if we can avoid it. When you tell me a movement is painful my goal is not to avoid it entirely, but learn where it is coming from. I want figure out exactly what movements, what loads, and what ranges of motion cause you pain, then pick exercises that get as close to those areas as possible without crossing the line into actual discomfort.

This is how we are able to eliminate the source of your pain rather than simply masking the symptoms.

Because remember, that pain is a signal, it is there to tell us something.

Yes it may be telling us that we are not ready for a certain movement or load or range of motion, but it is also pointing us in the direction of where you have the most room to improve.

Everyone should be able to squat on a slant board all the way down without their knees hurting.

If you can’t or that hurts guess what… you are going to get a ton of relief and see a ton of improvement by restoring that ability.

The key is to do that gradually, at your own pace, rather than jumping straight into the advanced stuff.

This is why the title of this article is ‘Why Pain In Rehab Might Be A Good Thing’… because it shows us what unique problems you specifically would benefit from solving the most.

It creates a clear roadmap to reach your goal of an athletic, pain-free life.

It’s like most things in life right — the way out is through.

This is why it can be so helpful to work with someone 1-on-1 who can diagnose your specific pain-points (whether that’s actual pain or just lack of progress) and create a plan to address them.

In leiu of that, however, you can still take this fundamental principle and apply it to your own training:

Do not push through pain, find the closest possible regressions or alternatives to challenge yourself in ways that not only don’t set you backwards, but actually move you forward.

If you just followed this one principle you could get a very long way in your recovery process. Just keep looking for ways to level up and challenge your body with something new.

Figuring out exactly how to do that can be tricky though, which is why working with a professional can help exponentially improve your progress. If that’s what you’re looking for, check out my training application:

You can also check out other articles here and videos on my YouTube channel for more in depth breakdowns of all things knee and ACL-related.

If you want to connect with me send me a message on Instagram @zakwoodwardatp

I’m always happy to answer questions.

Otherwise stay tuned for next weekend’s article.

Till next time, by