How do I know when to exercise through pain vs. take a break and/or seek treatment?

Here is Dr. Jessica Miller addressing another topic that so many of us have thought about.


As an individual either new or returning to exercise it is very common to sustain injuries. Most often injuries occur in the joints such as knees, hips, feet, low back, neck and shoulders. Although there are numerous reasons for injuries, the most frequent injuries are a result of poor body alignment, overuse injuries, increasing exercise duration or intensity too quickly, unequal strength that develops in opposing muscle groups, and improper shoe wear.

The warm up before exercising is very important because it allow for an increase in blood flow to the muscles. Red blood cells carry oxygen, a requirement for muscle function. As you become more “fit” your muscles get better at extracting oxygen from the blood. In addition to carrying oxygen, the increased blood flow to the muscles helps to “wash away” hormones and neurotransmitters that can build up in the muscles and cause irritation and pain.

Pain is an adaptive mechanism that the body uses to prevent injury. For example, if you put your hand near a fire you will sense instant pain and reflexively pull your hand away to prevent a burn and limit further damage. In this case the sensation of pain in beneficial.

The pain pathways are very complex and the body has a remarkable way of increasing and decreasing pain sensation. When you bang your leg and develop a bruise, the bruise and the surrounding areas become exquisitely sensitive. Due to the release of certain substances, the body is able to up-regulate the sensation of pain. Over time, as the bruise heals and the swelling decreases, the sensitivity in that area returns to baseline. However, sometimes the pain system can go awry.

In some cases, there is an acute injury that causes increased pain sensitivity, but instead of the pain receptor sensitivity returning to normal over time, they remain ultra-sensitive. Even though there is no longer a reason for the sensation of pain to be generated, the body gets “confused” and can interpret sensations of light touch, heat, cold, or pressure as pain. In this instance, the pain is no longer adaptive nor beneficial. This malfunction is often seen in individual with chronic pain.

In my mind, there are two types of pain, “safe pain” and “dangerous pain”. Safe pain to me, is pain that does not indicate worsening damage, cancer pain, or harmful injuries. Safe pain is pain that often gets better during exercise and mobility. In contrast, dangerous pain is pain that indicates a significant issue that needs prompt attention. Some examples of dangerous pain include but are not limited to:

A fall or high-speed injury resulting in immediate severe pain and the inability to bear weight. This pain can indicate conditions such as fractures, ligament injuries, or instability.

Chest pain or heaviness which occurs during exercise should never be ignored. Typically, cardiac pain is described as chest tightening or pressure which often radiates down the right arm or into the jaw. However, in individuals with diabetes, chest pain can be atypical and present like indigestion. Chest pain is a medical emergency and should be evaluated immediately.

Neck or low back pain with associated numbness, tingling, or weakness should also be evaluated promptly. In addition, any neck or back pain associated with bowel and bladder symptoms such as difficulty controlling urine, loss of sensation or funny sensation around the buttocks, and/or constipation and loss of bowel control needs to be addressed by a doctor.

The general rule of thumb is that pain which worsens incrementally with activity, persists despite rest, or is associated with numbness, tingling, radiating pain down arms or legs should be evaluated by a trained medical professional. Pain that improves after a few minutes of exercise and is not associated with the above mention symptoms will often improve in its own. Again, it is most important to listen to your body. If you feel that “something isn’t right” or your symptoms are not improving you should go with your gut and have your symptoms evaluated

Disclaimer. The information provided here is not intended to substitute for medical care and should not be used for treatment or diagnosis. If you have, or suspect you have a problem concerning your health please consult with a licensed healthcare professional.

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