A new way to think about pain with exercise
If you're training hard or rehabbing from an injury you may encounter pain with exercise; here's a new way to think about it.
This week, I want to let you in on a trade secret from someone who works with patients in pain every single day.
Pain… its an interesting experience.
Consider this definition of pain: : a localized or generalized unpleasant bodily sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress and typically results from bodily disorder (such as injury or disease).
This definition assumes that there is some physical injury or disease.
This is not always the case, however. Pain can be present in the absence of any injury or disease.
Consider a phenomenon known as phantom pain. “After an amputation, some people experience pain in the part of the limb that’s no longer there.”
They feel pain in a limb that is no longer attached to their body… crazy.
Now, it is exceptionally difficult, perhaps impossible, to tell if someone’s current pain is from physical damage, the threat of physical damage, emotional distress, or a combination of the three.
In my experience, it seems like it’s usually a combination.
So, what should we do if and when we experience pain while exercising?
This is something I encounter often when I am working with patients either in person or via a remote rehab program as we try to navigate their pain experience and work towards regaining physical function.
While the complexities of individual cases are beyond the scope of a simple article on my blog… I want to introduce the concept of The Traffic Light and pain with movement.
This is something I teach to most of my patients.
I wanted to have a written version of this in my own words so figured I would share what I wrote with all of you.
*I did not come up with this, I heard it somewhere and to be honest have no idea where I heard it first so can’t give credit where it is due but it certainly doesn’t belong to me.
The Traffic Light Framework for Pain with Physical Activity
I use this framework to decide whether or not an exercise or activity is appropriate for someone in pain.
Its important to consider your baseline of pain. Let’s say for the sake of this article I have lower back pain that at a baseline is a 4 but if I do a provocative activity, like bending forward, it jumps up to a 7 and it radiates into my left butt cheek a little bit.
Green Light Activities
These are a GO. Any physical activity that feels good, is good. This one is really simple. My baseline pain is a 4 but while I’m walking it goes down to a 2 or a 3. I feel good during and I feel good after. You can (and maybe should!) do green light activities all day and night.
Yellow Light Activities
These make you SLOW DOWN and think. Anything that causes some minor discomfort, either at your baseline level or slightly above but either A) gets better as you move or B) returns to baseline afterwards is probably okay.
Say my lower back pain is a 4 at rest. I am now trying to do some slow bridging exercises. My first few reps are a 4-5, but as I get to reps 10, 11, and 12 I feel good. My pain is dissipating. Now when I take a break at 15 reps and rest, I completely return to baseline. This is an example of a yellow light activity. This is an appropriate level of discomfort to have while doing activity in the presence of pain. It likely isn’t making anything worse, I just had to stop and think about it before giving it a go.
I usually say something like “you have pain while sitting and sleeping, right? It’s okay to have a little pain with certain exercises.”
Red Light Activities
These make you STOP. If you have worsening symptoms during the activity that stay elevated after the activity then I usually advise against these things for now. If my back pain is a 4 at baseline and then I go running and it jumps up to a 7. After I stop it stays at a 6 with radiation to my left buttocks. In cases like this, I would advise against running for now. It is something that is too much of a stimulus right now, but will be worked in at lower levels in the future.
If you are dealing with symptoms like this and have many red light activities then I strongly advise seeking help. Not because something is necessarily wrong, but being in pain sucks. If someone can give you an actionable plan to get your life back then you should do it!
I can’t emphasize enough that just because something hurts while you’re already in pain it does not mean that it either A) caused your pain or B) is causing more damage or C) means you can’t ever do that thing again.
Want more stuff like this? Check out my Troubleshooting Pain with Exercise article to find pain free ways to move.
DISCLAIMER: This article is not intended to be individualized medical advice. This is just a framework that I use with patients. Keep in mind, when I am working with a patient in a rehab setting after injury I have already screened them for very rare, but potentially life threatening red flags and ensured that it is safe for them to pursue exercise.