When Can I Work Out Again?

I don't consider myself to be an overly conservative physical therapist. It would be easy (and somewhat lazy) for me to simply ask my patients to rest while they heal. But people come to see me (or other health care providers) because they want to be proactive about expediting their return to pain-free function.

As a physical therapist, I employ modalities and interventions that aim to decrease my patients' pain and restore their motion, motor control, and normal function. But one of my most important roles is to identify and correct the root of what caused the injury/pain in the first place. In many cases, the location of pain does not correlate with the cause. To quote from Thomas Myer's Anatomy Trains, "In a crime, it's the victim that cries out, not the criminal." What that means is that people can often get to work right away addressing the impairments that may have caused their pain in the first place. It's an important concept known as active rest.

Patients always want to know when they can return to their sport/activity/exercise routine. I totally get that. I would want a time table too. But it's impossible to give definitive time lines. Nobody has a crystal ball to read the future. One thing that I am always imparting on my patients is to take the long view. A little bit of activity modification in the short term, while frustrating, will lead to long-term meaningful results. Remember, this does not mean complete rest!

Patient's who are unwilling to dial back their training volume and/or modify their routines should not be surprised when their injuries continues to flare up. It's akin to picking at a scab. Just when your body has laid down scar tissue, you go right back to aggravating it with the same offending activity. One must recognize that you can't just push through the pain. Rather, modification is called for.

This modification can come in many forms. Here are some examples:
• Complete avoidance of a specific activity (without absolute rest)
• Bracing/taping/strapping
• Decreasing load with resistance training
• Limiting ranges of motion
• Working in different planes of motion
• Decreased training frequency/volume
• Working on other non-painful joint dysfunctions in the kinetic chain
• Making ergonomic changes at work and home
• Use of an assistive device
• Use of modalities such as heat/ice
• Use of anti-inflammatory medications
• Dietary changes to enhance healing

One of the simplest pieces of advice I give on a daily basis is, "If it hurts, stop!" Pain is a warning sign of a threat either real or perceived. You would be wise to heed that warning. In the clinic, I discuss pain as yellow light discomfort red light pain vs. yellow light discomfort
red light pain
. The former entails experiencing a low level of discomfort that does not get worse, or even improves, through repetitions of a given exercise. The latter entails intense pain felt immediately when commencing an exercise or that quickly ramps up through a set. That red light pain is a definite STOP sign. Ignoring red light pain with a no pain/no gain approach is not a wise course of action.

So, if you find yourself in pain, don't avoid seeking attention for it out of fear that you'll be asked to completely stop all activity. You're better off finding out why it occurred in the first place, and then developing an action plan to deal with the cause. Remember, MOST rehabilitation courses will allow you to take an active role in your recovery rather than that of a couch potato. The goal is to get yourself moving without pain as quickly as possible. You just have to be smart and patient about it.