In this month’s “Ask a PT” column, Adam answers a very common question he receives from his patients.

Question:

“My doctor told me I can’t do (insert activity) because of (insert diagnosis). Is this true? What activities/movement can I do or not do with my injury and pain?”

Answer:

The general answer is it depends 🙂

Patients often tell me they can’t run because of knee pain, or can’t do something because of the back/shoulder/etc. pain they may be experiencing. Generally speaking, I’m typically not one to tell someone NOT to do something they may want to do, particularly if that activity brings them satisfaction and joy. However that advice is contextual, because simply returning, or continuing to perform an activity that contributes to pain creates a downwards cycle.

Everyone has pain. However, pain is complicated both in our experience of it and how it is communicated to others. That is why when someone comes to me, I continuously ask probing questions to better understand the source of their pain. For example, most times pain is the result of something in your body doing too much; resulting in something above or below it not doing enough. This ultimately results in the overuse of muscles/tissues, typically if the muscles/tissues are moving too much.

Other times, the same pain experience can be from a tissue that is moving too little. This creates a situation where superficial tissue, which contains sensory nerves that provide information to the nervous system, is unable to ‘cleanly’ (for lack of a better term) ‘floss’ (again, for lack of a better term) due to congestion in the tissue that moves too little. The irony is that patients who suffer from pain due to an overuse of muscles/tissues experience symptoms similar to patients who suffer from pain due to a lack of movement in their muscles/tissues. My rule of thumb is that if the pain doesn’t resolve itself in a couple weeks, or at least have a progression towards being pain free, that isn’t normal and seeking help from a professional is warranted.

Regarding specific activities, and “can I do them?”, I often say if it hurts don’t do it (I often say it with a large grin on my face). However, that doesn’t always work well for people, so I’ve adjusted that advice to “it’s your choice if you want to do it, especially if it’s painful. Often times, pain levels will increase during activity. When this happens, my recommendation is to take a rest from the activity (by slowing down/decreasing intensity) with the expectation that the increased pain level should return to the baseline pain level you began the activity at. As an example: If your calf/knee/back/shoulder hurts at a 2/10 before a run/swim/ride, your pain levels should return to a 2/10 as you rest post-activity.

If this happens, you may contextually continue the activity with an understanding that if your pain level doesn’t return to baseline within a reasonable time, you should NOT perform the activity until the guidelines mentioned above is met. Typically, this gives people enough guidelines to begin increasing/returning to activity in a safe and efficient manner.

A final example, specific to endurance athletes returning to activity: I recommend progressing no more than 1.5x your previous 4 week average.  Meaning if you’ve been running (without pain) 2 miles total for the past 4+ weeks, it’s not recommended to run 4 miles the next week because this is double your previous 4 weeks average and increases your risk of injury 40%, compared to those progressing at a slower rate. This number makes sense to me, so I’ve extrapolated that to any activity because it is a safe rate of progression for people to think about.

Please remember it’s hard to provide specific answers to general questions because everyone is different. If you do have continued pain or feel you need guidance about how to safely progress an activity, please reach out and schedule a complimentary 15 minute evaluation with one of our therapists to see how we can help you return to activity.