Does Rehab Need To Hurt?
The short answer is no.
The long answer is as follows and, trust me it’s so hard to do this, but I’ll try not to write a novel!
Growing up, most of us probably heard the “no pain, no gain” mantra to justify enduring what I would now consider potentially dangerous amounts of pain to demonstrate toughness. I don’t buy it--completely. What we need to realize is that we are all different. Some of us might perceive a mosquito bite to be excruciating, whereas others could fall down a flight of stairs and get right back up as if nothing ever happened (unless it actually does hurt and they are trying to play it off!).
Sensitivity to pain or temperature plays a huge role in rehab. There will always be a model that theoretically works for certain musculoskeletal or neuromuscular disorders. For example, it is logical to apply ice to an injury that just occurred. However, if you’re overly sensitive to cold, is the unpleasantness of this experience necessary for recovery? I vote no.
If you are stretching a muscle past your limit of being a “nice stretch”, is it worth continuing to push through? Again, I say nay.
So how does rehab work? In the context of pain, I think we first need to understand what pain is. As defined by pain scientists, Lorimer Moseley and David Butler, pain is “A perceptual inference, whereby the experience is considered an output into consciousness that reflects the best guess estimate of what will be an advantageous response. The tendency will usually be to err on the side of protection.” (1). In a nutshell, pain is a perceived response to danger, but not actual danger. With this in mind, we experience more pain when an activity or movement is perceived as more harmful. To explain that entirely would require another series of blog posts altogether!
The solution? Change how we perceive danger. If you perform a movement or exercise a few times, you maybe start to see that something that was once tight or painful becomes easier to do. Why is that? Our bodies adapt to stress! I mean, why else would we exercise if they didn’t, right? When we expose our bodies to ranges of motion, load, etc. that they have not been accustomed to for a while, they begin to make the neuromuscular connections required to permit better quality movement. Moreover, we can modify our body’s pain response with exercise. As exercises become increasingly easier to perform, we start to make our gradual return to our previous level of function or, even better, a stronger level of function!
So does this need to be painful? No, but pain can be a guide! As a matter of fact, exercising with pain has demonstrated significant short-term benefits compared to those without pain (2). However, let’s remember that we don’t live in a vacuum. Just because exercising with pain (and by pain, I advise no more than a 4-5/10 at any time) CAN be helpful it is not always helpful. This is where having a skilled physical therapist or other practitioner can be the difference between a shitty recovery period or an efficient one!
References:
Moseley, GL. and Butler, DS. (2015). Fifteen Years of Explaining Pain: The Past, Present, and Future. The Journal Of Pain, 16(9), 807-813. doi: 10.1016/j.jpain.2015.05.005
Smith, B., Hendrick, P., Bateman, M., Holden, S., Littlewood, C., Smith, T., & Logan, P. (2018). Musculoskeletal pain and exercise—challenging existing paradigms and introducing new. British Journal Of Sports Medicine, bjsports-2017-098983. doi: 10.1136/bjsports-2017-098983