Pushing Through The Pain is Dumb (Usually)

Guest Blog: Josh Hayes

As a PT, I have often come across patients that will say to me, “just do what you have to.  I know it’s going to hurt.”  I have often wondered where they have come to the understand that pushing through the pain equates to effective treatment. Now, I understand with the watering down of society, entitlement syndrome, and everyone gets a trophy mentality, that it may be refreshing to hear that there are still those out there that cling to the old school idea of “just rub some dirt on it”. That being said, though, there is nothing to support this idea, and in fact, often, it can be to the individual’s detriment.

Treatment Shouldn’t Hurt, Generally

Without delving too deeply into pain science, it is important to understand that pain is an alarm that is triggered in the brain to let the individual know that tissues are at imminent risk, are overworked, or are compromised.  So, when receiving a treatment, pain does not contribute to the overall effect, it simply gets in the way. Yes, there are times when pain may accompany a treatment, particularly in conditions that are inherently painful, such as adhesive capsulitis, more commonly known as frozen shoulder. But, by and large, pain limits the effectiveness of a treatment. A common example would be during stretching.

In the event that we have an individual who is lacking range of motion that will likely hamper their ability to perform activities and return to sport, a logical goal is to restore that range of motion to allow that individual to return to their prior activities. Now, if we are to stretch the tissues of the limited joint or muscle to the end of their range and to the point of pain, the brain perceives a threat through nerve cells called golgi tendon organs and muscle spindles, and reflexively protects that area through selective muscle contraction. In other words, the area that we are trying to loosen, just gets tighter because the body is trying to protect it from injury.  So, when stretching, pain prevents increased range and in turn leads to limited gains.

No Bruises, Please

Stretching is not the only way in which this idea of no pain, no gain has entered into the endurance athlete’s mantra, however. Another example is instrument assisted soft tissue mobilization, otherwise know as “scraping”. Aside from the fact that there is limited evidence supporting this treatment (“it worked for me” is not evidence in support, it simply shows the power of placebo), there continue to be providers and athletes alike who utilize “scraping” to the point of bruising. This seems to be in line with the idea that if is doesn’t hurt, then it can’t be effective. And while the effects of “scraping” continue to be challenged in the research, there is nothing to support the idea that for this technique to work, that it either has to be painful or has to elicit bruising.

When is it Good to Push Through?

Last, no pain, no gain does not translate to the endurance athlete’s training either. There are certainly times when overcoming pain is useful, or even necessary to achieve our goals. An athlete that can quiet the pain when pushing the last mile of to achieve a PR, push through a cramp, or return to activity through soreness, is one that often times will be at an advantage and able to reap the most of their performance.  Yet, pain from cardiovascular endurance limitations is very different from musculoskeletal pain which should be heeded.  Running on a foot with plantar fasciitis or a leg with Iliotibial band (IT band) pain isn’t tough, it is foolhardy.  Certainly, it is every athletes prerogative if they want to continue to train on an injury, however, oftentimes it is a foolish decision that can not only cost a race performance, but instead, the season or more.  So, let’s forget “no pain, no gain” and heed our built in alarm system to help us continue through from one season to the next while minimizing injury.

Happy training!