Should you push through the pain barrier?
Exercise is meant to be beneficial but it’s easy to overdo it. Here’s when to grit your teeth – and when to give yourself a breather
Most workouts are supposed to involve a degree of discomfort for your body to benefit from them. But the “no pain, no gain” mantra only extends so far and if you push past the point of severe discomfort you are likely asking for trouble down the line. How to tell the difference between everyday niggles and issues that could cause longer-term damage isn’t always easy, so when should you start to worry?
“The most useful initial guide we have is self-evaluation,” says Matt Todman, a chartered physiotherapist at Six Physio and a spokesman for the Chartered Society of Physiotherapy in the UK.
“Physios work on a pain scale of one to 10, where two-three is absolutely fine, but anything above four signals moderate pain.”
Acute inflammation or swelling up to 36 hours after a twist or fall, stiffness, loss of movement or a joint that won’t support your weight are signs that something beyond the ordinary probably requires attention. Yet noisy knees, stiff tendons and tight muscles are not necessarily a red-flag warning.
There are no strict rules about when pain is severe enough to seek help, says Paul Hobrough, a chartered sports physiotherapist and author of Running Free of Injuries. “Often it’s a case of monitoring discomfort for a few days. If it’s getting worse, not better, or if there is no improvement and you are starting to move differently because of it, then it is time to see a physiotherapist or other medical professional.”
Here’s a guide to spotting when not to push through the pain barrier:
I get a backache after I lift weights or do the gardening. Am I causing damage?
Todman says the human spine is designed to withstand heavy loads and becomes deconditioned when not loaded regularly, so both weights and gardening can promote back health if done correctly.
A study in the journal Sports Science, Medicine and Rehabilitation found a supervised whole-body resistance weight training program consisting of squats, bench press, dead lift and weighted row two times a week for four months was effective at preventing and improving low back pain. By the end of the study, participants reported their low back pain, sleep and daily movement had improved.
It’s a similar story with gardening. Nils Niederstrasser, a senior lecturer in the department of psychology at the University of Portsmouth, reviewed data from more than 5000 people aged 50 or older over 10 years and found that digging or raking the garden at least once a week helped to strengthen back and core muscles and lower the risk of developing back pain in the long term.
It’s overdoing things in the garden, using poor technique or lifting weights that are too heavy that can cause problems, Todman says. “With an exercise such as the dead lift, where you are engaging back, leg and gluteal muscles, there will inevitably be some aching the next day if you have worked the muscles appropriately, but if you get back discomfort after exercises that are not intended to use the back muscles, then you are probably using bad technique, which should be corrected to protect the back.”
Should I be concerned that my ankles and knees pop?
Adam Taylor, director of clinical anatomy at Lancaster University, says that the most common cause for painless popping joints is air bubbles forming in joint spaces. “Low pressure in the joint space causes gases within the synovial fluid – a natural lubricant – to form a gas cavity. The popping sound is usually a release of nitrogen from within the synovial fluid.”
As dramatic as it sounds, unless it’s accompanied by pain, it is rarely a sign of underlying injury or disease. “It’s a myth that popping joints is a precursor to arthritis,” Taylor says. “Many of us have some form of harmless joint noise as we get older, but we shouldn’t be alarmed by it.”
Should I apply pain-relieving gel to my joints before a workout?
Topical non-steroidal anti-inflammatory drugs (NSAIDs) that contain ingredients such as ibuprofen and diclofenac are available as gels, creams and in patches designed to relieve inflammation and prevent pain.
“There is some evidence that the topical applications work for pain relief but it is equivocal,” Hobrough says. Used sparingly they might be helpful for some people, but overuse is not helpful in the long term.
“Pain is not a direct sign of injury, but it is a useful guide,” he says. “If you are masking the pain with these products, you could be making matters worse by exercising on the affected joint.”
If pain is so severe that you need to use medications regularly, you probably need to consult a specialist for a rehab program.
My achilles tendons are tender and often sore in the mornings – do I need to stop running or power-walking?
Despite being one of the strongest tendons in the body, the achilles, which extends from calf to heel, is prone to degeneration as we age. Warning signs include stiffness and tenderness, initially felt in the morning but progressively becoming worse as the weeks progress. In some cases the tendon can become chronically sore and inflamed, so it is important to begin a rehab program as early as possible.
None of this means you have to stop using your achilles tendons, says Hobrough. The achilles are remarkably robust and, even when injured, can withstand a good amount of activity.
“The achilles tendon doesn’t like rest or rapid increases in activity levels, but you can ‘push into the pain’ with graded activity to help it heal,” Hobrough says. “It has a tremendous ability to respond positively to the right amount of stress being applied.” He suggests a program of daily calf raises.
“You can run if the pain you feel is lower than a four out of ten,” Hobrough says. “And the pain should not increase either during a run or throughout the week after it – if it does either of these things you do need to stop and rehabilitate further.” Avoid stretching the tendons before exercise.
“It might make you feel better briefly, but it is definitely not helping your tendons to recover,” Todman says.
Do I need to worry if my muscles are very sore and tight after a workout?
Lifting weights that are too heavy, attempting a spin class beyond your fitness level or running up and down hills are among the fastest routes to DOMS or delayed onset muscle soreness. It’s the result of intense exercise stressing muscles enough to cause damage and microtears to fibres, which then adapt and grow back stronger.
“You may not feel the effects immediately, which is why some people assume it is an injury,” Hobrough says. “It can be two to three days for the after-effects of a workout to take hold and for the soreness of DOMS to occur.”
That soreness happens when inflammation and swelling relay a pain sensation back to the brain that peaks about 24 to 72 hours after exercise. A good warm-up, stretching before and after exercise and taking recovery days are key to building up exercise intensity gradually, preventing DOMS. Using a massage gun was shown in one study published in the Journal of International Medical Research to be “beneficial and useful” for alleviating post-workout muscle soreness, but stretching also helps.
What if my joints are crunching and grinding when I walk, squat or run?
A grating or cracking sensation, called crepitus, can be harmless. “Many of us have a degree of creaking as we get older, but it’s nothing to worry about if it doesn’t hurt,” Hobrough says. If the crepitus is accompanied by joint swelling or pain, however, it could be an early sign of osteoarthritis.
Osteoarthritis can start in one’s 40s and, according to the charity Versus Arthritis, is usually down to a combination of general wear and tear, previous injuries and bodily changes that come with ageing, such as weakening muscles and weight gain.
“In healthy joints, surfaces that rub together are covered by a layer of cartilage,” Taylor says. “But that cartilage is worn away with osteoarthritis leaving bones in direct contact with each other which is when the crunching occurs.”
Even so, movement is very good for people with osteoarthritis. “It is best to get advice from a medical professional who will be able to help you plan a program that limits pain in affected joints.”
Should I stop exercising if I roll my ankle?
If pain subsides and you are able to walk on the ankle, then you should do so, says Todman. “Runners, walkers and footballers who have rolled ankles regularly have inadvertently trained their supporting muscles to react and support the joint,” Todman says. “If you can put weight on the ankle without pain, you should keep moving.”
If the discomfort is more severe than a four out of 10 rating or if there is swelling immediately or later on, you will need a rehab strategy.
“In the initial stages you should apply ice to reduce any swelling, but do this for no longer than 12 minutes,” Hobrough says. “Ice packs strapped to the leg for longer durations have the effect of increasing blood flow in an attempt to warm the area, which is not the effect you are after.”
Don’t try loading the ankle until 36 hours later. “A lot of people get straight back to exercise because their ankle feels OK after a day,” Hobrough says. “But you should leave it as there is a latent response which means a sprain often feels worse two days after you did it.”
Protect ankles by strengthening the muscles that support them with exercises such as the single-leg dead lift and single-leg squat.
Am I storing up problems for the future by doing lots of back-to-back workouts?
It’s sensible to factor in recovery after hard workouts, but essential for midlifers whose bodies are prone to wear and tear. A study in the Journal of Sports Medicine and Physical Fitness found that those people who did a lot of high-intensity interval training sessions combining weight-lifting and body weight callisthenics at maximum capacity were at greater risk for injury over time.
HIIT classes typically included the use of barbells, kettle bells and boxes, and exercises such as burpees, push-ups and lunges, and the most common injuries involved knees, ankles and shoulders. Men aged 20 to 39 were most likely to report injuries, although they were prevalent in all age groups.
“Plan your exercise to incorporate active recovery days,” Hobrough says. “This will mean your body has time to refresh and you will get more out of each hard session as well as reducing the risk of injury.”
The Times
