Working out with Pain – When is it Too Much?

Pain – we all experience it. How much pain you are in is a critical thing to know for both you and your coach. There are times that you will have to decide: is this a day to do my full workout or should I just run easy or should I take a day off? This is no small matter. Do too much… you end up seriously injured and have to take extended time off.

We don’t all experience pain the same. Pain is inherently subjective. We’re all wired differently and our psyches handle those very sensations that we call pain. Of course, what is pain to one person is an ache to another and a mere tightness to yet another. Some people are highly sensitive to any signs of discomfort and back off at the first sign of discomfort. Meanwhile others enjoy working through those very same sensations and see it as a test or a challenge to overcome.

Even day-to-day many of us have aches and pains. Perhaps we have a headache or we sleep awkward and have some back or neck aches. For some people this is sufficient to call in sick to work. Others shrug it off and accept it as part of life.

Here is something I find interesting about myself. I do not tolerate pain inflicted upon me or pain from some kind of an accident (for example – plates dropped on foot, stubbed toe). However, self-inflicted pain is something I tend to be able to work through. Running is a good example of this. I have always been able to push through those sensations of discomfort – burning lungs, searing quads, cramping muscles, that nagging Achilles pain. I’ve been known for having scorching kicks over the last mile or so of a race. Despite the previous miles, I find the strength and fortitude to push through all the discomfort to the finish. And if I’m already fatigued, having a bad day, irritable, stressed or whatever, my tolerance of pain of any kind is much lower – even for my workouts.

Here’s another interesting thing about the topic of pain. It is certainly in part due to our unique experiences of pain but it also reflects part of our personality. People have their own unique ways to describe pain. I notice those of us who have more heightened sensitivities use wording which conveys a much higher level of pain. For instance, given a similar injury one person says her leg is “killing her” while another says “it’s achey.” Given the same physical insult, one runner runs through it without further aggravation while the other walks off the track without even trying to do the workout.

Certainly pain is on a continuum. To get some kind of a handle on it we can even give it a number system. There are actually quite a number of pain scales and guides often used in medical settings. Some use word scales – such as “no pain” to “moderate pain” to “excruciating.” Some are numeric scales 0-5 or 1-10.

I pose a combination scale something like this for runners. Use a scale of 0-10. “0” would be no pain whatsoever. “10” would be excruciating pain. (By the way, don’t confuse this with the effort scales for workouts; we’re talking about pain sensation derived from an injury here.) It is still subjective at this point. But we can lend some descriptors to help more clearly define pain.

0-4 = Minor Pain

0 – 1 No aches and pains or just slightest tightness.

2 – 3 Slight ache, stiff, sore, but can warm-up and it goes away after warming up or first miles of workout

4 – 5 Pain lingers beyond warming up but pain diminishes by the end of the workout. Or low level pain is steady throughout workout; will not subside but does cause you to favor a side or alter form.

5-7 = Moderate Pain

5 – Pain is steady but gets worse the more I do; might complete workout but hurts.

This is a critical breaking point. If pain gets worse as you workout you are most definitely doing more damage. You should not be running. If you favor a side, you alter your running form; and you will injure yourself – perhaps somewhere other than the original pain!

6 – 7 Pain causes me to favor a side and/or alter form while running. Pain may prohibit me from even trying to run; but can walk OK. Need several days of rest. If pain not relieved – seek medical attention.

8-10 = Severe Pain

8 -Pain makes me limp even at a walk; may ache constantly. Need several days to a week of rest. If pain not relieved – seek medical attention. May need pain medication.

9 -Cannot tolerate pain without resting/sitting; needs pain relief medication. Should be seeking medical attention.

10 – Severe pain, can’t put any weight on limb; need pain killers now; needs medical attention now.

Of course no scale is perfect. But what we need is a workable scale that will help guide coaches and runners alike in knowing when we should be backing off versus plowing through; whether we should alter a workout or stick to the plan.

It still requires an honest assessment from the individual.

Complainers will have a litany of aches to talk about and might even make them into a nice excuse not to run or they’ll wear as a badge of courage after announcing them to everyone – as they do the workout anyway.

On the other hand, those with less fortitude will use the slightest ache to just bail out.

Stoics on the other hand may not even say where they are on the scale. For them pain is a sign of weakness. These runners are hardest to work with in many ways because as a coach, you never really get to know how much they do or don’t hurt; until it’s too late and they are seriously injured.

Then of course there are the fakers. They see some pain – real or imagined – as an excuse not to run. I see this more in youth athletes. Though adults aren’t immune to this. Sometimes we’ll cop out on a workout “just to be safe” when we know deep down inside, we should be doing that tough workout.

The point is that without candid feedback, discussion and evaluation of the various levels of discomfort – whatever the words you choose to use – we cannot design or modify workouts and workout programs that will keep the athlete healthy! The no-pain-no-gain mentality has long been dead. We must be better in tune with our bodies. We must be able to differentiate OK pain from bad pain.

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