Exercise and pain: Why rest isn't always the answer

My clinic sees a lot of athletes, and one question I ask every patient on their initial evaluation is, "What have you been doing at home?" The most common answer is, "Nothing."

Many people tell me that when they felt pain, weeks and even months ago, they just ran or exercised through it until it got bad enough that they could not do their sport anymore. So they rested for two weeks, four weeks, two months, then they went back to their sport and the pain came back. Sometimes, the pain comes back worse. No matter how long they rested, the pain returned and sometimes worse and in more spots then it was before they took time off.

Why doesn't the pain stay away after a period of rest?

The truth is that unless it was a traumatic injury, like an ankle sprain where you can pinpoint exactly when and what caused it to hurt, rest is going to do very little for the pain on a long term basis. There is a reason that you were having pain. This could be muscle imbalances in the body, it could be inflammation, and it could be—and most often is—a combination of factors.

Having pain in a joint means that there is a problem in the body and unless it came from a traumatic situation, then rest will not solve the reason that it got there in the first place. The reason for the pain must be identified and treated, not just the fact that you have pain. Treating the pain does not treat the injured area.

Why does it feel better after I rest but then hurt again?

Most often, when there is pain there is inflammation or swelling. Even though you may not be able to see a marked increase in fluid to the area, there may still be swelling. Rest allows the swelling to decrease. It allows the painful stimulus to subside. It allows any compensation patterns to diminish and it gives your body a break. The first couple times when you start back in, it may feel good. But over time you return to the old compensation patterns and you begin to experience the pain you once felt and sometimes even worse.

While you rested and did nothing, the remainder of your muscles began to weaken and this has made for a more precarious situation then you were once in. Not only are you dealing with an injury but now you are starting to have de-conditioned muscles.

So do I just exercise through it?

NO. The answer is simple, no. Pushing through it could cause you to damage something further or create a catastrophic injury from what was a simple compensation injury. But you cannot go and see your health care professional with every ache and pain either, otherwise you could be in there almost every day. The first step to take—and this goes only for injuries with unknown causes (commonly called non-traumatic injuries) is to ice.

If you feel no change in pain or the pain is getting worse then you go and see your health care professional. Anti-inflammatories do not take the place of ice. Popping a few Advil does not have the same benefits as ice. Ice needs to be applied to the area, there is no substitution.

But I am in pain, isn't it just best to stay off it?

The answer may be yes, to a certain extent. While it may be important to give your body rest from the pounding or the cutting of your every day exercise, it is very important to keep the muscles strong. Taking two weeks off and not doing anything can be just as detrimental as exercising through the pain. There are many ways to take the pressure of a painful area but still continue to exercise. It is important to see someone who understands athletes and how to keep the body active while allowing healing to occur.  Making sure that you seek professional help early can help you stay healthy and active for a long time.

Read more Sports Doc for Sports Medicine and Fitness.