The Pain Game: Activity vs Recovery
The body needs two things-activity and recovery. When any of these are out of balance-an issue arises. Most of us know that after we increase our activity level, for any reason, we may have to “pay for it” later. Meaning- the next day or two will be sore and most likely spent doing little to no activity. The same is to be expected with pain.
When pain arises, whether by injury or unknown causes, the body is letting you know there’s an imbalance in activity vs. recovery.
Can it really be this simple?
For now, let’s say it is.
I would bet that most of you would see decreased pain just by abiding by this principle. Activity-the body’s way of saying “I’m ready to move.” This phase is the classic “good” day. You get everything done on this day because you don’t know when another good day will happen. This is usually the phase where the injury or pain is created, as we over-do activity to certain aspects of our body. It’s safe to say that each part of our body operates and functions independent of each other. They can be combined to perform single tasks, yes, but they do so independently of each other. This principle typically leads to pain being felt in certain parts of the body rather than the entire body itself.
The term activity does not have to mean running/exercise/lifting weights.
Different parts of the body are responsible for different roles and movements. The extremities are typically in charge of movement while the trunk is typically in charge of stability. For people with low back pain (LBP), it could be more painful for those people to withstand long durations of sitting or standing in one position. Those lumbar muscles are very active during activities of prolonged posture, as they are postural muscles. Whereas someone with knee pain might have no issue sitting down or laying down since the knee is active during activities that require motion. To fully understand the activity vs. recovery principle for your specific pain, you’ll need to know the role(s) of your area(s) of pain.
Recovery-the body’s way of saying “I’m trying to recover and heal from being overworked, please be kind to me today.” This phase is the classic “bad” day. This is also the phase people experience the most pain. The reason pain is more severe on these days is because those tissues are trying to recover. To make a complicated system simplified- we break down our tissues with activity and they build up with rest. People that are not in pain are able to do both of these things pretty seamlessly. They’re active throughout the day and they rest at night (sleep) for around 8 hours.
(Note: people in pain tend to get 6 hours or less of sleep/night vs people not in pain get 8 hours or more of sleep/night).
This system is perfectly balanced between activity and recovery. The system gets thrown off with pain/injury. Whether you want to believe it or not-your unknown cause of increased pain is not because the world doesn’t like you. At some point you demanded more of those body parts than they could take at that time. That could’ve been over a period of time or in one exact moment, or both. Recovery/”bad days'' should be the easiest days to manage. The body sends warning signals immediately when you are using those tissues beyond their current capacity. As that happens, you can quickly modify that current activity, often by doing the opposite of that activity.
It's those good days that become too easy to over-do. We don’t know that we overdid it until later that day, or even the next day.
Pain that presents quickly during a movement is your body’s way of telling you it is still in the recovery phase.
So be gentle.
If you let pain be your guide you’ll have no choice but to be gentle and accommodating on these days. Please do not push through your pain.
Try to think of pain as your boss. What would happen if you stopped listening to your boss? A couple of things would happen:
1. They’d stop trusting you.
2. They’d have to monitor and direct you more often.
Pain acts this way.
If our body can’t trust us to avoid harm and danger- it’ll have to be louder and more persistent.
But what happens when you start doing what the boss asks of you?
1. They begin to distance themselves from you.
2. They begin to trust you and realize you don’t need them to constantly guide and direct your every move.
Pain will do the same.
Take over your body again. Take control of its outputs to you. You can do this by gaining its trust again. Quickly modify the painful movements or activities on the bad/recovery days. (Remember the key word is MODIFY, not stop.)
Avoid pushing your body beyond its capacity on the good/active days. Learn your painful area’s tolerance level to activity and try not to exceed it. Once your body begins trusting you again you will begin to have more freedom to gradually increase its tolerance to activity until you reach a level that you are happy with, a level that can endure your normal daily and weekly routine.
How to find a balance to reduce pain?
This is where I begin with each of my patients. Learning to balance activity and recovery will help you overcome anything. Knowing the role of that specific body part(s) in pain will help with this.
To give you a place to begin, the trunk is in charge of stability/posture while the extremities are in charge of moving. Tissues that are experiencing pain are therefore in a state of recovery, as we just learned. This changes as the pain lasts longer and longer into a chronic phase of pain. (Pain lasting longer than 3 months is known as chronic pain.)
The longer the pain persists the less it has to do with our tissues themselves.
But for now, and even for those in chronic pain, let’s focus on mastering this principle. To begin, find the activity tolerance level of that body part. This could be hard or easy depending on your conditioning level and/or how long you’ve been in pain. To be safe, expect that body parts activity tolerance to be very low.
As a rule of thumb- begin cautiously and increase gradually.
Most people in pain will over-do their good days. Often, you won’t know that you overdid it until the next day or two. So, beginning cautiously is crucial. Just because your body says you can, doesn’t mean you should. Our bodies are capable of doing so many things, but if we haven’t gradually increased our capacities to those levels, we will pay for it.
This principle is even true for those who don’t have areas of pain. Ask anyone who does something new, or something they don’t do often, they will most likely be sore over the next couple days. Again, just because you feel like you can does not mean that you should. You will turn those over-active good days into many bad days.
Once you find an active routine that doesn’t seem to lead to bad days-you can begin to work your way back to your normal self again, gradually. If you figure out a way to be perfect with this principle, then you aren’t human.
Unfortunately, the path to recovery is not smooth despite doing everything right. Bad days will still happen. You can only control so much.
Some movements/positions/activities will over-load those areas of your body at some point and will lead to increased pain. But don’t let it get you down. Continue to control what you can, and improvements will continue. Listen to your body better. Remember- pain is a sign of recovery, it’s your body's way of saying “you did something I didn’t like and need more time to recover than my usual recovery period during sleep.” During those “bad days” do everything you can to be kind to yourself.
Pain is our body's way of saying there’s a threat of harm or potential harm being done to the body. Or in other words- you are doing more to that body part than it can handle at that time. Modify your activity on those days. If you hurts to doing something, do the opposite.
This principle does not mean that you need to avoid movement and activity. Those tissues need two things, remember?
Activity and Recovery.
Most people in pain feel that they need to rest and recover and they’ll overcome their pain. They seem to avoid doing everything that might lead to increased pain. They think that taking a break from life will help them.
The more time being inactive the more intolerant to activity that body part will become and the longer it’ll take to get back to your normal status.
They will give you gentle exercises that will allow you to move without altering the recovery process of that injury/unknown increase in pain.
This is part 3 of 3 part series about pain from Spencer. Answers to some commonly asked questions coming next week.
Spencer Earnest works at Optimal Therapy an Affiliated Company on Paseo Verde.
To schedule an appointment call 702-564-6712 or click here to see a list of our locations.
Spencer Earnest was born and raised in Laguna Niguel, California, spending his time playing sports and hanging out with his nine older siblings.
Spencer earned his Bachelor of Science degree at Utah Valley University and went on to get his Doctorate degree in Physical Therapy at Touro University, Nevada. He has a passion for physical therapy and helping his patients achieve their functional and rehabilitational goals.
Spencer describes himself as being married to the most wonderful girl in the world and they have three amazing children. He loves spending time with his family and playing any and all sports.