Most everyone has heard the saying “no pain, no gain” when it comes to exercise. This may be true in terms of a healthy individual and when it refers to the muscle burn sensation that accompanies exercise. It may also be true in terms of the two days of soreness that follows the start or progression of a strengthening exercise program, or that follows the performance of an activity that has not been performed in a while. This soreness is better known as “delayed-onset muscle soreness” and is a normal part of the adaptation process of muscle breakdown.

“No pain, no gain” is not true when one has been injured. When one is recovering from an injury it is not wise to exercise with pain. When one is performing their rehabilitation program, one should only exercise in a pain-free range. If there is always a bit of pain present, as it is true after an injury or surgery, then you should never do exercise that creates more pain or increases your pain response. The increase of pain perception is the body’s way of letting you know you are overdoing things and that some tissues are not able to handle the stress that is put on them. The soft tissues (tendons, ligaments, muscles, and fascia) involved become weak and over-stressed.

Pain is a subjective feeling that we all have experienced at one time or another. We expect that we are going to experience pain after an injury or trauma. However, if there is no presence of pain during exercise we may think that there is nothing to worry about. This may not always be the case. Pain during exercise is the body’s way of telling us whether we are exercising too hard or overstressing our bodies. But just because pain is not present, does not mean that we may not be doing harm. For instance, a sedentary or deconditioned individual may not experience a pain response during exercise. However, then one day they find they have back pain or neck pain due to a lack of muscle endurance or some other musculoskeletal problem. For this reason, many people move into pain patterns without any apparent reason or trauma.

In summary, exercise should be performed without any increase in pain. Therapeutic exercise is utilized to promote healing, increase metabolism, and introduce gentle controlled loads so that the soft tissues can adapt to normal forces. Periodic maintenance through exercise can prevent non-traumatic pain patterns from occurring. It is important to give plenty of feedback to your physical therapist or other health professional so he or she can monitor and make any adjustments to your exercise program.

At least one member of nearly half (44%) of America’s households suffers from chronic pain. Within Maryland, 49% suffer from pain on a monthly basis and 40% experience pain almost daily.

The impact of chronic pain is devastating for the individual as well as for society. Persons with chronic pain suffer physical, psychological, and social detriments. Many say that their pain disturbs their ability to sleep and their productivity at work. It interferes with the ability to participate in daily home, leisure, and recreational activities. It can negatively interfere with sexual relations as well as relations with family and friends. Chronic pain sufferers describe feeling anxious, irritable, or depressed as a consequence of their pain. In severe cases, pain sufferers describe feeling helpless and alone. Chronic pain may be the single most costly medical problem in the U.S.

Annual costs for medical expenses, lost income, and lost productivity are estimated to exceed $50 billion. The International Association for the Study of Pain defines pain as: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described by the patient in terms of such damage.” Acute pain is indicative of inflammation and tissue damage resulting from injury, illness or recent surgery. It is short lived and usually subsides after the underlying cause and subsequent inflammation has resolved.

On the other hand, chronic pain can last for months or years. Chronic pain may start as a progression of acute pain after an injury or illness, even perhaps after the original problem has resolved. It can also be as a consequence of ongoing sources of pain related to medical conditions such as low back pain, cancer, arthritis, headaches, neuralgias, neuropathies and other pain disorders. In chronic pain, constant firing of pain signals occurs in the nervous system.

Over time, this persistent bombardment of pain signals can actually change the structure and function of the central nervous system thereby lowering the threshold of pain. For example, an individual’s perception of a normal painful stimulus can actually be perceived as extremely painful or an individual’s perception of a non-painful stimulus can actually be perceived as painful. These are only some of the examples of the complexities of chronic pain.

A skilled physical therapist will initially evaluate and treat involved painful nerves, muscles, and joints to decrease pain and improve function. This may lead to a decrease number of pain signals firing in the central nervous system and hopefully contribute to breaking of the pain cycle. Physical therapy can also be helpful in managing chronic pain by restoring normal movement patterns, developing a realistic exercise program, and providing education regarding goal setting, pacing of activity and other self management techniques.

Although the general medical approach to chronic pain is to manage the problem, there are occasions in which the underlying cause was not addressed but once treated may result in a significant improvement in one’s pain. An example of a chronic pain condition often overlooked is Myofascial Pain Syndrome, which describes pain due to sensitive knots in muscles called ‘Trigger Points’.

Despite the fact that chronic pain is a medically complex problem and can influence all facets of an individual’s life, a multidisciplinary treatment approach can alleviate one’s suffering in the management of the condition.