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Thursday, September 20, 2018

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Pain, Discomfort, Hurt and Soreness?

Michael Boyle
I had a Twitter follower ask some questions about one of my Retweets concerning pain and rehab.
The basic gist of the tweet I retweeted was from @enahncedphysper and said “ your rehabilitation process should almost always be a pain dictated process” .
I 100% agree and my response was the title of one of my favorite articles, just think “ Does It Hurt”
The reply from @teir1athletics was “ isn't there going to be some discomfort though? I recall when I was working through my ROM on my knee ( post ACL) after surgery there was some discomfort? Should we educate the athlete on the difference between pain, discomfort, hurt and soreness?”
As I thought about the question I came to the conclusion that yes, we should educate our clients and athletes about the difference between pain, discomfort, hurt and soreness.
The reality is that there is a bit of subjectivity to the ideas of pain, discomfort, hurt and soreness. I'll give you what I think are some good working definitions as they apply to rehab and exercise.
Pain is pretty simple. Wikipedia defines pain as a distressing feeling. I feel like pain is easy to understand even if it can sometimes be hard to describe. Painful exercise is always wrong (unless we are talking about tendinopathy and, that's a different post).
(Also, please don't give me all the “pain science” BS. I realize pain is not simple but, that has nothing to do with painful exercise.)
Now, we get into semantics when we discuss discomfort. I do think that discomfort is different than pain but probably has a lot more latitude? What really constitutes discomfort? Discomfort is a lack of comfort? I think we want to generally avoid discomfort also. Discomfort is probably pains next door neighbor and discomfort can quickly become pain. This is the gray area. I know that squatting after knee surgery ( particularly before all the swelling is gone) can be a bit uncomfortable but is probably OK, as long as it doesn't progress to pain. I've often found that discomfort decreases with movement while pain increases?
Third, we get to the word hurt. When I think Does It Hurt, I think does it cause pain. So in the case of hurt and pain, they go hand in hand. If something hurts, it's by definition painful. Effectively they are one in the same, at least as it applies to rehab.
Soreness is the last word that came up. Soreness is interesting. Soreness is a response. We have muscle soreness which is a natural by product of early exercise and, is to be expected. Think of soreness as an after effect. If someone is doing an exercise and I ask Does It Hurt they sometimes say, “no it's just sore”. That might be semantical but I consider that pain and we stop or regress the exercise. 
For rehab purposes pain is immediate and soreness is residual. I have a standard soreness mini-speech I give to athletes and clients. It goes like this;
“ muscle soreness is good, normal and to be expected. Generally muscle soreness will be worse two days after exercise. The important thing to understand about muscle soreness is that it should be felt in the muscle. Pain in the tendon or the joint is not normal and should be considered a warning sign”
I usually go on to explain the areas where I don't want pain. I point out the anterior shoulder, the SI joint and patella tendons as important areas that we don't want to experience post workout soreness.
In any case, we should avoid pain, avoid exercises that hurt, probably tolerate a small amount of discomfort and, expect post exercise soreness. However, never try to make it a mental challenge. Never make it about how much you can tolerate. Painful exercise is a prescription for failure. I've rehabbed just about every injury known to man armed with some knowledge and the idea of Does It Hurt with great success and, I've seen the “ you need to expect a little pain “ philosophy fail over and over. Hope this helps.

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