• Clare Donaldson

Let's Talk About Pain

How much pain is okay?

Is any amount of pain okay?

When should I stop what I'm doing?

Is this pain going to last forever?

These are questions we hear in almost every initial assessment we complete at CONNECT. Chances are you've got something that you love to do, and pain has stopped you from doing it. You're not sure whether you should push through it, or whether pushing through it is what caused it in the first place. You're not sure what is too much, or if what you're feeling is normal. You're not alone, and we're here to help you understand.

I love educating people about their pain. Learning to understand pain is often the most important thing you do with a patient on the first day. I like to think about pain like the "check engine" light in your car (and if you drive a car like mine, it turns on regularly!). If you're not a mechanic you can't tell if that light represents a big problem, or just a really minor one (ranging from tiny problems, to no problem at all because it's just a faulty sensor).That light grabs your attention and keeps it, most people start to worry that something is terminally wrong with their car, and immediately jump to the worst case scenario (I REALLY can't afford a car payment right now! How am I going to get to work?). Does the worst case scenario ever happen? Absolutely. Does it happen often? Absolutely not.

That brings us to the purpose of this quick post. This is a conversation I have with most of my patients on the first day, and the purpose is to disarm the alarm. This post will help you understand your pain language, figure out what is okay pain and what is not, and give you a language to communicate with us when you're explaining what you're going through.

The best part? It's incredibly simple, and it's something you see every single day.

The Pain Stoplight

Green Light

Pain that is, on a sliding scale, anywhere from 0/10 to 3/10 pain. This is typically pain that is more on the dull, or achy end of the spectrum. This is what we refer to as okay pain. It' is normal, it is not associated with any kind of tissue damage or harm, and it's generally what we call the "suck it up zone." If your pain is green, don't make a scene!

Yellow Light

On that same scale, this pain is anywhere from 4/10 to 6/10. This pain is more intensely achy or dull, and it may occasionally have a bit more bite, or sharpness to it. Often, exercises will fall into this category by the time you're near the end. This is our proceed with caution zone. This pain is still not associated with any kind of tissue damage or harm, but it's slightly more likely to stick around when you're done whatever activity is causing the pain. Here's the thing with Yellow Light pain - it's often exactly where we need to be for exercises to be effective, particularly when we're talking about gaining range. The easiest way to look at Yellow Light pain is when it happens: if you start an activity and it's already 5-6/10, you shouldn't stop immediately, but you're also probably not going to do it for long, if you finish a 10km run and you're in the Yellow Light zone by the end, and for an hour or so afterwards, that's just fine.

Red Light

Finally, we have the Red Light zone. This is where we stop. On that scale, it's any pain greater than 7/10. It typically is sharp, or intense and throbbing, but lets be very very clear: you still are NOT going to cause tissue damage or permanent harm when you enter this zone. Tissue damage requires extreme load, speed, or a combination of the two (and even then, often the structures are spared) - if you're running on even ground and your pain gradually increases to 7/10 pain, you haven't damaged anything (phew!). The Red Light zone is where the risk:reward ratio tips in favor of risk, and the primary risk is that you will stay sore for a long period after and can't do the things that you love to do - that is something we want to avoid.

What else can we learn from our stoplight?

  • If you start an activity and it's a green light, then by the end it's yellow, as long as it's back to green within an hour, generally that's good. If it stays yellow the rest of the day, and is still yellow the next morning, that might have been a little much and you can dial things back slightly.

  • While running a yellow light is okay, we don't want to constantly speed through them so that we're always a yellow light. Tone is down until you're normally green, with a little bit of yellow depending on how much activity you've done.

  • If you have sudden, red light pain with an activity but it goes away quickly, see if you can modify the activity (ie. squatting to a box, adding a band, or decreasing load/speed). If it's no longer red, keep going!

  • Try ANYTHING once, how else will you learn where your lights are? Within reason, activities shouldn't be avoided just because you (or your therapist) are afraid they might hurt. Often the best approach is to let you figure out what does and doesn't hurt, because your understanding of your pain is better than ours.

The best thing about the Pain Stoplight is that it gives you and your therapist a shared language to talk about your pain. What is 3/10 for me might not be 3/10 for you, because pain is a purely subjective experience, but we know that your interpretation is what's really important.

If you want to talk to someone who can turn your reds back to green and keep you active the whole time- give us a call at CONNECT