Pain is a tricky feedback loop. From birth, we are taught that it’s a bad thing, a threat to our homeostasis, and if we feel anything painful, we should stop doing the pain-causing behavior to keep surviving.
However, sometimes pain is a good thing. For instance, if you are looking to improve your strength, the pain and burn you feel from lifting weights and accompanying soreness afterward is a GOOD and necessary thing to gaining muscle. The same applies when it comes to weight loss. The discomfort of being hungry is good and essential for you to burn off that unwanted belly fat. The same applies to rehab. It is often painful to do the exercises to recover from an injury, but the outcome is no more injury.
Confusing, right? “Pain can kill me, but it also seems like it can help me.”
So when it comes to pain, how can anyone know:
- what is too much,
- when to rest
- when to see a doctor.
This week, I will attempt to answer that question using a game we played as kids in school: Red Light, Green Light. (yes, I am watching Squid Games right now)
Before we get to the traffic signals, I have two asterisks that you need to be addressed:
- When it comes to pain and exercise, stopping exercise altogether is WORSE for you than continuing to exercise while in pain. When you quit exercising, not only does the injured tissue atrophy but so do all the other structures around said tissue. When you eventually return to exercising, you will be generally weaker and more susceptible to additional injuries. Additionally, going completely sedentary is terrible for you and shortens your life expectancy.
- The below model applies to musculoskeletal injuries, not internal physiological conditions. If you are in pain and experiencing nausea, vomiting, numbs/tingles, unexpected or explained weight loss or gain, fever, changes in bowel/bladder, OR night sweats, you need to see a doctor.
- If you have a broken bone, DO NOT load it. That needs rest.
The Silbernagel Pain Monitoring System
In 2007 a PT named Karin Silbernagel published an RCT (random control trial) https://pubmed.ncbi.nlm.nih.gov/17307888/ on the effects of running and jumping on Achilles tendon injury rehab. She and her colleagues used a red, yellow, green light system to help determine if running and jumping activities that caused pain were too much loading for the injured tissues.
Green Light Pain is discomfort that is 2/10 or less on the Numeric Pain Rating Scale.
Yellow Light Pain is discomfort that is 3-4/10 on the Numeric Pain Rating Scale. If you are in the yellow light territory during and after the exercise and then wake up worse the next day worse, you need to back off whatever you did to irritate the tissue. If you are in the yellow light territory and not getting worse, it’s ok to proceed with the exercise.
Red Light Pain is pain that is 5+/10 on the Numeric Pain Rating Scale. This pain is bad enough that you will stop what you are doing dead in your tracks. If you are in 5+/10 pain all the time, then you need to see a doctor.
Since 2007 this model has become an industry standard for Doctors, Athletic Trainers, PTs & Strength coaches in the sports setting, and it is entirely applicable to us as “everyday” athletes.
Let’s use shoulder pain as our example. If you have 2/10 pain when you go to grab your coffee cup out of the cupboard and then after doing 21-15-9 Thrusters & 400m runs at the gym, your pain level increased to 4/10 pain after the workout was over, you are generally ok to proceed to do overhead barbell lifts. That is unless you wake up the next day and go to get your coffee cup, and it’s 6/10 pain. Then we can infer you did too much and need to lower the load or change the exercise. If your 6/10 pain sticks around for a week+ after the overhead lift, you need to see an Athletic Trainer, Doctor, PT, or other musculoskeletal therapists.
I know it’s not. The reality is there is not an easy answer to “should I lift overhead with shoulder pain,” BUT at least the Silbernagel Pain Monitoring System gives us a better direction to head.