Is it okay for my rehab exercises to hurt?!
There's a lot of research on the role of pain during injury rehabilitation, and the short answer is, yes. It's normal for rehab exercises to be painful, but tolerable. When an injury is painful and rehab is also painful, it's easy to just avoid pain and do nothing. This is the easiest and most ineffective strategy to manage any pain or injury. The only way around is through.
Instead, here are two concepts that help guide my rehab programming for patients:
Graded exposure Most injuries happen either from doing too much too soon, or too little for too long. Either way, we need to modify volume to suit where someone is at in that moment. We do this by creating a safe-to-fail situation where someone can experience tolerable stress. Over time we can slowly increase the stress, in small enough increments to continue to adapt but not overdo it. So rather of just walking into the gym for the first time and trying to squat 300 pounds, we start at a weight that is tolerable and slowly increase it on a weekly basis until we meet our goal.
Exercise-induced hypoalgesia "Hypo" means less, and "algesia" means pain. Said in other words, using exercise to decrease pain experiences is one of our most powerful tools when it comes to injury recovery. Exercise literally interferes with pain signals to make them smaller. Kinda like how you can decrease the pain of a stubbed toe by squeezing your toe in your fist. By providing a new stimulus for your brain to focus on, you can distract yourself from the pain. Done consistently over time, tissue gets stronger and the overall pain experience lessens.
Dealing with back pain is not easy, and without a plan to get back to yourself, things become much harder.
The only way around is through.
Matt
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