Will holds a MSc from McGill University in Physical Therapy. He is also a strength and conditioning coach. Will offers both physical therapy and personal training services at Clinique MV. Growing up ...
Sometimes you might experience pain when performing your rehabilitation exercises and the following questions often come up: should you push into pain? And how much pain is acceptable?
Depending on your condition, The primary goal with rehabilitation exercises could be to either work on capacity or tolerance.
Capacity: The idea behind working for capacity is usually that the tissue you are working on needs to develop a given quality in order to satisfy the demands of the tasks you ask of this specific tissue. Such qualities can be strength, resiliency, power, rate of force development, endurance, elasticity, etc… If the tissue cannot meet the demands of the task, yet you perform (or have performed, or plan to perform) the task nonetheless, damage, pain, or irritation might arise.
Example: if the average Joe positions himself under a loaded barbell with 600lbs on it and attempts to squat it, damage to the tissues, including the knee and the quadriceps will occur. That being said, if we can develop the strength of the quadriceps, by progressively loading it over time, we can get to a point where Joe may be able to squat a 600lbs barbell, pain-free! The same applies to going up and down the stairs, and well as bending up and down to pick up your kids. Go resistance training!
As such, pain other than normal muscle pain (which can sometimes be confusing to identify), should not necessarily arise in your quest to develop your tissue qualities. That being said, some discomfort here and there is acceptable.
Tolerance: the idea behind working to develop tolerance is to push further the threshold past which the different stresses imposed on your target tissue trigger pain. The premise when this is the goal is that your physiotherapist has concluded that you will not damage the target tissue even if you push into pain (pain does not equal tissue damage, but that’s an idea to develop in another story). As such, some pain is acceptable, and might perhaps even be necessary, in order to « convince the nervous system » that what you are doing is not dangerous, and therefore everything should calm down.
Example: Bending over to tie your shoelaces, and coming back up, may never have been painful. But you’ve injured your back a couple of months ago as you picked something heavy off of the floor, and ever since, you’ve avoided bending over to tie your shoelaces. During this time, your back has most likely healed from the strain it sustained, yet you still are fearful of bending over. After all, just bending over the sink is painful, but it usually goes away instantly. In this case, your brain has associated bending over with pain, and so every time you do it, a series of neurochemical reactions occur in your body that trigger pain occur. Your nervous system is on high alert. But what if we found a way to disassociate pain and bend over? This is where building up a tolerance to bending over comes in. This is where you work with your physio in order to, over time and progressively, using different strategies, build up the ability and tolerance to flex your spine, pain-free. Every event when you can bend over pain-free reinforces the patterns in your brain that say « bending over is not painful », and that when you win!