Know Pain, Know Gain – Transitioning from Rehab to High Level Performance

We have all heard the saying “No Pain, No Gain.” (If you haven’t then you just did!!). 

How much does this mantra hold true? How much pain is okay to work through when recovering from an injury? 

To make a long answer short, it depends – on the type of injury itself, the chronicity, and the severity. However, there is a general framework we follow in rehab that informs the timeline and expectations for return to certain activities. 

Initial Stages - Prioritizing Rehab 

Characteristics: presence of acute inflammation, sharp pain, strict mobility limitations/restrictions 

Goals = control inflammation and encourage healing, prioritize pain-free movement, high recovery 

Mid Stage - Restoring Normalcy 

Characteristics: inflammation and swelling are managed and controlled, pain with specific activities but not necessarily others, pain is mild and lasts only 1-2 days after activity 

Goals = restore symmetrical strength, minimize provocation of pain/setbacks, slowly progress speed, intensity, and complexity of movement 

• Return to “normal” / daily activities without limitations  

  • Upper Extremity = carrying groceries and luggage, modified lifts, initiate return to throwing, reintroduce and progress overhead activities 

  • Lower Extremity = walking long distances, modified lifts, tackling inclines/declines, initiate return to jogging, swimming

Late Stage - Progressing Back to Higher Level Activities 

Characteristics: pain is occasional, controlled, and/or gone, strength and/or coordination deficits may persist but performance capabilities are improving 

Goals = continue to progress strength, emphasize progression of speed, intensity, and complexity of movement 

• Return to higher level activities without limitations 

  • Upper Extremity = progress to full lifts, climbing, throwing and overhead activities, golf swing 

  • Lower Extremity = advance return to sport activities including longer running and sprinting, cutting and changing direction, advanced plyometrics

• Progress from predictable environments (practice, gym setting) to unpredictable environments (competition, sports) 

Key Takeaways 

1. The first step is to understand what your injury is, and how much pain and irritability you are dealing with. If the answer is severe, and a lot, prioritizing management of pain and inflammation is your first and only goal.

2. Once you are past the initial stages of frequent or constant pain and inflammation, we can start to re-introduce previously painful activities. This happens gradually, and takes a pause whenever that pain or inflammation spikes.

3. When normal daily activities are no longer limited, we can start to progress to more “risky” or demanding tasks. Again, this happens gradually and is based on tolerance and response.

4. This process is not always linear, and flare ups or setbacks do not always mean returning to ground zero – they are often just warning signs that you have done too much, too fast. They are opportunities to reassess and readjust, rather than a sign of failure.

Helping athletes RESOLVE THEIR PAIN by CLEARLY DEFINING THE PROBLEM and IMPLEMENTING EFFECTIVE SOLUTIONS to get them back doing the activities they love!

If you are currently struggling with an injury or unable to perform in the activities you enjoy. Please follow the link to schedule a consultation call to discuss how we can help you.