Exercising with an injury or during rehabilitation is confusing. After a surgery or with a chronic injury a lot of variables contribute to how you manage your habits and react to pain. Many athletes will endure the pain and ATTEMPT to train through the symptoms. On the other end of the spectrum people who have had a lot of chronic issues such as spinal pain, headaches, and other repetitive strain injuries tend to avoid pain or fear any activities that cause their symptoms. It is not a perfect science to determine when to endure the pain, when to rest, when to take medications, or when to ice/heat. In attempt of generalizing how to manage pain, I use The Traffic Light System.
Now, before I educate someone on how to use The Traffic Light System, I have asked them many questions such as: intensity of pain, episodes of pain, activities that increase it, time to recover, sleeping habits, medical history, medication use… I could probably spend 20 minutes asking specific questions about pain during a Physical Therapy evaluation. However, most people are afraid of pain. To focus on it will usually only cause a more heightened response. Pain, life stress, lack of exercise, and fear of activities can lead to something called central sensitization. This is when your nerve receptors become sensitive to pain eventually leading to inaccurate processing. Non-painful stimuli become painful. Everyone has a friend, family member, or patient who has been overcome by this type of pain mechanism. You know… the type that has dedicated their life to treatment modalities such as Massage, Yoga, Chiropractic, Acupuncture, Physical Therapy, MRI’s, and finding the latest research on the surgery to cure their pain. At one time these people had an acute injury that was not managed properly thus leading to fear of activities and central sensitization. Many have gone through emotional cognitive events during or prior to the injury predisposing them to this type of pain “mutation.” These factors eventually lead to chronic pain. If you follow the Traffic Light System you should avoid this “mutation.”
We are going to describe how to use The Traffic Light System by using an exercise example: 2 sets of 15 squats to improve your leg strength for decreased pain during running.
Red Light - STOP! During the exercise, if the pain is severe, sharp, radiating down the leg, or your leg completely collapses MORE THAN TWO TIMES do not continue with the exercise or activity you are performing. If you are walking or using the stairs, modify as needed to reduce the pain.
Yellow Light – Proceed with Caution. If the pain intensifies with the movement or exercise (mildly), continue for 5-10 reps. If the exercise intensifies your pain, STOP. If the exercise seems to loosen things up and you are able to continue without pain, PROCEED with the exercise. If you have a pain that is unstable in terms of how it reacts to activities, you should not push yourself with intensity (# of sets, reps, speed, vigor). This is where we get the term “listen to your pain.”
Green Light - Continue with the exercise. If you do not get your pain, finish out the exercise and progress as muscle soreness allows.
Again, this is a very general way for you to assess your pain during activities. If you have any doubt, STOP the exercise. Attempt a similar type of movement to see if it creates pain in the same location (example: lunge). The Yellow Light and Green Light needs to be progressed as an experiment. Do a little extra and assess what happens to your body or pain for the next 24 hours. If you feel the same or better, continue or progress with the exercise. If you feel worse and know that the pain is not related to any other activity you have done that day, take a step back in intensity of the activity. If you can’t figure out the equation, seek professional advise.