Pain Management: Should I Exercise or Rest?

Man with knee brace on in pain

Whether it’s low back pain, neck pain, a sprained ankle or a shoulder injury, it’s important to understand when you should be active and when you should give your body a break.

Pain Management: Should I Exercise or Rest?

By Mark Brammer, DPT

When you’re in pain, your body is communicating with you. But what message is it sending? Should you rest or should you move?

Whether it’s low back pain, neck pain, a sprained ankle or a shoulder injury, it’s important to understand when you should be active and when you should give your body a break.

It’s also crucial to understand the difference between acute, subacute and chronic pain. Each stage should be treated slightly differently throughout the healing process.

Here are the three different stages, with guidance on how you should manage the pain.

1. Acute Pain: Rest

Acute pain is a sign of abnormal stress to normal tissue. It’s the immediate result of an injury, such as an ankle sprain. This phase can last for up to one to two weeks after the initial onset. 

Symptoms of acute pain are swelling, redness and warmth. The pain is usually severe. 

At this stage, the recommended treatment method is to follow RICE – rest, ice, compression and elevation. This sequence helps to bring down the swelling and supports healthy blood flow. It kick starts the healing process. 

The tissue is protecting itself from any further injury and needs to be progressed cautiously. Manual techniques are important to help decrease swelling and pain. 

Dry needling has been effective in pain control. This is not a time to think, “No pain, no gain.” 

As this phase starts to transition to the next, you should start to notice the swelling and pain decrease and gentle movement is possible and you can start with light weight-bearing. You need to avoid being too aggressive as you can risk re-injury of the affected body part/anatomy. 

Mark Brammer applies resistance to a band
Physical therapist Mark Brammer applies resistance to a band during light movements to work on strength and mobility for this patient’s sprained ankle.

2. Subacute Pain: Gentle Movement

Subacute pain is a subset of acute pain and typically occurs between two weeks and three months. In the scenario of a bad ankle sprain, this would be when you start to increase weight-bearing, decrease the use of crutches, cane and braces, or a sling in the case of a shoulder injury.

In the subacute stage, tissue repair is occurring and scar tissue is more mature and stable. At this point, you should start to incorporate gentle movement exercises, light stretches and strengthening to the injured area.

Stretches should be light and create a strain, but not a pain. It’s best to hold stretches for 30 seconds and do three to five reps, two times a day. DO NOT bounce during the stretch. With strengthening, it’s always important to utilize light resistance and high reps. Two sets of 12 to 15 reps are recommended.

During this phase, massage and passive stretching can increase blood flow and help promote healing while decreasing scar tissue. Another technique we utilize is Graston, in which we use a smooth, metal instrument to gently strum along the injured body part, applying light pressure and breaking up some of the scar tissue. This helps to create a flexible scar and to avoid the injury transitioning to the chronic phase.

Another treatment method that works really well at this stage is dry needling. We insert small needles into the muscles that are the trigger points for pain, and they help to relax the muscles and decrease the pain signals and sensitivity. In some cases, we apply electric stimulation while the needles are inserted into the muscle, to help promote the healing process.

The manual techniques of massage, dry needling, Graston, passive stretching combined with movement exercises and light strengthening are effective in prevention of the chronic pain phase.

3. Chronic Pain: Increase Movement

Chronic pain reflects normal stress to abnormal tissue. In other words, you experience pain when you shouldn’t. During this phase, it’s important to keep in mind that “pain does not equal damage.” The fear or avoidance of pain has created this situation in many circumstances. For instance, you may just be walking and you feel pain as in the example of an ankle sprain. Daily tasks are a challenge because even the slightest movement can trigger pain.

Chronic pain is the result of tight muscles, scarred and inflexible tissues, or injuries that never healed properly. This stage occurs three months after the initial episode.

Although it may be painful, we recommend doing light cardiovascular movements, stretching and light strengthening exercises at this stage.

Pain doesn’t necessarily mean you’re hurting or worsening your injury; rather, you’re strengthening the tissue by bringing healthy blood flow to it. Discomfort and delayed-onset muscle soreness are OK for the first day or two after activity, but if pain and swelling persists after three days, you should stop the activity. In this situation, the activity may be too aggressive.

During the chronic phase, there is much, much need for patient education. I can not stress this enough. Like most people, pain is not a desired experience. In this phase, part of correcting the condition may require the creation of temporary pain to help reduce longterm pain and increase activity tolerance.

Massages and dry needling should be utilized to help with the discomfort.

If you’re ever experiencing sharp pain, tingling or numbness, you should stop what you’re doing.

Listen to Your Body

Education is a vital part of recovery. When you understand the signs and symptoms of the various stages of pain and you listen to your body as to when you should rest and when you should move, you should notice improvement and experience healing.

Everyone is unique and there’s no one-size-fits-all solution when treating pain. However, if you listen to your body and you’re patient with the healing process, you will learn when to rest and when to move, so you can get back to what you were doing prior to the pain.

For more information, tools and techniques for pain management, contact one of our 10 locations today.

Mark Brammer is a physical therapist at TuDor Physical Therapy and treats patients at the group’s Salem office. He is dry-needling certified and trained in various pain management treatment methods.