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Pain: When to Push Through and When to See the Doc

Author: Dr. Kaleb Redden Contributing Author, DO

If you’re diligently following a workout plan designed by Kris Gethin or any of the Kaged Muscle athletes, the reality is that you will experience pain at some point. Training to increase lean muscle mass and reduce body fat is a process that requires significant physical exertion, which can equate to feeling some aches and pains. Serious athletes have realized that if you want results, you must be willing to put in the work and push through pain from time to time. You’re likely familiar with the phrases, “pain is weakness leaving the body” and “no pain, no gain”. But what happens when the pain starts to linger longer than expected or begins to impede your ability to function properly in other facets of your life? Are you able to distinguish between pain you can push through and pain that requires an expert’s opinion?

At a basic physiological level, pain is a life-saving response that your body is equipped with through the reaction of pain receptors. For a moment, think about what happens when you touch a red-hot stove. Instantly, without thinking, your hand will fly away from the stove. This is an involuntary response dictated by your nervous system to protect your hand.  If you didn’t feel pain, the consequences would be devastating. The body recognizes when something is wrong based on the information gathered by its pain receptors. This feedback is imperative in diagnosing potential problems. In fact, one of the first questions medical professionals will ask is in regards to pain to learn more about the location, onset, duration, quality, and quantity of pain.

Recognizing pain is important, but so is learning how much pain is appropriate and what types of pain are acceptable. If you sprint full tilt, pretty soon your lungs will be burning, your legs will be aching, and your brain will tell you to stop in order to preserve your body.  If you stop, the discomfort will likely decrease and if you keep going it may intensify. Pushing your body to a place where it is physically uncomfortable will change the limitations you experience the next time you sprint.  Pushing through the pain helps raise your threshold to fatigue and improves performance – ultimately making you a better athlete. Unfortunately, if the pain you experience during exercise is due to an injury or disease, you may still be able to continue grinding out the reps, but instead of increasing your exercise capability and capacity, you may be causing further damage.

An example that may be more pertinent to powerlifters and bodybuilders is lower back pain. Squatting and deadlifting can induce hypertonicity, or spasms, in the lower back which can be quite painful.  The spasm may be a result of increased load and muscle breakdown, and pushing through will improve exercise tolerance. On the other hand, if continued lower back pain is caused by lumbar spondylosis, or degenerative disc disease, banging out more reps can cause significant damage and lead to long-term negative outcomes – taking you off the gym floor for months, or even requiring surgery.  

One question frequently asked by athletes is, “When can I work through the pain and when should I go see the doctor?” The simple answer is if the injury is acute in nature, meaning there is a clear cause of it, then you should see a doctor. For example; you’re completing your set on the leg press and your knee suddenly pops, and the knee cap nestles in the back of your leg. This is the result of a patella dislocation, something you won’t be able to walk off. In a case such as this, schedule an appointment with your health care provider, or head to a walk-in clinic ASAP.  

For other muscle or skeletal issues, here is a checklist of things to ask yourself to help determine when you should be evaluated and when you can keep training.

  • Is the pain coming from a joint? Pain that seems to be coming from the joint, not just from the area around it. Specifically the ankle, knee, hip, low back, neck, shoulder, elbow, or wrist. If one of these areas is painful, hot, red, or swollen for more than 48 hours, you should have an exam.
  • Does the pain wake you from sleep? Most aches and pains will not wake you from sleep, so if your injury is interrupting your sleep, you may need further evaluation.
  • Is there significant swelling or bruising? Initially, most sport related injuries will cause swelling and inflammation. This is a protective mechanism, but can also be due to bleeding from tissue trauma. If the swelling doesn’t respond to the normal treatment of rest, ice, and compression within 48 hours, have it looked at.
  • Is there a reduced range of motion due to pain, especially in a major joint? Is one side of the body not moving like the other? There may be a mechanical barrier that needs professional attention.
  • Is there numbness or tingling? This may be caused by a neurological dysfunction and should not be ignored.
  • Is the pain affecting daily routines? Shoulder pain that occurs during your chest workout should not cause problems folding laundry four days later.
  • Is pain causing an avoidance of activity or a change in your routine? For example, pouring milk with the opposite hand because it hurts to carry the jug on the affected side.
  • What is the duration and intensity? Pain lasting longer than a few weeks and not decreasing in intensity should be evaluated.
  • Is the muscle or joint pain associated with systemic symptoms? Meaning, if you have a fever, darker urine than usual, have a headache or feel sick, along with muscle or skeletal pain, go get checked out as quickly as possible.

One of the main barriers among athletes who are suffering through pain is the fear that their doctor will tell them to stop doing what they love. The truth is, there are doctors in the world who are athletes themselves and understand the importance of keeping patients as active as possible. The key is finding a balance and creating a treatment plan that will optimize performance and not cause further damage.  In order to build that plan, an accurate diagnosis must be made. A physician has the necessary knowledge and tools to make that diagnosis, including things like imaging, blood work, physical examination, and functional analysis. They also have the knowledge to refer you to the appropriate specialist or therapist, as needed.

Another common concern shared by many people is thinking that the only option in fixing an injury is to undergo surgery. In reality, there are a myriad of treatment options for musculoskeletal injuries. A physician’s job is to do everything possible to help your body heal without turning to surgery. Obviously, there are some problems that require going under the knife, but if surgery is indicated, it’s likely worth the downtime to get the injury fixed so you can get back to being 100%. Your health is one of your most precious commodities, protect it by taking the time off as your body dictates.

As an athlete, be open to the idea of spending a little time to go see your doctor. Then, put the time into developing a treatment plan so you can get back to doing the things you love, pain-free. It's imperative to break barriers and push through some pain in order to improve, but if pain is halting your progress or interfering with day to day life, it’s time to seek help and address the problem before it gets worse.