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It’s 6:15 a.m. and you are five minutes into your first run in weeks. The temperature is perfect and the sun is just emerging, turning the sky into a stained glass masterpiece.
Then you feel a twinge in your knee stepping onto a curb. Was there a click? It aches a little, but not badly. Maybe you’re just rusty — or maybe it’s the beginning of a meniscus tear. Should you push through, or is your workout done?
In an ideal world, you would be able to immediately consult a doctor every time you felt pain during exercise. But in real life, you have to make judgment calls. Most of the time, you can walk it off, suck it up or push through it. But other times, you risk real injury.
Everyone’s perception of pain is different, and doctors are loathe to make sweeping statements that might cause someone to exacerbate an injury. But the choices you make in the moment — or the next day — can be the difference between a temporary nuisance and a persistent problem, said Beth Darnell, an expert in pain psychology at Stanford University and a former ultramarathoner.
“It actually might not have been a big deal, but suddenly we’ve created a big deal because we pushed through an additional five miles,” she said.
So we turned to a few pain and movement experts for tips on what to watch out for the next time your shoulder starts to complain at the gym.
How to spot worrisome pain
Whether you are playing a pickup game or running a marathon, there are a few key signs to consider when you feel pain during exercise.
Track how your pain changes
None of these rules are hard and fast, and all have exceptions, the experts said. Sometimes, the best approach is to wait and see how your pain changes. It sounds obvious, but pain should lessen over time.
Dr. Fox suggested checking in a day after feeling workout pain and then every day for a week, writing down the pain’s severity, from one to 10. Look for the same list of issues — swelling, loss of movement — but notice whether they change or move. If the pain changes location or doesn’t improve with proper treatment, it may be time to talk to a physical therapist or even a physician.
“Having a sore foot right after you exercise is one thing,” said Dr. Fox. “But having that persistent pain for five days where nothing has helped” is a red flag.
That said, muscle soreness, especially after a new form of exercise, can flare up as much as a day later and last for a week. Such delayed onset pain and may get worse for a couple of days, but it shouldn’t feel sharp and shouldn’t swell or limit your range of movement.
But even the experts sometimes misread the signs. Dr. O’Donovan once ignored a nagging back pain after a soccer game even as it worsened and his legs began to swell. Eventually, he learned he had dangerous blood clots and spent five days in the I.C.U.
“I did not read the pain cues correctly and wrote it off,” he said. The lesson? “If it’s getting progressively worse, something’s going on.”
Chronic pain can change the rules
If you have persistent pain — a trick knee or lower-back issues, say — some of the advice can be different, and you should follow your own comfort levels. It’s important to set goals and guardrails before exercising, Dr. Darnell said. Whether you are running a 5K or just playing with your kids, plan out how often to take rests — and stick to them, even if you feel OK.
If you have pre-existing pain, most experts do not recommend pushing through it without the guidance of a medical professional. Instead, pace yourself — going easy at first and then progressively harder — and regularly check for changes in the quality or location of the pain. One way to know if you’ve pushed it too far is if you experience a “pain hangover,” Dr. Darnell added, which can cause trouble sleeping that night and tiredness or limited your range of motion the next day.
But that’s not to say you should avoid working out. One thing that experts know for sure, Dr. Darnell said, is that some kind of regular movement is healthy for all of us and exercise can be an excellent treatment for pain.
“It helps reduce stress, it helps you sleep better, it improves mood,” she said. “You don’t want to do too much, but you also don’t want to stop.”
Dr. O’Donovan, who also works with chronic pain patients, agreed. “Your body’s built to move,” he said. “It’s healthy to move. And a little bit of increase in pain is OK.”
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