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There are many benefits to exercise, including the potential for improved physical and mental wellbeing. However, there may also be some physical discomfort associated with these activities due to the stresses placed on the body.

When experiencing discomfort, it is important to understand the difference between exercise-related muscular soreness and pain. Muscular soreness is a healthy and expected result of exercise. Pain may be indicative of injury.

But pain is personal, and the degree of injury does not always equal the degree of pain. Also, different people have a different pain tolerance. Understanding pain is helpful to managing pain.

Individual Activity Threshold

In order to make physical improvements, your body needs to be pushed to an appropriate level where gains can occur.

Each person's body has a different activity threshold dependent upon many factors, including age, baseline strength, and participation level. Remaining on the safe side of your threshold will result in muscular soreness. Exceeding your threshold will result in pain.

One of the expected outcomes of exercise, when done appropriately, is that this threshold will progressively increase. For example, when an individual begins running, their safe threshold may be 5 minutes of running. After several weeks of progressive increases in duration, this runner's threshold may increase to 20-30 minutes.

To maximize your exercise gains and minimize injury risk, it is important to be realistic about your activity threshold and to be able to differentiate between moderate muscle soreness and pain.

Soreness vs. Pain: How To Tell the Difference

The chart below highlights key differences between muscle soreness and pain.

Muscle Soreness

After activity, muscular soreness typically peaks 24-72 hours after activity. This is the result of small, safe damage to muscle fibers and is called Delayed Onset Muscular Soreness (DOMS). During this time, your muscles may be tender to touch and feel tight and achy. Movement may initially be uncomfortable but moving and gently stretching your muscles will help to decrease soreness. During the few day period that you experiencing muscular soreness, you might consider performing alternate exercise activities in order to give your sore muscles an opportunity to recover while strengthening other muscles.

Pain

In contrast to muscular soreness, you may experience pain during or after performing exercise. This may feel sharp. This pain may linger without fully going away, perhaps even after a period of rest. This may be indicative of an injury. Pushing through injury can worsen the problem. If you feel that your pain is extreme or is not resolving after 7-10 days you should consult with a medical professional.

How a Physical Therapist Can Help

A physical therapist can be a valuable resource to you throughout your exercise journey. Before beginning an exercise routine, your physical therapist can perform a variety of pre-activity assessments to determine your readiness for exercise. Based on this, your physical therapist may also recommend specific exercises that will best prepare you for your desired activities. They will also discuss the best strategies for introducing and progressing exercise activities while minimizing your chance of becoming injured.

In the unfortunate situation when exercise leads to an injury, your physical therapist will assist in your recovery in many ways. They will help with initial pain management, identify and address all factors that may have contributed to your injury to prevent further problems and provide specific recommendations regarding reintegration into exercise as appropriate.

Physical therapists treat chronic pain through movement, hands-on care, and patient education. The CDC recommends safer alternatives like physical therapy before using opioids to manage pain. Learn more.

source https://www.choosept.com/Resources/Detail/soreness-vs-pain-whats-difference

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though "there has not been an overall change in the amount of pain that Americans report."

In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.

But for other pain management, the CDC recommends nonopioid approaches including physical therapy.

Patients should choose physical therapy when ...

• ... The risks of opioid use outweigh the rewards.
  Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, "experts agreed that opioids should not be considered firstline or routine therapy for chronic pain," the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, "risks are much lower" with non-opioid treatment plans.
• ... Patients want to do more than mask the pain.
  Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
• ... Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
  The CDC cites "high-quality evidence" supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
• ... Opioids are prescribed for pain.
  Even in situations when opioids are prescribed, the CDC recommends that patients should receive "the lowest effective dosage," and opioids "should be combined" with nonopioid therapies, such as physical therapy.
• ... Pain lasts 90 days.
  At this point, the pain is considered "chronic," and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are "preferred" for chronic pain and that "clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient."

Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for nonopioid treatment.

"Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions," the CDC states.

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.

Related Resources:

• Health Center on Opioid Use for Pain Management
• CDC Recommends Physical Therapy and Other Nondrug Options for Chronic Pain
• Using Opioids for More Than 30 Days Could Increase Depression Risk
• Widespread Pain is Creating Widespread Prescription Drug Use
• Health Center on Pain

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management

source https://www.choosept.com/Resources/Detail/physical-therapy-vs-opioids-when-to-choose-physica

1. Pain is output from the brain.

While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses a virtual "road map" to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.

2. The degree of injury does not always equal the degree of pain.

Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding(s) may not be the cause of your pain.

A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.

4. Psychological factors, such as depression and anxiety, can make your pain worse.

Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your perception of pain.

Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.

6. Understanding pain through education may reduce your need for care.

A large study conducted with military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for low back pain less than their counterparts.

7. Our brains can be tricked into developing pain in prosthetic limbs.

Studies have shown that our brains can be tricked into developing a "referred" sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or from the "phantom" limb. The sensation is generated by the association of the brain's perception of what the body is from birth (whole and complete) and what it currently is (postamputation).

8. The ability to determine left from right may be altered when you experience pain.

Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain, and have noticed your sense of direction is a bit off, it may be because a "roadmap" within the brain that details a path to each part of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual roadmap that isn’t clear. Imagine spilling ink onto part of a roadmap and then trying to use that map to get to your destination.)

9. There is no way of knowing whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way.

While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain "feels like."

Read more about Pain and Chronic Pain Syndromes.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our #ChoosePT page.

Author: Joseph Brence, PT, DPT

Bibliography

Allegri M, Montella S, Salici F, et al. Mechanisms of low back pain: a guide for diagnosis and therapy [revised]. F1000Res. 2016;5:F1000 Faculty Rev-1530. doi: 10.12688/f1000research.8105.2.

George SZ, Childs JD, Teyhen DS, et al. Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial. BMC Med. 2011;9:128.

Carroll I, Wang J, Wang M, et al. Psychological impairment influences pain duration following surgical injury. J Pain. 2008;9 (Suppl 2):21.

source https://www.choosept.com/Resources/Detail/9-things-you-should-know-about-pain