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Scaling your pain for training


TOUGH AS TEAK French race walker Yohann Diniz passed out mid-race in the 50km walk at the Rio Olympics, only to get back up, continue on and finish eighth. He is pictured here in the European Cup Race Walking 2015, Murcia, Spain. Pic: Aronu/CC BY-SA 4.0.


Andrew O'Brien

In case you haven’t realised, Christmas is fast approaching, making my job here somewhat more difficult. How to give physiotherapy-based recommendations with a festive theme?
I’ve made some pretty feeble attempts the last couple of years. So much so, that this time I’ve decided to forget that it’s Christmas and write a follow-on to my last piece in which I discussed those occasions when it’s time to seek medical attention, when trying to keep battling through your pain (or additional symptoms) isn’t a good idea.
I regularly espouse the benefits of general exercise and movement over all other forms of treatment for almost all injuries and illnesses. But the question needs to be asked, if I am coming back from injury, how hard should I push? If it’s ‘just’ pain, how much is too much?
It’s an interesting discussion. All sports have stories of the legendary hard men and wonder women who have been able to fight through the pain barrier to win matches or races. There’s John Sattler, an Australia rugby league player, who played 70 minutes of the 1970 Grand Final with a shattered jaw. As the winning captain, Sattler refused to go to hospital until he had accepted the trophy and made his acceptance speech.
Many would never have heard of Yohann Diniz, but the French race walker suffered violent diarrhoea and passed out mid-race in the 50km walk at the Rio Olympics, only to get back up, continue on and finish eighth. Tough as teak.
In a way, the ability to suffer pain and carry on is part of what sets the truly great sportsperson apart from the also-rans. But the important thing is that these instances happen in competition, whereas in training discretion can be the better part of valour, especially when returning from injury.

The Visual Acuity Scale
As I have mentioned before pain doesn’t always equate to tissue damage, so there is no hard-and-fast rule on when it is okay to continue and when it is necessary to stop doing that aggravating activity.
A very common tool used in physiotherapy is the pain scale, known as a Visual Acuity Scale (VAS), of 0 to 10. A rating of 0 equates to no pain, and 10 equates to the worst pain you can imagine. Research has shown that while two people might give the one stimulus a very different rating (what Mary rates as 3/10, John might rate as a 9/10), the reliability of one person’s rating is pretty consistent.
Using VAS to rate your pain during rehabilitation can be a very good guide of how hard to work. Symptoms rating between 0-3 are in a safe zone; there may be slight discomfort, but not enough to worry about and it’s generally safe to keep going.
A rating of 6 or more is considered excessive and, while it may not be damaging to tissue, it’s certainly irritating already irritated tissue, and you should ease off or try a different exercise.
The 4 to 5  zone is an area of potentially acceptable risk, and as a rehab programme progresses, it’s here that athletes will spend a lot of time. If you have a pain rating of 4 or 5 that settles quickly and doesn’t cause undue concern the following day, then it’s okay to continue. If your pain is in this zone and persists for a day or two, then you have gone too hard and will also need to either reduce the effort or try something different.
In order to stay within these relatively safe parameters, it may be necessary to reduce the speed if running or the weight if working in the gym. A heavier session, in terms of speed or load, may need to be shortened.
Another alternative is to try cross-training, doing a completely different exercise, until the symptoms settle further. The important thing to remember is that there are plenty of variables that can be manipulated to keep the pain scale at an acceptable level other than just stopping altogether.
Which makes me think; maybe I can get a festive pain scale message in here. When celebrating the season, having one, two or three probably won’t cause too much harm, but four or five might be a bit sore the following day. I think we all know having eight or ten just isn’t worth the pain for the next 24 hours!
Happy Christmas to all.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.

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