Updated: Jul 25
Throughout our time on this planet, we can't hide from the fact that gravity exists. We also can't deny the fact that we as a species must overcome gravity in order to exist. What that looks like is very different from person to person. There are things that humans must do in order to survive, while there are also those things that people do just because they enjoy them. If we navigate our reality with intentional purpose each of these types of activities may collide. This would be where what we must do aligns with what we want to do.
Regardless of the types of activity you perform each must be performed against gravity. It's often during our attempt to perform loaded activities that we at some point may likely experience pain or discomfort. When we do feel pain or discomfort the temptation for some is to jump to the worst-case scenario, while others blow it off as something they can “work through”. How we respond to pain or discomfort can significantly impact how our pain or discomfort may manifest in our lives. How or why we respond to pain and or discomfort is a topic for another day, but whether we continue or not is likely one of the major determinants of whether a person will experience a successful outcome throughout their recovery.
Unfortunately, when pain or discomfort does occur with activity, a common misconception is that a person should completely stop activity. In fact, many folks are advised by their medical provider, “if it hurts, don’t do it.” We realize this may sound like sage advice, especially if we consider the source of that recommendation. Recall the last time you visited your primary care physician for some physical problem you were having. Did you take the time to question what your physician recommended or prescribed for you? Maybe it had something to do with pain, high blood pressure or general fatigue. The fact is that some of you may have thought a bit about it, but many of you likely took it at face value and, though you may have been depressed or upset about “having” to take the medication, you quickly made your way to the local pharmacy, got the prescription filled, and then began taking it without a second thought. Sound familiar?
I mean, the advice to "not do something if it hurts" sounds like great advice, right? But if you stop and think about it for a minute you likely already figured that part out on your own... before you made the appointment. So now what? Do you stop doing it for a few days, weeks, months…the rest of your life? Maybe more medicine? This is where things get a bit muddy, and an inconvenient truth is that many folks (including medical professionals) are often not well versed in the rehabilitation, recovery & restoration process for musculoskeletal pain and or dysfunction, post-injury, surgery or otherwise. Yet, I often work with patients who mention specific things they can’t do because of some injury they sustained many years ago. Interestingly, as we discuss a bit more about why they can’t perform specific activities, they often say that someone (e.g., physician) has told them they should avoid an activity for some reason or another, and not necessarily because the person continues to struggle with the problem. The sad fact of the matter is by the time many of these folks decide to do something about the lack of function or their overall dysfunction it is extremely difficult to regain the motion or function, especially considering the pain response they experience if and when they actually do use the joint or joints, they were told not to move.
Please understand that this is not meant to slight any particular medical profession (this could apply to anybody, licensed or otherwise), but more to illustrate the point that when we seek advice, or allow someone to speak into our unique situation, we need to be mindful of the fact that the advice is only as useful as it applies to our specific situation in the context of our needs, wants and desires. In other words, a blanket statement such as, “if it hurts, don’t do it” does not afford you the opportunity, much less the tools, needed to promote full recovery from your injury.
Modifying what you do (e.g., if it hurts don’t do it) is likely only appropriate under specific circumstances (i.e., acute injury vs. persistent pain), and likely only for a limited time (i.e., maybe 24-48 hrs.). Something that should be understood is that in many cases there are likely alternative activities that may be performed that can help to maintain our body’s overall ability to function while also allowing our individual tissues to heal. As our tissues begin to heal, we should gradually, but progressively, begin to explore movements into those directions that originally cause us pain. If we continue to avoid those directions of movement those movements as well as the joints and muscles involved will no longer be as efficient at moving into those directions.
So, when considering whether you should “…not do it” remember that our bodies are reliant on movement as well as our ability to function against gravity, and in order to maintain its quality of function, even in the face of injury, we must find ways to keep active while at the same time our bodies are continuing to heal. Along those lines we’d like to conclude with some more current recommendations by Dubois & Esculier, 2020 who described the acronyms PEACE & LOVE in an effort to empower you to better understand how you may want to proceed when managing your acute injuries. This process consists of the following...
P = PROTECTION – avoid activities and movements that increase pain during the 1st few days after injury
E = ELEVATION – elevate the injured limb higher than the heart as often as possible
A = AVOID anti-inflammatories – avoid taking anti-inflammatory medications because they reduce tissue healing. Avoid icing.
C = COMPRESSION - use elastic bandage or taping to reduce swelling
E = EDUCATION – your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role
L = LOAD – let pain guide your gradual return to normal activities. Your body will tell you when it’s safe to increase load
O = OPTIMISM – condition your brain for optimal recovery by being confident and positive
V = VASCULARISATION – choose pain-free cardiovascular activities to increase blood flow to the healing tissues.
E = EXERCISE – restore mobility, strength and proprioception by adopting an active approach to recovery.
So, the next time you suffer from pain or injury remember that your body thrives on movement and therefore an early return to motion as well as a little PEACE & LOVE just might be a bit better course of action than the ole "if it hurts, don't do it" advice.
Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020:54(2);doi:10.1136/bjsports-2019-101253