Body Language
No pain no gain.
Goal of many orthopedic procedures, especially fractures, is to get the person back on his feet as quickly as possible, with minimal support. It allows the person to get back to activities of daily living, whilst the fracture is healing. One of the important factors is being able to bear weight on the limb.
We usually have two categories of doctors and patients. First, who are very cautious and will allow or walk, only when the fracture is showing signs of healing. Despite it meaning a longer recuperative phase. The second being, walk as quickly as possible, even if there is a bit of discomfort. A third, but more sensible category exists, among doctors, who will allow progressively increased weight bearing based on the rate of healing. The easiest way to achieve this is, to weight bear as tolerated. Most patients tend to err on the side of caution, in fact excess caution. Sometimes this is detrimental and can lead to complications like blood clots in the deep veins of the legs.
"An elderly female known to me had had a minor surgical procedure, which was done as day care. She was the darling of the family and fussed over by the family members, and they insisted that she takes adequate rest. Despite the fact that the doctor asked her to be as mobile as possible. She under the watchful eyes of her well-wishers was doing the bare minimum possible. She walked to the bath room on the third day and collapsed. The guess is, she had developed blood clots in the veins of her legs and this led to further complications."
How does this weight bear as tolerated work? As and when the fracture or soft tissue starts to heal, it will automatically be in a position to take the load bearing forces, with less and less pain. The rate of healing varies from person to person, and the amount of pain can be taken as an indicator of the rate of progression of healing. Instead of straight jacketing everyone into a fixed parameter, imagine that the body is talking to you. If it is allowing doing a particular activity, it means that, it will not cause any harm. If there is pain, it’s a protective mechanism, in terms that the body is informing you not do that particular activity. Let's look at another example, if you put your hand too close to a hot surface, you feel pain and instinctively withdraw. Isn't that the body telling you to withdraw, or else you will continue, leading to an injury.
The same applies to athletes and fitness enthusiasts. They swear by the phrase “no pain no gain”. But that is not entirely true.
Any exercise, be it cardio vascular or weight training, stresses our body. Due to which there is an enhancement of strength or endurance. By pushing, to do a little more every day, we are gradually improving our performance, by giving the body time to adapt, to the new demands we place on it. This comes with some discomfort or pain. The two common words we hear.
We need to differentiate between the two. Any process of enhancement in our performance or physical limits is usually associated with some amount of inflammation in the muscles. There are micro tears and the body heals these, this process of healing generates some amount of discomfort. There is a sensation of burn during activities, both of these are good for us, and indicates the adaptive process of the body. This kind of discomfort diminishes with rest and adaptation. This is the good pain fitness guru's talk about.
There are times when feel a sharp stabbing pain, which is strong enough to make us stop doing that activity or it persists for longer periods, or pains that disturb our sleep or painful even at rest. These are signs of an injury and we will need to rest or modify our activities. The commonest mode of injury to the muscles is when we have an eccentric contraction, that is contraction and lengthening happening at the same time, typically seen in downhill running. We can continue rest, combined with stretches and range of motion exercises while healing occurs. This is the best way to tide over the period of injury while maintaining a certain degree of fitness. There is fine line between pushing through and the need for rest. We can achieve this by making a distinction between discomfort and pain.
Recurring pains associated with exercises are often due to incorrect posture or technique. It would be useful to have your training buddy or coach, to have good look at you, to correct these errors and retrain yourself, so that these can be avoided. Just be sure to always follow proper technique and posture for any type of exercise.
Both, discomfort and pain, can be alleviated by application of ice and heat. Judicious use of anti-inflammatory medication under the guidance of a doctor may be useful. Inflammation is a protective response of the body, it's not advisable to counteract this without proper guidance.
Start low and go slow is an age-old adage. Meaning start at very low intensity levels and duration and slowly ramp up the time and effort, to build strength or endurance. It's always advisable to take time and work towards realistic goals.
Rome was not built in a day.
