What a pain! Is it soreness or a sign of an injury?

Summer is approaching and the weather is an invitation to be outdoors, to be more active and to enjoy the longer days walking, jogging, biking, swimming, golfing, gardening, pickleball … or playing with the grandkids.

However, fun in the sun also brings the risk of overdoing things.

If you wake up the next morning with sore and achy muscles, are they indications of too much too soon? Or have you injured yourself?

“I tell my patients, if you can come up with a reason for the pain, I’m not too worried,” said physical therapist Stephanie Gradone, DPT, ATRIC, at Orleans Rehabilitation Center. “But if you’re not sure why you’re hurting, we need to be concerned.

“If you raked leaves for six hours, did three dump runs and you’re sore the next day, OK, that’s understandable. If you just did your normal routine and now have a weird pain, then we need to know why.”

Two-Hour Rule

Gradone, who specializes in sports orthopedics and aquatic therapy, uses the "Two-Hour Pain Rule," recommended by the Arthritis Foundation, to help distinguish between good and bad pain. 

If pain continues or increases for more than two hours after exercising, you’ve likely overexerted yourself.

Good pain typically occurs after an activity and includes muscle soreness or fatigue. Bad pain is often characterized by sharp, sudden or persistent pain that limits movement and doesn’t improve with rest.

Delayed Onset Muscle Soreness or DOMS is a condition that helps Gradone evaluate patients. DOMS is “good pain” and a common experience of muscle stiffness or discomfort usually occurring 48 to 72 hours after a new activity or exercises more strenuous than you’re accustomed to.

“Anyone who has been an athlete or a regular exerciser can tell you the difference between good pain and bad pain,” said Gradone. “When I was in my 20s, I went to Yosemite and hiked Half Dome. I’m very fit, but not for that activity, and for the next three days my legs were so sore I could barely sit.”

Listen to Your Body

So, when is it OK to push through a twinge or an ache and finish the workout, and when should you listen to your body and stop? 

“Our bodies are giving us signals all the time,” said Gradone. “But stubbornness tends to make us ignore those signs. Part of my job is to help you understand the signals. You felt this but kept going. Why? Or you felt something and stopped. That’s good. Listening to your body is a very important part of getting back to your activity.

“We have an active older population on the Cape and many of them love their pickleball. If you lunge and hear a pop in your knee, or have a sharp pain, that’s a concern. Pay attention over the next few days and see if it resolves itself. If there’s an injury correlated with that, you’d likely get swelling and that’s your indication it’s not a good pain.” 

If the pain lingers and is not getting better, that’s something to address with your primary care provider, she said, and see if further imaging is warranted.

Zero to 10 pain scale 

Assessing and defining the intensity of pain is always a challenge, Gradone said. 

“On a zero-to-10 pain scale, zero is nothing at all and 10 is so severe you feel like you want to go to the emergency room,” she said. “That helps put pain into perspective for patients. Insurance companies require us to ask the (zero to 10) question, but people sometimes struggle with a number, so we also have a visual analog scale with different kinds of smiley faces. That can help determine where they are.”

Patient Education

A conversation with the patient is also important, said Gradone, who listens for buzz words when discussing how and when the pain occurred.

“We ask them to describe their pain, and we want some context. Is it sharp or nagging? Is it achy or throbbing? What kind of activity were you doing? Did you increase your level of exercise, or did this just come out of the blue?” she said.

The descriptors help her determine whether it’s good pain or bad pain and then she can proceed.

“Everyone has a different personality, and the same approach doesn’t work with everyone. My goal is to understand each individual’s mindset, where they’re at, and help guide them through their journey and back to what they enjoy doing,” she said.