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It is well known among athletes that some discomfort is part of athletic activities and it is often part of a successful training program. For muscle strength to increase, the muscle must see some intensification of stress compared to what it’s used to experiencing. This stress is usually perceived as the “burn” in your muscle during activity. This mild burn is what we call good pain and is the basis of the popular phrase, “No pain, no gain.” The pain should be of short duration and resolve soon after the activity ends.


Fatigue after a good demanding workout is also an indicator that the activity is pushing the parameters of the athlete’s physiology, but it should not be too extreme. This fatigue should leave the individual somewhat more tired than usual but not overly exhausted. Fatigue that lasts days means the individual’s physiology has been overly challenged and that the muscles and the energy stores are not being effectively refreshed. Chronic fatigue after inordinate exercise suggests that the individual may be overtraining. If after appropriate rest the fatigue continues, it may be a sign of other medical problems and you should consult a pain management doctor.


What are the signs of bad pain?

The muscles, tendons, ligaments, cartilage, and bones of the body are living structures that react to the stress of exercise only gradually. If they see stress too fast they cannot respond functionally and may begin to fail. The cause of the failure can be too much stress too fast, or it can be aggregation of excessive stress over time. When this happens, each one of these tissues responds a little differently. This can result in bad pain.


For example, when muscles see a lot of stress, they respond by getting sore. A little soreness or discomfort means that the muscle has been stressed, not usually something to worry about. But if the muscle has been stressed too much, the muscle can become very sore to move or touch and even swell. To prevent this problem with your muscles, we usually recommend the following rule: take the amount of exercise you think you can do and cut it by one third until the soreness subsides. 


In a similar fashion, the tendons that connect muscles to bones may get irritated if they see too much stress too rapidly. They respond by getting inflamed, which is characterized by pain and sometimes swelling. Tendonitis pain typically occurs during exercise and can continue afterward when performing activities using that muscle or tendon.


The bones, likewise, need time to respond to new stress. When bones see increased amounts of stress, such as an increase in running when preparing for a marathon, they respond by putting more bone in the areas of the bone that are seeing more stress. This response is called ‘remodeling’ and strengthens the bone. However, if the area of bone sees stress too fast, the bone will actually begin to fail. The first sign of this stress reaction is pain along the bone, which occurs with activity. As the situation worsens, a stress fracture can develop. This may result in a limp and even pain at night. If untreated the bone can actually break, which can be a severe injury.


Cartilage also needs stress applied very gradually. Cartilage is the slippery white tissue on the ends of the bones in the joint that allows the bones to glide and move smoothly over one another. When the cartilage sees too much stress too rapidly, it can result in pain and fluid in the joint. Swelling in a joint is a worrisome sign meaning that the cartilage is irritated. If the joint is not rested, the pain and swelling can increase and result in functional problems.


How can pain be treated?

The treatment for any ache or pain after exercise is to cut back on exercise for a period of time. How long to rest depends upon the severity of the pain. Typically, we tell patients not to do anything that hurts. For casual athletes this is easier to do than for elite athletes. It is important to maintain aerobic capacity or stamina when resting a body part, so other exercises that do not cause pain are acceptable. For example, if your knee hurts, it is usually reasonable to continue exercising your upper extremities or even to do lower extremity exercises, like swimming or aqua jogging, that do not aggravate the problem.


The second way to treat a painful area is by icing. Ice should be used after activity with an ice pack or ice massage for 20 minutes. The old standard of 48 hours followed by heat is no longer recommended. We believe that ice is your friend. However, if pain persists, despite the use of ice, more serious problems may exist and you should consult with a physician.


The third thing to do if you have aches and pains after exercise is to continue to move the joint or extremity to avoid stiffness. If the joint becomes stiff over time it will affect the ability of the joint to function normally and may affect athletic performance as well. Remember, range of motion exercises or stretching to maintain the motion of the joint should not be confused with exercising the joint, which tends to stress the structure and make the pain worse.


The fourth way to treat aches and pains is with over the counter pain relievers or anti-inflammatory agents. These medicines include acetaminophen, ibuprofen, naproxen, and aspirin and are believed to be effective at decreasing pain and swelling. If you do not have any contraindications to taking these medications, we suggest following the instructions on the label. If you have any questions, speak with your pharmacist or physician. If these medicines do not substantially improve the pain over a few days then you should consult a healthcare professional.


In summary, if you develop pain after exercise, you should rest and decrease the activity that is causing the problem, ice the painful area, keep moving the extremity (but not stress it), and consider over the counter medicines to treat the pain and inflammation.


When should I be concerned about bad pain?

There are several things you should look for when judging how concerned to be about your pain. First, the pain should not last long after exercise. Pain that begins to affect your sports performance is not normal and this may be more of a problem early in an injury for a high caliber, competitive athlete than for the casual athlete who can more easily rest the injured part. Pain that does not go away with rest is not normal.


Pain that begins to affect your function outside of sports, such as walking or sleeping, is not normal. Pain that is constant or increasing over time and does not go away is not normal. Pain that requires increasing amounts of pain medication over time is not normal and you should consider seeing a physician. Pain that begins to wake you from your sleep is also a concern, especially if it increases over time.


Another sign that may indicate a more serious problem is the development of weakness. The development of tingling or numbness is also not normal and may indicate nerve problems. If you notice that you are gradually losing motion of the extremity you should also seek professional treatment.


Fever, chills, or severe sweating at night are not normal and you should consider seeking evaluation right away.


What about the pain that occurs with an injury?

It is often difficult to know if an injury due to an accident or trauma is serious or not. Signs that an injury is more serious include: severe pain that makes the individual nauseated or extremely uncomfortable, abnormality at the place of the injury, rapid and marked swelling at the site of the injury, loss of function of the part that is injured, tingling or numbness of the extremity, and inability to move the fingers or toes of the involved extremity.


We tell athletes that pain always occurs for a reason. More severe injuries have more swelling and pain. Injured areas that turn black and blue over time indicate that blood vessels have been broken and there is the possibility of injury to the tendons, bones, ligaments, or cartilage.


If you have any question about whether an injury is serious or not, you should seek professional treatment.


Sometimes you can manage small injuries yourself, as we have set forth in this article. But don’t be stubborn! If you have a major injury, or if your nagging woes don’t clear up, get help.


At Southern Coast Specialists we offer a multi-faceted and integrative approach to relieve your pain, heal your injury, and get you back to competing in the sport you love.