When Pushing through the Pain doesn’t Work

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I have a love-hate relationship with pushing through my pain. Sometimes pushing through the pain ends in great results. Other times, it is disastrous. And the uncanny problem that I am trying to wrap my brain around is that there is no forewarning or way of knowing ahead of time which direction this deadly dance will swing.

For example, there are days I find myself lying on the couch in moderate to severe levels of pain until I am forced to go to work in the afternoon. I get up, go about my job, and when I come home later in the evening I am rejuvenated, my pain levels have decreased slightly, and my spirits are infinitely higher from the personal interaction. Sounds great, right?

But, no. It gets confusing, because this best case scenario only occurs about 50% of the time. On other occasions, I do my best to push through the pain and I find myself in a mild to moderate flare for the next few weeks or a full-blown setback that will take 2-3 months to get back to baseline.

Sometimes I am required to push through, as in the case of going to work. In those instances, the choice is easy – I get up and go to work regardless of how I feel. But, what about those situations when I have a choice? To push through or not to push through? That is the unanswered question that I have yet to wrap my brain around.

The common train of thought that I hear from most pain management resources is that pushing through is the better option. If you have the choice to go out – do it because you need to live your life. If you are participating in any sort of pacing program – keep going and increasing on schedule regardless of your pain levels. If you are doing housework and feel an extra twinge in your back – don’t stop and rest, keep going.

As a specific example of this, I was recently reading an article published this past January on NPR entitled, “Pain in the Back? Exercise May Help You Learn Not To Feel It.” The basic premise of this article revolves around a boot camp for individuals with chronic back pain, many who have experienced pain for years without relief. Under the guidance of a trained professional, participants are put through what seems to be an intense exercise program and encouraged to continue pushing through, even on many occasions when pain increases.

The underlying thought behind this strategy is that pain does not equal damage. Participants push through the pain, and over time, as their body strengthens and becomes desensitized to pain, many see moderate to large improvements in their condition.

I just struggle with wondering how translatable this is to various chronic pain and illness conditions. I struggle with believing that pain does not equal damage for my specific diagnosis and for my body personally. My ligaments were literally sprained in my initial chiropractic injury, and I keep getting the feeling that every time I have a huge setback that lasts several months, it is because I have re-sprained the already damaged and vulnerable ligaments from overexerting myself. I have talked about this before, but situations such as moving boxes, vacuuming, increasing my exercises too quickly, etc… have all been triggers to set me into full blown setbacks, often after periods of relatively steady progress.

I came across an interesting article in The Journal of Manual and Manipulative Therapy that gave some credence to this viewpoint. The article entitled Evidence-based Diagnosis and Treatment of the Painful Sacroiliac Joint states the following:

“Inflammatory processes such as those found in ankylosing spondylitis87,88 are known to affect the SIJ [sacroiliac joint]. In addition, instability secondary to trauma or childbirth may well be responsible for repeated minor traumas producing, perpetuating, and increasing inflammatory activity in the joint.”

So, number 1, there are inflammatory processes going on, which confirms my decision to participate in a strict anti-inflammatory diet. And number 2, there is evidence that repetitive minor traumas to the SI ligaments perpetuate inflammation in the joint. I can’t describe how much sense this makes to me based on my personal experience.

This research seems to support my caution in not always pushing through the pain. Perhaps pain does equal damage in my case, damage in the form of “repeated minor traumas” or re-spraining of the damaged ligaments.

I have found that pushing through the pain poses a huge risk for me. When I start to do too much too fast, or if I ignore sudden increases in pain, I can immediately lose months of hard work in the span of a night. This is not worth it to me. For me, slow and steady leads to the most progress. Now, if I can only manage to learn how to keep this progress.

How about for you? Does pushing through the pain help or hurt? Do you have any strategies for knowing ahead of time when you should or shouldn’t push through?

15 responses

  1. I don’t always push through my pain unless it’s something really important that I have to do. I find that pacing myself helps the most. When it comes to house cleaning, I do a little bit at a time and take breaks. My Rheumatologist told me that if I do exercise then it should be something really boring like riding on a bike at the gym or walking through shallow water in a pool. I don’t think you can really push it through chronic illness that’s not curable.

    • That makes a lot of sense. I think it might be slightly different for me, as my condition is supposed to be treatable and curable to the point of living a normal life. Everyone (doctors, PT, etc…) just tells me it is VERY difficult to get to that point.

      That is interesting your doctor said to choose an exercise that is boring – what is the purpose behind that?

  2. I rarely push through the pain because ultimately it ends up in a flare/setback. The only times that I push through the pain are when I absolutely have to get something done. I think it’s probably different for everyone who has chronic pain. I sense that “normal” people (who don’t have pain) don’t understand when I make a decision to not do something or to stop before a project is done…their bodies might remain sore for a day or two, my soreness might last for a month or two. It’s difficult to explain that without sounding like I’m being lazy or unproductive.

    • Yes, I agree that is it probably different for everyone. Part of my frustration is that when I research these things, the pain management advice is extremely general and not related to specific diagnoses. It makes sense to me that a doctor’s advice on pushing through or not would somewhat correlate with diagnosis, but I do not see much information like that.

      If you don’t mind me asking, what type of chronic pain do you struggle with? I know that is a personal question, so no pressure to answer if you do not want to. I have appreciated your comments and was curious to put them into context 🙂

      • I don’t mind you asking. For over 10 years, I have suffered from chronic back pain, specifically in 3 different areas. There are “slight” bulges in those discs, but not enough to warrant surgery. I also suffer from irritable bowel and bladder. Most recently I had an episode of left-sided paralysis that lasted for a couple hours and then mellowed out to weakness for a couple weeks. In general, I deal with weakness and fatigue, but it had never been one-sided like that. I had stroke and MS ruled out, along with many other rare neurological disorders. My neurologist has reluctantly diagnosed me with fibromyalgia and treats me as such, although I am not typical. I sometimes wonder about Lyme disease, but I have tested negative several times. I’m a “mystery.”

  3. Pushing through the pain always comes at a cost for me. If I play, I pay. Like you said, it could last a few days into several months, or longer for me, sometimes. But, if I choose to never push through the pain I’ll have no life at all. I already spend most of my time in bed, except for my many appointments that do force me to get up, shower, get dressed, all those basic things we should be doing every day, anyway. I never know ahead of time what the repercussions will be. It’s a chance I’ve got to take, if I can bring myself to try without the fear of what is going to happen to me. Some days I just can’t! Hope you’re having a “good” day. 🙂

  4. Great to read your post as I have such an issue with the mainstream suggestion by medical professionals that more often than not encourage a certain degree of pushing through, exercising, etc. I know my body and my back and if there is one thing I have learnt it is for me to never push through. Like you it just ends up with setbacks and not a day or two like most medical professional say but weeks or months. It bothers me that they put out this general advice. It causes me to feel insecure about my choices, judged by my choices and also I don’t want others in my life to hear this kind of information and assume that “pushing through” is how I should be approaching my medical situation. I “pushed through” for the first two years and all that did was lead me to be more disabled by my pain. Thank you for discussing this very important topic.

    • We are definitely on the same page about this – you described back exactly how I feel! And I am glad to know that others with back pain experience this in the same way. I guess my question is why does it work for some people and not others? And is there a way for doctors to know the difference so they can give better recommendations? Clearly it seems to work for some people, and it really makes me questions myself when it does not also work for me. It must come down to individual bodies, types of injuries/problems, back mechanics/structural issues, etc… and so on. I hate that it is given as a blanket recommendation and that I feel looked down on because it doesn’t work for me.

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