Frequently Asked Questions:

One of my patients asked me to come up with a “frequently asked question” for today’s article. I will do my best to be clear and direct and may use this format in the future. Also, I am more than willing to address a question or concern from anyone reading my articles so feel free to reach out to me if you have a question. One of the most common questions I hear on a weekly basis is “what should (or shouldn’t) I do?” My typical response is: “Do everything that makes you feel better and stop doing the things that make you feel worse!” Although this may seem obvious or too simplistic to a lot of you, I would ask you to take a minute to consider how often you “keep going despite the pain.” Or maybe you are the person that is afraid to do too much and set yourself backwards. In either case the key is somewhere in the middle. Kind of like “Goldie Locks and the 3 Bears”...not too much….not too little...but somewhere in the middle that is “just right.” Fortunately there is an easy way to figure out what is “just right”...it’s called PAIN. The body has an alarm system that we call “pain.” The body alerts us to activities that we should pay attention to by sounding the alarm (i.e. increased pain). Pain is, more specifically, our body’s way of asking us to stop what we are doing to evaluate whether or not we should continue what we are doing. For example, if when we stop an activity that is causing pain, and our pain goes away immediately, then the body is saying, “You are OK...proceed.” I typically explain that what I mean by “immediately,” is a few minutes...up to 5-10 minutes. When the pain lasts for several minutes (around 5-10 minutes) the body is saying, “Stop doing this activity right now. You can try again later but do not do any more of this right now unless you want an injury or more inflammation and pain.” But if/when the pain does not stop for several hours (or more) then clearly there is an issue with the activity. If/when the pain lasts more than 30-45 minutes, the body is telling you that you are pushing the limits and this might be part of the reason we are struggling to get better. More importantly anything that causes your pain to increase and stay increased for more than 24 hours is a major concern and should be avoided at this point. And anything that causes your pain to last more than 72 hours is most likely an injury and will delay the recovery even longer. This applies to people in constant pain too. If your pain increases more than your baseline pain, then your body is asking you to pay attention...the alarm is sounding. When you stop the activity it is best to evaluate and see if the pain returns to the same level as when you started. If so, then it is OK to continue the activity. This means your pain increased but did not stay worse. Often people are looking for activities as the source of why they are not getting better, but more times than not, it is the inactivity that is causing the problem. Or the other common reason is they are ignoring the thing that is provoking them because they “need to do it.” Due to my many years of trying to go too far too fast, I recommend a more methodical approach now. For example, when you are trying to resume an activity that has caused you problems in the past, ( I often use the example of the marathon runner returning from an injury). The best approach is to gradually resume the offensive activity. In my marathon example I say, “marathon runners do not train by running a marathon each day, they start with a few miles and build their bodies tolerance to running with occasional changes in distance and/or speed.” The same principle can be applied to any activity you are trying to resume. Get successful at a smaller version of the activity and gradually add to it until you are able to do it fully without lasting pain. If, for example, you are trying to resume vacuuming your living room floor then you should divide the room in half and only do that one half at first. Remembering to stop if the pain increases and evaluate to see if the pain lasts. Stay at that amount until you have two consecutive successful days using this strategy. In my vacuuming example it would be ¾ of the room instead of half. At this point a lot of people would try to do the whole house because half the living room did not hurt. This is too much too soon. By methodically building on your activities you will likely arrive at your desired goal faster! I know this sounds “impractical” and may be not realistic, but the point is when you “push through your pain” to finish something, you are more likely to re-aggravate the problem and end up delaying your recovery. Sometimes “how” we do things is the issue. So when people ask me what to avoid I say, “whatever makes your pain worse...and stay worse.” On the other end of the spectrum, when you find something that helps to alleviate your pain, you should continue doing it….and do it frequently. Unfortunately a lot of people have heard or been told there are things that are “bad for you” despite the lack of real scientific evidence that it is true. For me, the body will let you know if something is bad for you by alerting you with pain. So rather than tell someone to avoid something that “could possibly be a problem” I have them focus on what alleviates their pain and when they find them, to do them more frequently. Most of my week is spent encouraging patients to find movements and positions that help them feel better and move better. Often moving better first will lead to feeling better second. I routinely say that any activity that helps you move better is helping you get better. Sometimes the pain response is slower. It is very rare for someone to achieve more mobility and not feel better. There are cases but because it is rare, I focus on the improvements and try to remind patients to do the same. I have also learned that there are two major reasons that people do not find lasting relief when they find something that helps alleviate their pain. 1. They don’t do the thing that helps OFTEN enough...so increase the frequency to 10 times per day or more. 2. They don’t do the thing that helps LONG enough....so if you find a position that alleviates your pain stay in the position for longer periods of time. When we find an activity that seems to help I often recommend performing it more frequently and gradually to a greater degree. So, when people ask me what to do...I say, “whatever helps you feel better and move better.” If you are wondering what you are doing wrong regarding your recovery from an injury or if you are dealing with a chronic issue, the solution lies in listening to the body’s clues and finding the “just right” point….not too much...not too little. If it is helping do it more and if you have lasting pain from an activity, stop doing it for now and re-test at a later date after you have gradually built up your ability to be successful. If you have specific questions please email me at This email address is being protected from spambots. You need JavaScript enabled to view it. or you can check out my updated website and send me a question or comment that way. Also you can call to speak to me at 518-306-6894. Thanks for reading!