1. Is it safe for me to exercise?
This is probably the first question you need to ask your Physio or Doctor. There are very few incidences when complete rest is recommended or that exercise is not advised for helping in the recovery of musculoskeletal or nerve related pain. In fact, exercise is often a vital part in recovery in conditions such as osteoarthritis, sciatica, painful tendons and ligament injuries to name but a few. In the event where you can't exercise you can still train around the injury. This keeps the other tissues fit and healthy and you will have a far better result in the long term.
2. Just because you are hurting does not mean you are harming the area.
For most individuals whose pain has become more persistant, their symptoms are more an indication of how angry or sensitive the system is rather than an indication of doing in further damage. Pain is your alarm system and with acute pain it stops us from doing more damage. However in persistent pain the alarm won't switch off and often is disproportionate to the problem. I often liken it to a child having a tantrum or the volume turned up to 11, ( spinal tap anyone ?). In the words of David Butler and Louis Gifford, " hurt does not equal harm".
So how hard should I exercise ?
Here are a couple of rules that often work for me. In the early days I like to find movements that are relatively comfortable to do but are related or specific to the problem. When freshly injured, I prefer to work within limits that don't provoke the injury. There is no point poking the bear with a stick in the early days as we want to build confidence with movement and good habits.
I also like to incorporate general exercises that are not targeting the affected area and whole body aerobic work to keep the rest of the body fit and healthy. The healthier you are the better your recovery.
You will have flare ups along the way, its inevitable. However think of a flare up as a learning process — you now know what is “too much” for you. Sometimes flare ups are a result of pushing too far, which I see as a good thing as it demonstrates confidence in your ability. I'd much rather that scenario than somebody that is fearful of movement.
3. Sometimes you need to "Rattle the snake".
When the pain settles down and becomes easier to predict then its time to challenge it and give it a nudge. Remember that flare ups are more a reflection of the sensitivity of the tissue rather than an indication of the physical state of the tissue. This is especially true of more long term aches and pains rather than the acute pain associated with a traumatic injury e.g an ankle sprain.
Giving the pain a "nudge" is sometimes a useful way to help desensitize the condition. I often tell those with nerve pain that they will flare up again on their way back to full fitness and often they come out of the flare up alot better than when they went into it.
So how much pain is acceptable from a flare up? This is very individual but its like goldilocks and the three bears, not too little, not too much its about getting it just right. I try to work on the premise that the pain should settle within a couple of hours and should not really get to more than 5-6 out of 10.
4. What exercise should I do ?
That all depends on what your problem is and what is required to get you back to full fitness. This may involve having better movement, improving strength or control, a better aerobic fitness or a combination of all of these factors. So it is important to make a plan with your physio that will help you achieve your desired outcome. Whatever it is be consistent and remember ,
What doesn't challenge you doesn't change you!