Soreness: How Much Is Too Much?
As physical therapists, soreness is probably the one complaint we get more than any other. After all, we are often times dealing with pain, right? Anytime we push our bodies to new limits, we will experience the phenomenon. A knowledgeable and caring physical therapist should respect your objections to pain and progress or regress your program appropriately. However, distinguishing between good and bad soreness is an important skill that every therapist should walk through and educate with patients. Determining if your soreness is at an acceptable level is extremely important for expectations, keeping a positive mindset, and avoiding risk for injury. The aim of this blog is to give you, the patient, insight into progressing, regressing or continuing your rehabilitation or workout program when you are sore.
The University of Delaware Physical Therapy Clinic published the Knee Soreness Rules. (1) This guideline applies specifically to rehabilitating the injured or post operative knee. But using clinical thinking and expertise, we can reasonably apply it to many other orthopedic injuries including many forms of tendonitis and impingement.
Soreness that goes away after warm up.
If a patient returns from their home exercise program citing soreness, after ruling in and out red flags, a therapist should ease you into a warm-up. If your soreness goes away during a warm-up, then you are at an appropriate intensity. It would be advised to continue at the level of intensity that made you sore, without progressing too much, in order to maximize your positive progress and continue without fear of further injury.
Soreness with inflammation or mobility deficits.
Next, soreness that is accompanied by increasing pain, inflammation, or range of motion deficits are an indication of an overaggressive approach. Swelling doesn’t necessarily mean to take a day off, so the therapist should use good clinical judgement in incorporating rest days or decreasing the intensity of a program.
Soreness that does not go away after warm up.
If you experience soreness during a warm-up that does not go away, or goes away and then redevelops during the session, taking a day or two off and even regressing the intensity or volume of your program is within reason.
No soreness.
Finally, if you experience no soreness, your health care provider or trainer may advance your programming. While soreness isn’t the goal or intention of rehab, it is one of many signs that helps us guide your intensity level.
Of course, these are not steadfast rules, but excellent guidelines. Regressing then progressing programs is often a part of the rehabilitation process and is vital to achieving pain-free performance. If you are frustrated with physical therapists either considering pain too much or too little, consider a free phone consultation with The PATH Rehab & Performance. We value your input regarding pain and soreness. We will push when you need to be pushed. We will rest when you need to rest. We are who you need us to be.
Reference:
Manal TJ. The Knee: Physical Therapy Patient Management Using Current Evidence. In: Current Concepts of Orthopedic Physical Therapy. La Crosse, WI, WI: Orthopaedic Section, APTA; 2006:29-29.
Cody Benavides
PT, DPT, TPIc
Co-owner | The PATH Rehab & Performance
