Good pain vs. bad pain: How to tell the difference

Before rushing into an exercise routine following an extended layoff, it’s important to make sure your body is up to it. For example, yoga can help strengthen your core muscles to reduce the likelihood of injury when returning to, say, golf. (Stock photo)

By Jay Morange, jmorange@stph.org

When you’re hurting, it can seem like pain is pain is pain. But in actuality, not all discomfort is created equally.

There’s good pain and then there’s bad pain. Or, to put a finer point on it, there’s soreness and then there’s real pain.

The kind of soreness you get after a rigorous workout – clinically referred to as “delayed onset muscle soreness,” or DOMS – is generally “good” pain, not only because it’s a perfectly normal part of exercising but also because it indicates muscle growth.

Yes, it hurts, but – with a nod to John Cougar Mellencamp – it hurts so good.

Typically lasting for 24 to 72 hours after physical activity, DOMS is the result of micro-tearing occurring in muscles. These micro-tears stimulate new muscle growth. The body will adjust by adding new neural growth as well to help those muscles “fire,” or contract.

You can expect to feel the results after a particularly rigorous workout or – as is the case with many of us – when you return to your regular workout after months of binging equally on Netflix and junk food during your COVID-19 confinement.

Blame Wolff’s Law, which states that if you don’t use something, you lose it. That includes muscle.

After extended periods of disuse, your body realizes it doesn’t need so much muscle mass and so it slowly reabsorbs these cells to use as energy elsewhere.

That’s why it’s important to ease back into an exercise routine after an extended period of inactivity. Rushing things can set you up for “bad” pain, which can indicate an injury.

Imagine, for example, that you’ve decided to return to real, live golf after months of making do at home with a video-game version. You step up to the first tee box and swing like you’re competing in the U.S. Open.

Your body is nowhere ready to perform this activity. The body mechanics that go into a golf swing are advanced, given that they involve multiple planes of movement and torque throughout the body, particularly at the spine and knees.

If you are lacking tone in your core and stabilization muscles in your back and knees, this puts you at a high risk for injury.

You may get away with it for one hole, 18 holes or none at all. But, if you don’t prepare yourself for this activity, you’re asking for injury.

So how can you tell the difference between soreness and injury, or good pain and bad pain?

Soreness will generally go away after a short period of time and typically is felt only when the movement is reproduced. Pain will be persistent, especially with mechanical injury.

You should seek medical attention from a doctor or physical therapist if:

• Your pain lasts more than 72 hours.
• You feel pain at night.
• You feel pain even when at rest.
• The pain is reproducible with a certain motion.
• You are unsure if it is pain or merely soreness.

The good news is that, generally, all it takes to avoid such an injury is patience.

Because golf requires a solid core, before returning to the game you should prepare for a week or two with exercises to re-strengthen your core muscles, such as your abs, oblique and back. If you need extra help, physical therapists are a great option, whether you visit them in person or via a video visit.

YouTube also has plenty of free videos that can help. Taking classes at a local yoga studio is also an effective way to work on your core.

These steps may seem tedious, and they will take time, but this will better prepare you for a return to activity and keep you from feeling “bad” pain – not counting the kind you feel when you review your scorecard.

For that, you’re on your own.

Jay Morange is the manager of inpatient physical therapy at St. Tammany Health System.