Should I load or protect a painful area?

Not everyone can or should push into pain right away, whereas others need to stop avoiding painful activities. The following factors listed determine if you should be loading or protecting this chronic pain during your daily life:

• Time since onset of pain: In acute and sub-acute situations, pain serves a protective purpose to restrict the ability to make the injury worse. For example, you wouldn’t run on a sprained/broken ankle. However, if the pain has been there chronically for example 3 years, it is recommended to use the area to reduce stiffness and increase movement once again even if there is pain.
• Pain presentation: For a mechanical pain presentation avoiding painful activities makes sense if it is only key specific things at the end range of movement. However, if all movements are painful, it is impossible to avoid it and therefore you must not be worried about moving the painful area within your daily life.
• Presence of psychosocial factors and avoidance behaviours: Within patients that don’t seem to have any factors such as fear avoidance keeping them from moving, keeping them in pain free movement is accepted. However, if a patient shows a huge guarded approach to activity, it is best to slowly be exposed to more movement patterns on a gradual increasing basis.
• Goals of the client: Some goals may require pushing into some chronic pain such as building endurance to perform daily activities. In contrast, goals can be achieved without entering pain thresholds such as educating in keeping a neutral spine during lifts. Therefore, it is important to determine the goals prior to making a decision.