Steven Nakano, MSPT, physical therapist
Q: How active should I be after an injury?
Pain that comes on suddenly and limits your activity should be looked at by your health care provider. With minor injuries, however, many of us like to take a wait-and-see approach. After trying rice (rest, ice, compression, elevation) for sprains and strains, however, the next step may be unclear. Should you keep resting, or just act normally and ignore the pain? The answer lies somewhere in between — we call it “active rest.” Get your body moving as soon as it’s comfortable — that may mean putting up with a little discomfort, but no more than a 3 on a pain scale of 1-10. With active rest, the goal is to find the right amount of activity that your body will tolerate as it heals, so your activity level can progress along with your healing. If you can’t find a comfortable level of activity when using the injured joint or muscle, choose activities that don’t involve that area. If it hurts your ankle to stand, for example, then sit and use hand weights. If your hand hurts, walk more. 
Q: I’m afraid to be more active because I’m afraid it will cause more pain. How can I get past that?
Understanding how pain works can help. When your brain perceives a physical threat (an injury to your knee, for example), it sends you a message — pain — to stop you from doing anything that might cause further damage. As you’ve seen, it works — the pain stops you from doing any more of that activity. Unfortunately, your fear of receiving more pain messages is often enough to stop you from activities that might actually help your knee. To get past that, you can send messages back to your brain to lower the perceived threat level. One way is to exercise at a level that keeps pain low and tolerable. Another way is to reduce your overall stress level. Massage, topical rubs, meditation — essentially, anything that feels good and doesn’t significantly increase the threat to your injury can influence your brain to back away from the pain trigger. Some of the tips for chronic pain on pages 1-2 also may help.
Q: what if the joint starts to feel uncomfortable?
As you progressively increase your activity, you may run into physical limitations such as joint tightness, tingling or weakness. Fear of doing damage or of doing the “wrong thing” may also stop your progress. You can stretch, massage and exercise your way through some of these barriers. If pain increases, slow down and take it easy for a bit, but then get right back at it. If something is stopping you from moving forward, then it may be time to get some help. A physical therapist can help you safely move past the barriers and get back into game form. Steven Nakano, MSPT, sees patients at our Beaverton and east locations and is the Portland clinic’s director of rehabilitation services.
