This post was inspired by a conversation I had with a reader in our SI Joint Saga Discussion group.
This reader asked for my thoughts on her new exercise plan from a physical therapist. She had SI joint issues as well as sciatica, which sent pain down into her hamstrings (the muscles in the back of the thigh).
She had been told by her doctors that, because she’d been injured and in pain for so long, she’d lost a significant amount of strength. They urged her to take painkillers and try to push through the pain, because if she didn’t get stronger, she wasn’t going to get better. She wanted to know my thoughts, and here’s what I said.
First of all, I never want to disagree with a doctor or a PT who’s evaluated a patient in person. I can only offer suggestions based on my own experience (and please, of course, run everything I say by your own doctor!).
However, what I told this reader is that I think there’s a difference between taking painkillers to try to cover up muscle pain, or pain coming from one of your SI joints/ligaments.
In my experience, muscle pain, although it can be incredibly uncomfortable at times, is ok to use painkillers for. This is, assuming a doctor has evaluated you and deemed that it isn’t something more serious. (For example, when I was running track in high school, thought I had muscle pain, but it turned out to be compartment syndrome).
In fact, painkillers such as Advil or some of the stronger prescription painkillers can really help in situations of chronic pain, because a lot of your pain is likely to be coming from muscle spasm, when they body is sort of freaking out and causing the muscle to be firing and remaining tight.
Painkillers can actually help to break this cycle, because they interrupt the chemical signals that keep the spasm going. So when you exercise, you’re actually able to get increased blood flow which helps to flush the byproducts of inflammation out.
However, it’s very different to take painkillers when you’re trying to cover up pain from a joint.
In my experience, Advil and Tylenol never really worked to cover up pain from the SI joints, so you’d probably be talking about prescription painkillers/opiates.
I am not against these drugs. I think they have a time and a place. They have helped me at multiple times throughout my life, and I did not become addicted.
When it comes to the SI joint, or lumbar spine issues, I believe you need pain to tell you what is too much for your body. With the SI joint in particular, you’re counting on pain to let you know what’s putting stress on your ligaments, and what is not.
A big part of recovery, for me, was keeping careful track of what actually was putting too much force on my SI joints, and learning to change the way I did things, or modify certain exercises.
The key to healing the SI joints is to find ways to strengthen your muscles while also allowing the ligaments to heal as much as they can.
If you’re constantly pushing through exercises that significantly increase your pain, that’s a pretty good sign that your ligaments can’t handle what you’re doing. Although you may not make your injury permanently worse (it’s possible, but it would take a lot to do that), it’s more likely that you would prolong your healing time by not giving the ligaments a chance to heal.
However… strengthening is the other, equally important piece.
You can’t heal the SI joints without strengthening, because you need muscle strength to hold the joints in alignment, especially after the ligaments have been sprained. So you’ve got to start strengthening at some point.
In this reader’s case, it sounded as though, despite her trying to rest her joints for months, the pain had only gotten worse, and was now around the clock, 24 hours a day.
In my experience, pain like that has become chronic. The nervous system is always firing, sending those pain signals, regardless of the exact activity you’re performing at the moment.
Once that happens, pain is far less useful as a guide of when and when not to exercise. Because it’s going to tell you not to do anything at all. Everything is going to hurt, even lying still in bed.
I’ve been in that place many times in my life, particularly in my early 20’s, before I developed SI joint dysfunction. (In fact, SI joint dysfunction was never actually as painful as the battle I fought with central sensitization before that).
And what I always found, every time, was that at some point, I needed to start moving. I couldn’t do it alone, of course– it’s really terrifying when your body is telling you that everything is a bad idea. When that happened, I would need a good coach (in the form of a PT) to really tell me where to start– what was okay for me to do, and what wasn’t.
It sucks when pain stops being a good guide, and tells you everything is dangerous. Pain, of course, isn’t trying to hurt you. It’s actually your body’s way of trying to protect you. The problem is that, sometimes it goes overboard, and the results can be counterproductive.
So… when pain becomes chronic, it is okay to try to push through it.
As long as you’re working with a good PT and have been cleared to exercise, at some point you’re going to have to start ignoring the pain. At least to an extent.
I’m not, of course, telling you to go out and run a marathon. I’m still not saying to do anything that dramatically increases your pain. I’m just saying that, if you’re at the point where your nervous system is telling you to do nothing, you’re going to have to do something.
That’s the only way out of this cycle– trust me, I’ve been through it myself.
The best place to start is with the core.
Particularly with a muscle called the transverse abdominis. This is such a key muscle to stabilizing the SI joints, and when you first start learning how to strengthen it, it should be super gentle.
Here’s a video that shows what it should look like when a PT teaches you to activate this muscle. As you can see, it’s super gentle, and shouldn’t increase any pain to your SI joints:
For more on core strengthing, you can check out my posts:
- The most important place to start strengthening: the core & transverse abdominis
- Start building core strength with exercises that are gentle on the SI joints and lower back
- The muscles of the core (and why we focus on the transverse abdominis!).
There are other exercises I recommend (which will be the subject of my upcoming e-book!). However, learning to activate the transverse abdominis really is the most important, because once you’re able to contract it, it supports you during all of your other exercises.
Okay… that’s all I have to say for now!