The Pain Guide After A Back Injury

In order to know if you are going in the right direction or not, you need to follow some guidelines. These were created from a combination of personal experience, patient experience and science.  The 48 hour test will tell you if the exercise was correct for your condition or not. Also ‘The Right Stage Rule’, which complements the 48-hour test, tells you what type of exercises to do based on where you are in the recovery process. And finally we go over the valuable ‘Traffic Light Guide’ for pain and discomfort. 

When commencing exercises, the 48-hour response will show how your system responded and the type of pain.  The pain I’m talking about is the ‘injury pain’ or ‘site of original injury or aggravation’  – not muscle soreness. 

If your injury site pain is worse then you are absolutely doing the wrong exercises or the right exercise with the wrong load.  If you have general muscle soreness then I think you are probably ok with the exercise. 

Likewise If your pain is no better after 48 hours and you are not worse  then it’s possible you are doing the wrong exercises.  Well targeted and dosed exercises should give you less ‘injury pain’ – although you may have muscle soreness. 

This is why I value the 48 hour test because if you’ve actually aggravated it or made it better – then you’ll know within 48 hours. 

Rehabilitation phases are time frames that consider general healing constraints and serve to plan the rehabilitative interventions.  

However, it is important to recognize that there is no absolute transition from one rehabilitation phase to the next. In fact, the phases may overlap.

Where you are in the healing process really dictates the type and intensity of the exercises. As mentioned before, timing is everything in rehab after an injury.  

In the first 7 – 15 days the goal is protection and to not disrupt the healing process. So in this stage it is more about calming the system, and depending on your situation , maybe a few gentle stretches. Walking is also very important. 

During the next 15-20 days you progress to more motion, initiate strengthening and still maintain a certain level of protection. 

Then around the 30 day mark, you should have full range of motion and minimal sensitivity thus your system is ready for more intense strength and functional training. 

Performing exercises that do not coincide with your approximate healing time frames or level of tissue sensitivity could lead to less than optimal results. 

Here is my traffic stop pain guide when doing exercises or activity after a low back injury. 

Red light. Lets give an example for stretching the low back. When performing the stretch and the pain is either present or starts and then worsens, then you need to stop and adjust or it’s the wrong exercise.

Yellow light. Continuing with low back stretches, let’s say we stretch in the opposite direction this time. It will feel different as you proceed. Pain is produced each time you perform the stretch, but the pain doesn’t get worse. In that case you would continue but not push the amount of stretch.

Green light. It’s very possible the new stretch initially is painful but then as you do more, the pain actually goes down with each repetition. We call this ‘directional preference’. 

If the pain increases by One Level then you need to immediately change postures, motions or loads until the pain returns to baseline.

Everyone will be different during this process, some will advance faster, some slower; our program follows this timeline for a low back injury with exercises and activities that allow for graded movement and loading.

Healing times and exercise interventions vary with injury type and severity. These are just general guidelines and should not be applied to all situations

PDF guide is included with the Better Built Exercise Programs.