A 40 something fitness athlete posted on Facebook a general question about her knee hurting.  The simple question that she asked was, “Should I train on the knee since it is hurting?”

Luckily I am a friend and a physician to this young lady and responded for her to come see me quickly to help evaluate the situation.  Like most busy people, the time got away from her and she continued to train on the knee.

After a week of additional and more intense pain, she finally called me and based on the phone call I ordered an MRI.  She brought the study to me immediately and the news wasn’t good.  The MRI showed full tears in main ligaments, but more specifically some aggressive bruising on the cartilage and also the bone itself.

In this case, training on the injury wasn’t a good idea and likely complicated her original condition by nearly doubling her healing time.  This still brings up an important topic on when you can train on an injury.

Any condition that you have, which last for longer than 2 days, should be reviewed by a physician.  Any condition being treated should show some improvement in less than 2 weeks period of time.  If not, discuss treatment with your physician and ask for second opinions.

If a condition has bleeding, fever, radiating pain, nerve loss, motor loss, rash, moderate to intense swelling, a cold sensation, intense pain or pain with movement, then exercise should be avoided.

In most cases exercise can and should be continued, but with adapted movements to modify the intensity.  Simply stopping any movement can cause atrophy to the affected areas.

An example of this is common with plantar fasciitis since once an injury has occurred; most people just stop doing anything.  Exercise avoidance is likely the worst thing you can do since this often causes more destruction of the plantar tissue.

Several conditions require exercise to improve their outcome.  Any condition that has non-rheumatoid arthritis needs exercise, but this is done in a modified way.

I worked at one of the leading heart hospitals in the country. Following open heart surgery, I literally was the person helping the first patient get out of bed so they could take a few steps down the hallway and then back to bed.  This event was witnessed by a hallway of applauding physicians, nurses, physical therapist and hospital administrators.

The point was no one had ever moved a patient out of bed for several days following an aggressive surgery. It was determined that the effect of leaving the patient in bed caused more complications to the post-surgical outcome of the case.

It is better to adapt the exercise to the condition and begin slowly rather than stopping all attempts at movement.  A physical therapist or chiropractic physician is typically skilled in the art of adaptive exercise protocol.  Later adaptive techniques can be reassessed by those same professionals or passed off to personal trainers and/or coaches.

To modify the exercise, lower resistance, general intensity, reduce the range of motion, switch to a non-weight bearing movement and also slow down the speed.  Any of these alters the body’s reaction to the stress in a less destructive way.

Most health care professionals will often suggest you not exercise with an injury based on their need to prevent liability and their gross lack of understanding about exercise.  This may be helpful to them, but as indicated, can lead to more damaging results.

Common sense goes a long way here and the 10,000 years of ancestral heritage speaks volumes about when to keep going and when to stop.  In general, it is always best to ask a physician for some diagnostic testing. Once these results are known, the gloves come off and depending on the outcome of the reading, you are freer to be start continuing some exercise program.

When you become injured, it is best to not begin any new exercise program.  This can often lead to more symptoms of soreness and pain and make diagnosing any condition almost impossible.

As with any injury seek out professional help and consider the information carefully. Exercising when you have pain is necessary since you are “darned if you do and double darned if you don’t.”