Since 2020 Dr. Shireesh has been an Adjunct Associate Professor of the Primary Spine Practitioner program at the University of Pittsburgh’s Physical Therapy department. Primary Spine Practitioners (PSP) provide first-line management for patients with spine-related disorders as well as serving as an inter-professional care coordinator. Dr. Shireesh’s involvement in this cutting-edge educational program has allowed him to collaborate with some of the foremost practitioners, educators and researchers in pain science.

True to Equilibrium’s commitment to evidence-based practice, our providers bring the most current relevant data into practical use in the clinic. The most recent pain science data indicates that pain is often not an indicator of tissue damage. That is not to say that your pain is not real, but there’s more to the story.

Pain is your body’s alarm system. And like most alarm systems, it is not 100% accurate.

For example, think of how often you hear a car alarm go off when there is nothing harmful or dangerous happening. Maybe someone is breaking into your car, but maybe a pedestrian accidentally bumped it, or the alarm button on your remote was pressed on accident.

So, hurt does not equal harm. It’s okay (and actually pretty normal) to experience pain with activity. How your body responds to that pain dictates whether or not you should continue.

How do you know if an activity is safe or not if you can’t always rely on those pain signals?

Sticking with the car alarm analogy, when you hear your car alarm you use other indicators to determine if the situation is serious or not. Those indicators might be whether or not there is someone loitering by your car, or if you are sitting on your keys. The alarm does not provide all the necessary information. The same basic principle goes for our pain ‘alarm’. There are some additional factors to check in order to know how to proceed.

Step 1: Write down your baseline pain level on a scale from 0-10) pre-activity. Also, perform a few movements to “self-check” your painful body part. For example, if you are dealing with back pain, perform a self-check by bending backward and bending forward and note any stiffness or pain during these motions.

Step 2: Perform the desired exercise/activity and write down the highest pain level experienced during action. Perform the same self-check and note any changes.

Step 3: If pain increased during activity, monitor how long it takes to return back to your baseline level.

Step 4: Perform self-check ~every 8-12 hours for 24 hours.

The results of this routine will tell you whether this activity is a “red light", “yellow light,” or “green light” activity for you right now.

Green Light: You experience an increase in pain during activity but following activity the pain quickly comes back to baseline levels. You can do this activity as much as you’d like!

Yellow Light: You experience an increase in pain during activity and afterwards it takes a little while for your pain level to come back to baseline. This activity is not dangerous, but you should proceed with caution.

Red Light: You experience an increase in pain during the activity and your pain levels take a long time to come back to baseline following activity. There may be a lingering effect on your “self-check” movements as well. If your body has this response, you should stop doing this activity for the time being, and get assessed by a medical professional.

Here is just one example of what this might look like:

Maria has a history of chronic low back pain. Due to the pain, she avoids most exercise.

Step 1: At rest, Maria rates her pain 5/10. She feels increased pain when she bends backward and when she bends forward.

Step 2: On the advice of her chiropractor, Maria goes on a short walk. Her pain increases to an 8/10 during the walk.

Step 3: Her pain stays increased after the exercise and her self-check reveals that she still has the same range of motion but slightly increased pain during motion.

Step 4: Maria’s pain slowly returns to baseline after about 36 hours. During this time, none of her self-checks reveal a decrease in range of motion.

We would call this a “yellow light” activity response. Maria needs to proceed with caution. While 36 hours may seem like a lot, with a history of chronic pain Maria’s ‘alarm system’ is very sensitive. While her pain was increased, her self-checks did not show a change in range of motion. As Maria continues to become more active, her pain response will likely decrease as her body becomes accustomed to it.

If Maria experienced a quick decrease in her pain back to baseline (within one to several hours) she could continue walking freely, as much as she likes (green light). If Maria’s pain level remained at an 8/10 for 48 hours or longer, she should discontinue walking exercise and check back in with her chiropractor or medical provider (red light).

Regular movement is very important for overall health! Ceasing movement activities can often worsen conditions or lead to more pain. However, not all circumstances easily fall into these three categories. So if you have any questions, please ask our providers!

To hear Dr. Shireesh speak about this analogy, click here.

For more a more in-depth look at the science mentioned in this post, we recommend reading A World of Hurt by Annie O'Connor and Melissa Kolski.