Navigating pain with “the Traffic Light”

The traffic light 🚦 is an analogy that we use at Back Bay Health to help people with pain understand what is known about pain science and what that tells us about the pain experience, as well as gain a nuanced understanding of when they should modify movement/activity in the context of pain.

The traffic light analogy: Understanding when to ‘stop’ and when to ‘go’ as it relates to pain.

So if you’ve ever been frustrated by the advice that you should ‘just listen to your body’ or ‘if it hurts don’t do it’, this blog is for you. First, let’s start at the beginning…

What is pain? ⚡️

Pain is an unpleasant physical or emotional experience that is multifactorial and is associated tissue damage but is relative to threat.

Let’s break it down…

• Pain is unpleasant. - no news here.

• Pain is not just physical - heart break, grief and other classically emotional experiences can be physically painful also.

• Pain is multifactorial - Pain does not have one cause (or one solution). It is impacted by sleep, diet, lifestyle, stress, mental/emotion factors and of course physical aspects like tissue damage or injury.

• Pain is associated with tissue damage - in acute pain (pain that is less than 24 hours old) there is a high association with tissue damage. In chronic pain (pain that is over 3 months old) there is a low association with tissue damage or injury. We can get information about what tissues are involved with pain based on the location or type of pain. But the amount of pain, especially with chronic pain, is not relative to the tissue injury.

For example…

• You can have a high amount of tissue injury and low amount of pain. About a week after a broken bone when it’s casted, and you have seen a trusted provider with a plan, you have very little pain, even though it takes 10+ weeks to heal this kind of an injury.

• You can have a low amount of tissue damage like a paper cut, and they are relatively pretty painful, if salt gets in that cut - watch out.

• The amount of pain a person has, is not relative to tissue damage or injury, it’s relative to threat. Which means if a person feels more threatened (sleeping poorly, more stress, struggling mentally/emotionally, over training, under training) they will likely experience more pain.

On an individual level, not every person is going to be sensitive to all the same things, and some people are gong to be more sensitive to one thing over another. Knowing how you react as an individual is key in understanding your personal pain experience.

Enter the traffic light. 🚦

The traffic light… A guide to help make sense of your pain, and make decisions around when to stop and when to go when movement or activity is painful that is specific to you. Just like a real traffic light, green is go, yellow is caution and red light is stop. We are going to set some definitions as it relates to pain and when it’s ok to go, use caution and stop.

Before we get to that, it’s important to know that movement is incredibly important for health, even looking outside of the musculoskeletal system. Most people have some understanding that movement is healthy for bones and joints and muscles, but it is equally important for sleep, mental/emotional health, energy levels and fatigue. For this reason, we want to make sure that if we are going to discourage someone from activity due to pain, we are doing so for very good reason.

One good reason to discourage someone from activity is if we can be quite sure that the pain they experience during movement is causing severe tissue damage or injury. Luckily, for reasons we discussed above (pain being a measure of threat not of injury) mild amounts of pain have a very low correlation with this type of tissue damage.

Green Light: 🟢

Mild pain is considered green light. Very safe to move through and low risk for injury or tissue damage. So if we experience mild discomfort during activity or 24-48 hours after the activity: it’s safe to continue. The important take home is that it is safe to move through low levels of pain. Getting back to movement sooner than later when pain is low is extremely beneficial, and waiting too long has down sides. We don’t want to wait for pain to be gone to move.

Yellow Light: 🟡

Moderate pain during activity or 24-48 hours after activity is considered yellow light. If we see a yellow light while we are driving we use caution, it’s not an automatic stop or go. As it relates to movement, when we experience yellow light, we modify the yellow light activity. Like we mentioned, we know how beneficial movement is and that stopping or eliminating movement entirely has downsides, so modifying is the way to mitigate symptoms without shutting down activity.

For example if I run 3 miles and it feels fine and the next day I experience moderate pain - this is a yellow light. This does not mean that I can’t run at all. It means I should take a look back at the running I did to see what I can change or modify. First, did I sleep poorly the night before the run? Did I not get enough calories to fuel the exercise? Was I particularly stressed or not in a good headspace? If the answers to any of these were yes, then I’d start there and try the 3 miles again. If the answer was no, then I’d look to modify the run somehow. Some options are: to try running 2 miles instead of 3. Accumulate 3 total miles via walk run intervals. Run at a slower pace. Run on a flat surface if my other run was hilly. These are just some options.

Red Light: 🔴

Severe pain during activity or 24-48 hours after the activity is considered Red light. With a red light, there’s less negotiation. Risk for tissue injury does increase, but it still does not necessarily mean that unequivocally there is tissue injury. But the downside becomes more significant. Severe pain related to injury or damage it can have a worse prognosis or take longer to recovery from. Severe pain without tissue damage or injury, means your system is becoming over reactive and in a hyper-threatened state. This also has a worse prognosis and can take longer to recovery from.

The traffic light analogy: a guide to pain and movement.

If you have questions about your pain or injury, or making use of the traffic light, we can help! Click this link to book a free discovery call now. We are excited to help you get back to a pain free active lifestyle!