The Wrong Question to Ask

The number one question I get from patients who love to train is some version of this: “Can I still work out while I’m hurt?”

It makes sense that this is the first thing people ask. You’ve built a routine. You have goals. You do not want to lose momentum. And honestly, the fear of quitting and never coming back is real.

But that question, “can I work out?”, is the wrong one. It’s too binary. The better question is: what is this pain telling me, and what does it mean for today’s session?

That reframe is what led me to start using the Traffic Light System with my patients at Central Ohio Spine and Joint. It is the single most useful framework I have found for helping people make smarter decisions about training with pain, and it works because it honors what the research actually says about movement and healing, rather than defaulting to the outdated idea that pain always means stop.

The Traffic Light System: How It Works

The Traffic Light System is a pain-guided training framework. It gives you a real-time way to decide whether to push, modify, or back off based on what your body is actually communicating, not just on whether something hurts at all.

[IMAGE PLACEHOLDER: COSJ Traffic Light Graphic: Green / Yellow / Red zones. Insert the COSJ traffic light image here. Source: your existing brand asset.]

Green Light: Go

Pain level: 0 to 3 out of 10. Pain that does not increase during or after the exercise. No neurological symptoms: no numbness, tingling, or weakness radiating into an arm or leg. Pain that feels like mild muscle soreness or a dull background ache, not sharp or electrical.

Green means you can train. You may want to modify load or range of motion slightly, but you do not need to stop. In fact, stopping when you are in the green zone often makes things worse over time. The research on most musculoskeletal conditions: including disc herniations, tendinopathy, and non-specific low back pain, consistently shows that controlled movement speeds recovery. Rest is not the default answer.

Yellow Light: Proceed With Caution

Pain level: 4 to 6 out of 10. Pain that is noticeable but not alarming. Pain that starts at a manageable level and stays there. It does not climb during the set. Pain that goes away relatively quickly when you rest between sets.

Yellow means: train smarter, not harder. Drop the weight. Reduce the range of motion. Swap the exercise for something that loads the same pattern with less stress. The goal in the yellow zone is to stay active while keeping the tissue from being pushed beyond what it can currently tolerate.

The key rule in the yellow zone: if your pain climbs past a 6 during the exercise, or if it does not return to your starting baseline within a few minutes of rest, you have moved into red. Stop the movement and reassess.

Red Light: Stop

Pain level: 7 out of 10 or higher. Or any of the following, regardless of pain level:

• Sharp, electrical, or shooting pain during the movement
• Neurological symptoms: numbness, tingling, or weakness into a limb
• Pain that continues to climb throughout the exercise with no plateau
• Pain that is still significantly worse 24 hours after the session
• A new injury where you heard or felt something go wrong

Red means stop. Not forever, but for that movement, on that day. A red light is your body asking you to pay attention, not punish yourself further by pushing through it.

Why Complete Rest Is Usually the Wrong Call

Here is what I see in practice: patients come in convinced that complete rest is the safest choice. They stop training entirely. They walk less. They avoid stairs. They do everything possible to “protect” the injury. And in most cases, they feel worse within two weeks.

This is not a coincidence. The research on recovery from musculoskeletal injury consistently shows that graded exposure: controlled loading that stays within pain tolerance. This approach outperforms rest for long-term outcomes. Rest is appropriate in very specific scenarios: acute severe injuries, red-flag conditions, and the first 24 to 72 hours of a significant tissue tear. It is not appropriate as a default strategy for back pain, knee pain, tendinopathy, or most of the conditions I see week in and week out.

The Traffic Light System exists to help you stay in the green and yellow zones instead of defaulting to stop. Movement is medicine. The dosage just has to match where your body is right now.

The 24-Hour Rule

Here is the single most useful self-check for any training session with pain: how do you feel 24 hours later?

If you wake up the next morning and your pain is at or below where it was before your session, you made good decisions. The load was appropriate. Keep going.

If you wake up the next morning and your pain is meaningfully worse than before your session, the load was too much. That is not a reason to stop training. That is information. Scale back, modify the exercise selection, and try again.

Pain that increases for a day and then returns to baseline is usually tolerable. Pain that climbs over multiple sessions without recovering is a signal to come see us.

How We Apply This at COSJ

The Traffic Light System is not just something I tell patients to use on their own. It is built into how we structure care at Central Ohio Spine and Joint. When a patient comes in with a training-related injury or pain that is interfering with their fitness routine, our goal is to get them back to the gym with clarity, not to keep them out of it.

Repair

The first thing we do is reduce the tissue-level problem that is driving the pain. That might mean chiropractic adjustments, dry needling, shockwave therapy, or soft tissue work depending on the structure involved. The goal of the Repair phase is to lower the threshold: moving a patient from red or yellow into yellow or green so they can start loading again safely.

Retrain

Once pain is manageable, we address the movement patterns and muscle activation that contributed to the problem in the first place. Most training-related pain follows a pattern: over-reliance on certain muscles, insufficient activation in others, or technique issues under load. Retraining fixes that pattern before adding load back.

Reinforce

This is the phase where training returns to full intensity. We use our in-house Tonal and gym equipment to build durable strength in the repaired tissue and around the joints involved. The Reinforce phase is what separates patients who get better for three months from patients who get better and stay that way.

Still Not Sure Where You Land?

If you are trying to figure out whether your pain is a green, yellow, or red, and you are not sure, that uncertainty is worth a conversation. Come in. We will assess what is happening, give you a clear answer about what your pain means, and build a plan that keeps you in the gym while the problem gets fixed.

You do not have to choose between training and getting better. Most of the time, you can do both.

 

In your corner,
Dr. Blake Richard, DC
Central Ohio Spine and Joint | Westerville, OH
cospineandjoint.com/schedule-appointment