flare down: how to manage a pain flare-up
If you’re in pain right now, this is for you.
If you’ve been dealing with chronic pain for years, this is even MORE for you.
If you’ve experienced flare-ups in the past, or are going through a flare-up of pain right now, this is even EVEN MORE for you.
Let’s get the big thing out of the way here: flare-ups FUCKING SUCK. They hurt. They’re dispiriting, frustrating, disempowering, and they can make you feel like anything you’ve done up to that point from a rehab standpoint, and any progress you’ve made, has been for nothing.
Let’s get the second big thing out of the way here: no one’s pain experience is the same, and both the way that your flare-up manifests, and the way that you work through your flare-up, may look different than other people’s. There’s no one-size-fits-all way to deal with a flare-up. BUT… there are principles and strategies we can use to give you the best chance of staying calm, getting things under control as quickly as possible, and reduce the risk of a flare-up happening again moving forward.
Here’s an acronym I created that details my 5-step process for getting through a flare-up: FLARE
Feel the feels
Look back at what happened during the flare-up for clues (zoom out)
Audit program
Regress painful movements as needed, but stay active as much as possible!
Ease back into provocative movements within tolerance
Let’s dive into what each of these steps entails, and what they look like in practice!
Feel the feels
You will experience a lot of emotions in the event of a flare-up. Frustration. Anger. Despair. Sadness. This is normal. Give yourself permission to feel these things for a short period of time. But then, let them settle and move on. The key here is not to let your mind spiral out of control, into catastrophization or rumination land. Beyond being a natural human response, these emotions will do more harm than good if they are allowed to run rampant, unchecked, because they will not be a productive piece of you getting OUT of the flare-up. This leads us to step 2.
Look back at what happened around the flare-up for clues. Or, as I always tell my clients, Zoom Out!!!
Context is everything. Like a detective, we want to look back at the timeline and factors surrounding the flare-up and investigate for clues. Was there a change in your activity level (a spike in movement, etc). Did stress increase, or sleep quantity/quality take a nosedive? Did you change a significant piece of your routine? We want to try and correlate the flare-up with potential precursors or triggers. Correlation doesn’t necessarily equal causation, but the more we can establish a relationship between these potential factors/ precursors and the pain, the better we can modify the plan to calm things down, and create an even better plan to cautiously and intentionally scale back to these things down the road.
Audit your program
This is a continuation of step 2—as we zoom out, we want to take a close look at your exercise program itself to find clues at both the micro and macro level. Was a new exercise recently introduced that could account for the spike in pain? Or had there been a larger accumulation of stress with insufficient recovery across the preceding weeks (e.g. you’re on week 5 or 6 of a challenging block, and have noticed a dip in your recovery and energy while relentlessly pushing hard in the gym)? There are lots of things to consider here, but once again we want to find patterns or precursors that could account for the flare-up, and cross-examine them with what we know about your history, previous aggravating activities/factors, etc. If what we find seems like a relevant piece of the flare, we can take appropriate steps to modify the training program, which leads us straight into step 4.
Regress painful movements as needed, but stay active as much as possible!
This one is pretty self-explanatory, but once we’ve identified any aggravating movement(s), we want to regress them to a more tolerable variation (for the short term). The goal is to calm pain and the whole nervous system down by not consistently poking the bear, while still training the movement pattern(s) in question in some capacity. Outside of that, we want to keep moving as much as possible! For example, if your knee is hurting and back squats are provocative, maybe we regress to a leg press or wall sit while continuing to walk, train upper body, and spend some extra time on surrounding knee tissues that need more mobility/capacity.
Ease back into provocative movements within tolerance!
As symptoms and sensitivity die down, the final step is to start scaling the ladder back to those previously aggravating movements. The timeline can vary tremendously here, and will be influenced by a lot of factors, but laying out a roadmap of what’s tolerable right now, and what the sequence of movements/checkpoints will be to get back to aggravating movements, can be helpful to stay grounded and provide light at the end of the tunnel. It won’t be easy, but it will be so worth it, and with consistency and guidance from a trusted provider, you’ll get there!
To reiterate: navigating a flare-up (and pain in general) will look different for everyone! You should always consult with your provider if you’re experiencing a flare-up, and rule out red flags in the event of a sudden change in your pain presentation. This is not intended to be medical advice; it is merely a framework that I have used myself and with clients, and should not take the place of guidance from your individual provider.
