When someone gets pain, they usually stop doing the activity that is painful. They might wait for a few days or weeks for it to get better, but sometimes it doesn’t get better with rest. So what is the next step? Most of the time, someone will go to their GP or physiotherapist. When you’re doing some of the testing movements or rehab that you’re asked to perform, there is pain present. What do you do?

If you have pain with exercising and need to avoid pain, then how will exercising reduce your pain?  You’ve heard the phrase “no pain, no gain!” - but that doesn’t sound very scientific does it? But what is the answer? Should rehab be pain-free? Or should you ignore your pain and just grin and bear it!

You’ve probably heard the phrase “no pain, no gain” from a very young age. It has been used by football coaches, bodybuilders, and other groups of people whom you should generally never take medical advice from. On the opposite end of the spectrum, physios and doctors often tell patients that it is crucial to avoid exercises that are painful, as pain is the body’s way of telling you to STOP!

However, research over the last few decades has answered this question unequivocally: Rehab does NOT always need to be pain free!  

Bone Pain

With bone pain, there are a few serious issues that we want to look out for. With an increase in activity, particularly in the lower limb, stress fractures are a risk. Stress fractures occur when we put more force through a bone than it is used to. Although bones are resilient and can adapt to training, it takes some time. Therefore, someone who has never run before, suddenly running 30km every week may get a stress fracture, or at least be at risk of this. Any prolonged bone pain in the feet, legs, or hips after a recent increase in exercise or activity should be monitored. If you begin getting bone pain while sitting or lying down, or when doing a simple daily task like walking, then you should probably get assessed as this may be a serious injury taht can turn into a complete fracture if you continue to mismanage it.

Joint Pain

Similarly to bone pain, this can be due to a recent increase in loading. Some joint pain can be attributed with older age, such as osteoarthritis. This type of pain is often worst first thing in the morning, then gets a little better with gentle movement. If your joint pain doesn’t ease with gentle exercise, then it may be more serious. In this case, the advice is to do as much as you can while staying below a 4/10 pain. Keeping a joint moving within this pain threshold is a good plan as long as pain levels don’t start to increase during your activity.

Muscle Pain

In the presence of muscle strains, movement is paramount. Although loading the muscle may be painful initially, it is important to get the muscle loaded through the available range of motion and keep blood flow going to the muscle. Although resting the muscle may seem like a good idea, this will lead to stiffness and weakening of the muscle. Similarly to joint pain, as long as you are keeping pain to a 4/10 or below, you’re likely doing the best treatment in the first few days after injury.

Tendon Pain

Tendon injuries can be some of the more stubborn injuries. They can take longer to rehab, and can significantly affect daily tasks. With tendons, we know from the research that resting the tendons will only decondition the tendon and make your function worse. Despite pain, it is important to load the tendons with a heavy resistance program to improve function. in tendon rehab, pain levels of up to 5/10 are often recommended to get the full benefits of training. Don’t be disheartened that you may go through 2-3 months of tendon rehab before you begin to feel a decrease in pain, but hopefully your physio will will improving both your strength and function in this period.

In Summary:

All in all, “No Pain, No Gain” is not always the answer! Here are some main takeaways:

• Pain during rehabilitation is okay and in many cases beneficial to your recovery.

• While small increases in pain during rehab are okay it is important that your symptoms or function is improving from week to week.

• When you are uncertain if an exercise is safe just remember 2 simple rules:

  • Your pain during and after an exercise should be tolerable

  • An increase in pain the day after you rehab is a sign that you should decrease the intensity of the exercises you are performing.

If you have any questions on whether physio is the best option for you, or you have any questions about MVMNT in general, feel free to contact via email.

- Jay Towolawi, Specialist Sports Physiotherapist and MVMNT Founder.