“No pain, no gain!”  The most common adage uttered in every physical therapy practice across the country…usually from patients who aren’t really getting better.  

“If it hurts, don’t do it.” The second most common adage uttered in every physical therapy practice across the country…this one usually comes from the therapist.

So which is it?  Should you push through pain, or avoid the activity if it’s painful?  Like any good politician, my answer is “it depends”. Really, the question should be reframed:

Is it worth it in the long run for me to ignore my symptoms?  

THAT answer depends on what you are doing – if you are being chased by a pack of wolves…temporary increases in pain probably outweighs being mauled.  If you are trying to run through a stress fracture in your femur…then pain isn’t so good.

As therapists, we often further delineate pain into good, normal pain with exercise, such as the burning sensation felt in muscles while running up a hill, or the muscle soreness experienced the day after a solid weightlifting session.  Those types of pain exemplify the adage “no pain, no gain”. Yet, most of the patients who come to therapy aren’t being driven through the doors due to general muscle aching.

So when is it OK to push through pain, and when is it not?  If you are struggling with this question, you should follow up with a local physical therapist.  They will be the best resource to guide you on whether to push through pain or back off. Generally speaking, though, the three rules below can be followed when you are exercising:

  1. When dealing with bone-related injuries, such as stress fractures or fractures, it is not recommended to push beyond any pain other than muscle soreness (pain levels 0 or 1)
  2. When dealing with a muscle injury, such as a muscle strain or partial tear, it is usually not recommended to push beyond minimal soreness during any exercise (pain levels of 3 or less)
  3. When dealing with a tendon injury, such as Achilles tendinopathy, it is OK to push through a little more pain (pain levels of 5 or less)

To further complicate matters, it’s common to feel perfectly fine while performing an activity, but start to experience soreness the next day.  In this scenario, using pre-established “soreness guidelines” can help you determine whether you are OK to push through symptoms or when to back off.  Check these out from a recent article by Capin and Schneider-Macklin1:

Soreness during warm-up that continues take 2 days off, then back off the activity

Soreness during warm-up that goes away – Stay at level that led to soreness

Soreness during warm-up that goes away but redevelops during session 2 days off, then back off the activity

Soreness the day after lifting (not muscle soreness) 1 day off, do not advance program to the next level

No soreness – OK to advance activities as instructed by healthcare professional

These “soreness” rules are not ubiquitous to all injuries and all situations, but I do feel they give some general guidelines as to whether to push, rest, or back off an activity.  As always, it is best to be evaluated by your local healthcare practitioner.

So in closing, I would like to recommend we rephrase our favorite two adages in physical therapy:

For patients: “know pain, know gain”

For therapists: “if it hurts, don’t OVERdo it”

Until next time.  

References:

Capin JJ, Snyder-Mackler L. The current management of patients with patellofemoral pain from the physical therapist’s perspective. Ann Joint 2018;3:40.