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No Pain, No Gain!?

by Athletico5 Comments

The theory of “no pain, no gain” is a popular saying and belief that I address in the physical therapy setting on a daily basis. Some people believe that in order to improve pain, strength, or flexibility, pain must be involved. Many attend therapy with the impression that physical therapy will hurt immensely and will nickname their soon-to-be physical therapist the “physical torturer”. Some come to their first session with fear and some come with the attitude of “hurt me so I can get better!” These are the individuals who are often surprised and/or relieved when I say that the goal is to relieve the pain, not to create it.  Of course, there are times when I have to create some pain to help a patient get better, but for the majority of patients, I am looking to find a way to increase mobility and strength without pushing through pain.

Treadmill ExercisePain is our body’s way of telling us that something is not working well. Pain may result from lack of strength, lack of mobility, injury or anatomical structure. Research puts emphasis on using manual therapy and exercise that allow healing and optimization of motion and strength, and does not make the pain worse in the process. This theory holds true even for adhesive capsulitis, also known as frozen shoulder, in its early stages. Frozen shoulder was once believed to only respond to aggressive stretching leading to pain. Now the management of this diagnosis is to not stretch aggressively in the early stages. Restoring the mobility, strength, and allowing an injury to heal will ultimately reduce pain, and there are many ways to achieve these goals without making the pain worse.

Some exceptions to this theory of pain avoidance do exist such as stiffness as a result of a total joint replacement or other surgical technique. To relieve the stiffness, you may need some increased stretching leading into some pain to avoid adhesions and scar tissue build up, as well as, needing to enhance overall movement of the joint. Most patients with surgery will be able to restore motion without a prolonged increase in pain during treatment. Those whose joint becomes stiff quickly may need an extra push. The extra “push” into pain when needed ideally will not make the pain stay worse more than 10 minutes. Research is showing this thought process is needed for diagnoses such as non-insertional Achilles tendonopathy or patellar tendonopathy. Exercise will lead into pain but should not make it flare up for prolonged periods of time.

In addition, at a physical therapy first evaluation, some tests will be used to try and mildly provoke your pain to help with the decision making of what is occurring at the joint; what makes it feel better or worse; and how we need to address the problem. Muscle soreness that night or over the next couple of days may occur when working on stretching or strengthening muscles or joints that haven’t been used in a while.

When talking with a patient about pain during a technique or exercise I often ask these questions:

  1. Is the pain sharp? Is it because the muscle is tired/fatigued or because of a stretching feeling in the muscle or joint?  If the muscle is tired/fatigued or stretching, these are sensations that some consider pain and are okay to feel in a workout or recovery.  Muscle fatigue is important for getting stronger and stretching is important for gaining flexibility.
  2. If the pain is sharp or throbbing? Is it only at the end of the motion? For instance, do you only feel it when you raise your arm all the way up, or during the movement as well?  If it is only felt at the very top, I will often ask the patient to go only to the pain, but not through it. This may mean the exercise is performed in a shorter range of motion and in a pain free zone. Sometimes reducing repetitions or amount of resistance used is necessary.
  3. In some instances I am okay with mild pain, but I will ask if the pain stays worse after the exercise. Occasionally, it is important to perform the exercise and as long as the pain goes away when the exercise is over, I am okay with it. I would not want to continue an exercise that creates pain and the pain stays worse for the duration of the day. If this occurs, it provides us with good information and we will need to alter the exercise or choose a different exercise for the time being. At times I am okay with having a patient perform an exercise that may create some mild discomfort as long as the increase in pain does not stay worse. However, I do not recommend this thought process at the gym or for healthy individuals who are just working out.
  4. Are you a healthy individual who is experiencing pain while working out? Is it fatigue or stretching?  If so, that’s great! You are experiencing an effective work out. Is it actual pain? Stop what you are doing, lower repetitions, reduce weight, or find an alternative exercise to work out the given muscle. Still having pain? See your Athletico physical therapist for a free 30-minute complimentary injury screening! Don’t keep pushing through the pain! Visit our locations page to find the clinic closest to you, and to schedule a screening today.

As with any blog post that discusses pain, diagnoses, therapy, or other treatment, not everything said will apply to every individual. Each individual is unique in his/her pain, problem, and situation and will need to be treated on an individual basis. However, hopefully this blog helps the understanding of what to expect in regards to pain with therapy and how to address pain within your own workouts. “No Pain, No Gain” is not always the best theory to follow!

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  1. Penelope Smith

    I liked that you explained that the type of pain you have will affect how you do physical therapy. It is a good thing for me to know because my brother has been thinking about going to a physical therapist based on some pain he has been having in his knees. Hopefully that way he won’t get any more issues with his knees.

  2. Heather

    I just had a partial knee replacement, I’m 2 weeks out. I have been doing my physical therapy at a center, I know there will be pain during my Pt and I will be pushed, but should I be pushed to the point of where I’m in tears ?

  3. Athletico

    Thanks for reaching out Heather. Pain messages sent to the brain after knee replacement is normal and help to stimulate healing. As you continue to bend your knee repeatedly, and the muscles and joint start to stretch out, the nerves will stop sending alarm signals over time. It’s essential to keep moving and stretching so your body and brain can get used to your new knee. That being said, it is important that pain is controlled as you move through this process. Please openly discuss your options for pain control with your surgeon and your therapist if you are having concerns. One of our experts will also reach out to provide you with more information.

  4. Mahsa

    I had a meniscus repair 8w ago. I am having a stiff knee due to the delay in getting to Physiotherapy ( Coronavirus! ) My knee hardly bends over 80 degrees after 10 sessions now. Physiotherapy sessions are extremely painful and I am afraid I cannot tolerate it anymore. Is there anything I can do for that.

  5. Athletico

    Hi Mahsa – Stiffness after a meniscal repair is very common. While there may be some pain with trying to reach goals/milestones in the recovery process, too much pain can feed into a bad cycle of guarding and protective spasm. Fear and anxiety can exacerbate this bad cycle. Headspace, Calm, and other mindfulness apps can be helpful to work on belly breathing and relaxation as you are driving to or warming up prior to your physical therapy sessions. Make sure your physical therapist is aware of how you are feeling, and see if they have other exercises or positions you can try to achieve your flexion goals, both for in-clinic sessions and home exercise program. Best of luck with your recovery! Appointments are available in-clinic or via telehealth. Request an appointment here:

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