Can You Train With Pain? A Performance Physical Therapist Explains

Whether you are new to working out or are a seasoned veteran, you are bound to experience discomfort with training at some point. Even if you check all the boxes of eating healthy, sleeping well, and following a well-structured program, pain is inevitable at some point. Where most people struggle is determining whether or not they should push through the pain, or call it quits. In today’s blog, we’ll discuss what best evidence recommends, different ways of assessing your current pain levels with training, and our philosophy for managing pain here at Strive Performance in West Ashley, SC. 

No Pain, No Gain… Right?

We’ve all heard this phrase countless times before. Maybe you’ve heard a meathead in the gym say it while he’s mid roid-rage, or perhaps your grandparents who walked to school uphill both ways in the snow told you to “suck it up, buttercup”. While I am a firm believer that doing uncomfortable or challenging things helps people grow, there is some nuance when it comes to rehab. The sensation of pain itself, as in it actually hurts and causes discomfort physically, should be met with caution in certain situations. 

Research helps shed some light on this topic for rehabilitation. Studies have shown that mild discomfort for certain injuries, such as shoulder rotator cuff tendinitis or tears, is actually totally fine during a PT session. The same is true for some other tendon injuries or joint conditions. BUT, and this is a big but, depending on the type of pain, how intense it is, and how long it lasts are where these allowances for discomfort may change (we’ll discuss this later in the blog). Pain does not automatically equal damage, but pain also shouldn’t be ignored. 

Hurt vs. Harm

Here, we’ll discuss the bread and butter of this discussion. Let’s get right to it by discussing when/what type of pain is usually okay to train with vs. when it’s time to see a Doctor of Physical Therapy. Because everyone learns differently and has their own way of remembering things, here’s THREE different ways to assess pain during training: 

1) Straight to the point: 

✅ Pain That’s Okay: 

• Pain is <4/10 discomfort (either during or after the session)

• Delayed onset muscle soreness (DOMS) or muscle fatigue 

• Pain that improves during your warm-up

• Pain that does not linger or worsen the next day

❌ Pain That’s Not Okay: 

• Sharp or stabbing pain

• Pain that worsens during the session

• Pain that leads to swelling, loss of motion, or leads to feelings of instability

• Pain that lingers for more than 24 hours OR worsens the next day

• It won’t resolve/reduce with modifying movement patterns 

2) The “Pain Traffic Light” System: 

🔴 STOP: 7-10/10 pain, sharp or stabbing, persists for >24-48 hours, leads to large loss of range of motion, notable swelling, or instability 

🟡 CAUTION: 4-6/10 pain, discomfort for ~24 hours but no worse the next day, symptoms reduce with rest and slowing down, minimal loss of motion and mild swelling

🟢 SAFE: 1-3/10 discomfort, dull/achy, improves with warm-up or activity, better within 24 hours and no worse after activity, no loss of motion or swelling 

3) “The 24 Hour Rule”: 

If pain returns to baseline within 24 hours → acceptable

If pain worsens or lingers 24+ hours → you’ve exceeded tissue capacity 

Real Life Examples: 

Example #1: You’ve been having some discomfort in the front of your knee over the past few days. At the gym, the first set of barbell squats is 2/10 soreness, however as you progress along sets, the pain subsides. The next day you wake up with no discomfort. All is good!

Example #2: Your shoulder has been aching constantly with normal day-to-day activities after a heavier upper body workout a few days ago. When you go to the gym, the pain is somewhat sharp and only worsens the longer you go. No pain, no gain… right? That evening you need an anti-inflammatory to sleep, and the next day the pain is even more noticeable. STOP!

The Strive Performance Way

At Strive Performance in West Ashley, SC, we follow a very similar approach to the previously discussed recommendations. We also understand that every person is different, has unique needs/goals, as well as perceptions of pain and take this greatly into consideration when determining your rehabilitation plan. 

Our philosophy is simple: Modify > Eliminate

Our Doctors of Physical Therapy will start by trying to modify the painful movements before completely eliminating them. If pain is still in the yellow or red zones with reducing weight, range of motion, placement of the load, or altering the path of movement, then alternative movements are tested. We take pride in having an open line of communication with our clients, so even on days without physical therapy we can make recommendations or changes to the plan. 

If you have been struggling with pain that prevents you from working out or competing, send us a Physical Therapy Inquiry to speak with one of our Doctors of Physical Therapy. Our performance PTs will perform a comprehensive assessment and create a plan that keeps you progressing safely.