Should you train through pain?Understanding “Good” vs “Bad” Pain during Rehabilitation

One of the most common questions people ask during rehabilitation is whether they should stop exercising if something hurts.For many people, pain immediately creates concern that damage is occurring. It is understandable why. Pain can feel threatening, particularly when it occurs during exercise, running, gym training, or rehabilitation following an injury. However, pain and tissue damage are not always the same thing, and rehabilitation is often far more nuanced than simply avoiding all discomfort completely.

At SurfEdge Sports Physiotherapy, this is a conversation that occurs regularly with runners, gym-goers, surf athletes, active adults, and people returning to activity after injury. One of the biggest misconceptions surrounding rehabilitation is the belief that all pain during exercise is harmful or should be avoided entirely. In reality, many injuries and conditions actually require progressive loading to improve capacity and function over time.

This does not mean people should simply ignore pain and push through aggressively. There is an important difference between appropriate rehabilitation loading and repeatedly overloading an irritable tissue.Pain itself is a complex protective response influenced by many factors including tissue sensitivity, previous injury, stress, sleep, fatigue, recovery, training history, and overall load tolerance.

This does not mean pain is “all in your head.” Pain is very real. However, the amount of pain someone experiences does not always directly reflect the amount of structural damage present. This is one reason why some people can have severe pain with relatively minor tissue irritation, while others may have significant imaging findings despite minimal symptoms.

This concept becomes particularly important in rehabilitation settings. Completely avoiding all pain can sometimes become counterproductive, especially in conditions where tissues require gradual exposure to load in order to improve tolerance. Tendinopathy is a good example of this. Conditions such as Achilles tendinopathy, patellar tendinopathy, rotator cuff-related shoulder pain, and gluteal tendinopathy often respond poorly to prolonged rest alone. While temporarily reducing aggravating loads may help calm symptoms initially, long-term improvement generally requires progressive strengthening and graded loading.Many people become frustrated because symptoms improve when they stop activity, only for the pain to return immediately when they attempt to resume running, gym training, or sport.

In these situations, the issue is often not simply pain reduction, but reduced tissue capacity.Appropriate rehabilitation is usually about finding the balance between underloading and overloading. If a tissue is consistently overloaded beyond its current capacity, symptoms may continue to worsen. Conversely, if a tissue is never exposed to meaningful load, it may fail to adapt and become increasingly deconditioned over time.

This is where pain monitoring during rehabilitation becomes important.In many rehabilitation settings, some mild discomfort during exercise can actually be acceptable. While there is no universal rule that applies to every injury or every person, many clinicians utilise symptom-monitoring approaches where low-level discomfort during exercise may be considered acceptable provided symptoms settle relatively quickly and do not significantly worsen over the following 24-48 hours.

At SurfEdge, rehabilitation advice often revolves around monitoring both symptom severity and the response following loading.

A temporary increase in discomfort during rehabilitation does not necessarily mean damage is occurring. However, pain that becomes progressively worse, remains significantly elevated for prolonged periods after exercise, or results in declining function may indicate that the current load exceeds the tissue’s capacity.

This distinction is important because rehabilitation is rarely perfectly linear. Small symptom fluctuations are common, particularly when people begin reloading tissues that have become sensitive or deconditioned.This concept also applies heavily within gym-based rehabilitation and return to sport. In many cases, complete cessation of training is neither necessary nor ideal. Exercise modification is often more appropriate than total avoidance of activity. This may involve temporarily reducing load, altering exercise selection, decreasing range of motion, adjusting training volume, modifying running intensity, or changing movement strategies while maintaining as much meaningful activity as possible.

For example, someone with shoulder pain may temporarily tolerate pressing exercises better with a neutral grip or reduced range of motion. A runner with Achilles pain may initially reduce hill running or speed work while maintaining some running exposure. Someone with knee pain may tolerate split squats better than deep bilateral squatting early in rehabilitation.The goal is generally not to avoid movement forever. The goal is to progressively rebuild confidence, capacity, and tolerance to the physical demands that matter to the individual.

Pain flare-ups can also create significant fear during rehabilitation. Many people assume that any increase in symptoms means they have “reinjured” themselves or caused further structural damage. While this can occasionally occur, temporary symptom flare-ups are not uncommon during rehabilitation and do not automatically indicate tissue damage. Sometimes symptoms increase simply because the load exceeded the tissue’s current tolerance temporarily, recovery was insufficient, training progressed too aggressively, or multiple stressors accumulated simultaneously.

This is one reason why rehabilitation often requires ongoing adjustment and individualisation rather than rigid protocols.Importantly, there are situations where pain during exercise should not simply be ignored. Severe pain, rapidly worsening symptoms, significant swelling, inability to weight bear, instability, progressive neurological symptoms, or suspected bone stress injuries should all be appropriately assessed. Certain conditions require more careful load management and some injuries are less tolerant to aggressive early loading than others.

This is why individual assessment remains important. The management approach for a persistent tendinopathy may look very different to the management of an acute ligament injury, a bone stress injury, or post-operative rehabilitation.

One of the major goals of physiotherapy rehabilitation is improving tissue capacity and confidence with movement, not simply reducing pain in the short term. This often involves graded exposure to load, progressive strengthening, symptom monitoring, and helping people return to meaningful activity in a structured and evidence-informed manner.

Unfortunately, many people have previously been told that pain automatically means they are “damaging” themselves, that their body is fragile, or that they should avoid all painful movement indefinitely. These beliefs can sometimes contribute to fear, reduced confidence, avoidance of activity, and poorer long-term outcomes.Evidence-informed rehabilitation instead focuses on understanding the condition, improving physical capacity, restoring confidence with movement, and helping people return to activity safely and progressively

.If you are unsure whether your pain is safe to train through, repeatedly flare up with exercise, or feel stuck in a cycle of recurrent injuries, appropriate assessment can help guide rehabilitation and loading decisions.

SurfEdge Sports Physiotherapy is based in Maroochydore on the Sunshine Coast and provides evidence-informed rehabilitation for runners, gym-goers, active adults, and athletes.

Recover. Perform. Excel.