No Pain, No Gain? Understanding Pain During Exercise and Physiotherapy

Many patients ask the same question after exercise or physiotherapy:“If it hurts, should I push through it — or stop?”

The popular phrase “No Pain, No Gain” can be misleading.In rehabilitation and exercise science, not all pain is equal, and understanding the difference is critical for safe recovery.

Good Pain: Delayed-Onset Muscle Soreness (DOMS)

Delayed-onset muscle soreness typically appears 24–48 hours after exercise, especially following new or increased activity.

According to the American College of Sports Medicine (ACSM), DOMS is caused by microscopic muscle damage that occurs during loading.This process is a normal physiological adaptation, leading to stronger and more resilient muscle tissue over time.

Key characteristics of DOMS:

• Dull, achy, or tight sensation

• Appears hours after activity, not immediately

• Improves gradually with movement and time

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Bad Pain: Injury or Tissue Overload

In contrast, pain that is sharp, stabbing, electric, or associated with swelling may indicate tissue overload or injury.

This type of pain is linked to nociceptive signaling, where sensory receptors detect actual or potential tissue damage and send an immediate warning to the nervous system.

Red flags include:

• Sharp or burning pain during movement

• Pain that worsens during or after activity

• Swelling, instability, or loss of function

Pushing through this type of pain can delay healing and increase injury risk.

The 24-Hour Rule: A Practical Clinical Guide

In rehabilitation, clinicians often use a pain-monitoring model to guide safe progression.

Silbernagel et al. (2007) proposed the 24-hour rule, commonly used in tendinopathy and exercise-based rehab:

• Pain during or after exercise should remain ≤ 4/10

• Symptoms should return to baseline within 24 hours

• If pain is worse the next day, the load was too high and should be reduced

This approach allows continued progress without compromising tissue recovery.

Clinical Takeaway

Pain is not the enemy — but it is information.Listening to pain signals, rather than ignoring them, leads to safer rehabilitation, better long-term outcomes, and fewer setbacks.

At our clinic, we emphasize evidence-based load management, not blind tolerance of pain.

References

• American College of Sports Medicine (ACSM). Exercise-induced muscle damage and adaptation.

• Silbernagel KG, et al. (2007). Pain-monitoring model for tendon rehabilitation. British Journal of Sports Medicine.