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Rules For Working Out In Pain

columbus dr. matt pain management physical therapy running strength training workout Feb 23, 2024

Bonus Material: Free Rules For Working Out In Pain Checklist

Let’s play a little game called:

“Should I keep exercising even though I’m in pain?”

We’ve all dealt with it at one time or another - pain while exercising. And when you’re in pain, it’s hard to really enjoy anything because your only concern is how to NOT be in pain.

Getting out of pain, especially if it’s chronic, requires that you appropriately manage the pain as you work through it. And the longer you’ve been in pain, the less likely it is to just go away on its own.

As you read this article, it’s important to understand that PAIN DOES NOT EQUAL DAMAGE and the presence of pain should not be feared; rather, it should be used as a tool to monitor your training and adjust accordingly.

Persistent pain often results because your body has become deconditioned and not used to movement. Pain is not a sign of tissue damage, but rather a sign that your body needs appropriate exercise so it will become strong and conditioned enough to do what you need it to do.

To be clear, I’m not telling you to just “push through pain.” The best thing you can do is to stay active & keep moving within a set of predetermined ‘pain rules’ to keep you safe. 

In fact, recent studies show that exercise protocols allowing painful exercise offered a small, but significant, benefit over pain-free exercise.

So, my goal with this article is to give you a system to manage your symptoms while exercising so that you never end up doing “more harm than good” and you can finally reclaim the active lifestyle you love.

Let’s dive in.


The Pain Rules

Rule 1:  Pain Must Be Tolerable

‘Tolerable” is a subjective term, meaning this is going to be different for everyone. That said, we must avoid extreme levels of pain. 

We use a scale from 0 to 10 and have found that keeping pain at a 4/10 or less usually prevents excessive increases in symptoms that interfere with daily life or lead to flare-ups lasting more than 24 hours.


Rule 2: Avoid Increasing Symptoms More than 2 Points on a 0-10 Scale

If you’re in pain, it’s important to monitor how pain responds to movement. This will keep you safe and will inform decisions about movement patterns, intensity, volume of exercise and range of motion.

If your symptoms improve or stay the same during movement, you’re on the right track. If symptoms become worse with movement, that’s a red light and a signal that we need to modify.

This may mean reducing the weight, number of sets/reps or modifying the range of motion to more tolerable levels. For example, if a deadlift from the floor causes too much pain, you can try reducing range of motion by switching to rack pulls from knee height.

It’s important to avoid stopping exercise altogether, as complete rest is unlikely to solve the problem and often only leads to further deconditioning. Instead, modify the exercises to a level that is tolerable and keep moving.


Rule 3: Pain Should Return to Baseline Within 60 Seconds After You Stop Moving

How symptoms behave after exercise provides valuable insight into the irritability of your condition. 

If symptoms go away or return to baseline within about 60 seconds after you stop moving, that’s a sign that you’re tolerating the exercise well and you’re on the right track.

If symptoms stay above baseline or increase after stopping for more than 60 seconds, that’s a sign that you’ve pushed too far and need to dial it back. 

It bears repeating - avoid just stopping exercise altogether. If symptoms remain elevated, modify the exercise to a level that is tolerable by reducing weight, reps or modifying the range of motion.


Rule 4: Pain Should Return To Baseline Within 48 Hours After An Exercise Session

Some symptoms and discomfort post-exercise is completely normal. However, you don’t want symptoms to stay elevated above baseline for more than 48 hours.

If symptoms go away or return to baseline within 48 hours after a bout of exercise, your body is tolerating and adapting to the exercise load and you’re on the right track.

If symptoms remain elevated above baseline for more than 48 hours, the exercise load was too much and you need to dial it back next time. 


Rule 5: Avoid Reaching Levels Where Sleep Becomes Disrupted More than Usual

While some discomfort after exercise is totally normal, we never want post-exercise soreness that disrupts sleep more than normal.

If you are noticing that sleep is becoming more and more disrupted over time, the current exercise load (or other life stressors) is too much and you need to dial it back. 

Want a free checklist to easily reference these rules whenever you need?
Download our Free Rules For Working Out In Pain Checklist that outlines the Red - Yellow- Green light system we use to our clients get back to their active lifestyle, pain-free!


Tracking Progress

While all of these rules are important to monitor, it’s also important to understand how to appropriately track progress. 

While zero pain would obviously be ideal, it’s also unrealistic to expect that in the short-term. This process takes time, so the main thing we want to see is an improving trend in symptoms over time.

If your symptoms are becoming less frequent, less intense or less long-lasting, you’re making great progress.

However, if the frequency, intensity and duration of symptoms are increasing, you need to make some adjustments to the plan, and the information you collect from the rules above will help you appropriately adjust. 

The main takeaway here is that pain is not a sign of tissue damage, but rather a signal to pay closer attention to your body. And while you should NOT just “push through pain,” you should continue to stay active and train through pain within the predetermined ‘pain rules’ above to keep you safe. 

Before you go, click here to download our Free Rules For Working Out in Pain Checklist!

Stay strong,

Dr. Matt


Reference: Smith BE, Hendrick P, Bateman M, et al Musculoskeletal pain and exercise—challenging existing paradigms and introducing new British Journal of Sports Medicine 2019;53:907-912.

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 Remember, Movement is Medicine! 

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