One of the most common questions physical therapy patients ask goes something like this: “My _____ always hurts when I _____.  I usually just try to ignore the pain and push through it, and sometimes it goes away after a while.  How do I know if I should stop or keep going?”

The adage ‘No Pain, No Gain’ is probably one of the most common sayings associated with exercise and other physical activities.  It is also one the least favorite sayings physical therapists want to hear when trying to get someone feeling and moving better.

To answer the question of whether to push through the pain or not, we first need to distinguish between pain and work.   When physical therapists hear someone say, “oh man that hurts” during an exercise, our follow-up question is usually “does it hurt (actual pain), or is it muscle burn (work)?”

Pain is a sensation that everyone experiences a little differently.  It can be described as sharp, stabbing, or tooth-achy, and is usually felt at or very close to a joint.  Pain felt during exertion is often an indicator of tissue (e.g., bone, ligament, muscle, tendon) irritation or damage.   Pain sensations are actually helpful for our bodies to experience, at least in the short-term.  They are part of an innate alarm system which tells the brain that the tissue being stressed is starting to break down.  For example, if someone feels a sharp stab in their shoulder when lifting something overhead, it means that one of the tissues near the shoulder is being overstressed.

When a person’s brain receives the pain signal, one of 3 scenarios will occur.

  • If the person pays attention to the signal, they will stop the movement that hurts.
  • If the person chooses to ignore the signal, the body will change the way the movement is performed and tissues that are not normally engaged during the movement can become stressed.
  • If the person completely ignores the signal and just barrels ahead, they risk causing injury to the tissue.

Work, on the other hand, is a sensation usually experienced near the center of the muscles that move a joint.  It is the burning or fatigued sensation we experience when pushing a muscle hard or when performing exercise at a high intensity.  If you were to do 50 squats while reading this article, you’d likely feel a burning in the muscles on the front of your thighs.  That burning sensation means that the muscles are working hard and does not usually signal any significant damage to the tissue.

In fact, if you don’t experience a little burn during a work-out, you may not be getting the maximum return on your effort.  However, if the burn becomes really intense, it can mean that muscle is being seriously overworked.  The muscle may stop doing its job to protect itself, which will cause other muscles to take over.  As with changes in movement due to pain, we don’t want that to happen either.

Now that the distinction has been made between pain and work, we can revisit the original question of whether to push through the pain or back off.  Pain, as defined above, is not something you should work through or ignore.  Any discomfort that makes you limp or makes it difficult to lift or move a body part, is a signal that tissues are being stressed beyond a healthy level.

If very mild pain, which doesn’t alter movement, is present during the first few minutes of an activity, it is typically ok to continue at a lower intensity.  But if the pain lasts more than a few minutes, it’s probably best to stop.  If the pain sensation starts to go away after 5 minutes or so, it is likely that your brain has started to ignore the sensation.  Think of your clothes.  After the first minute or two of being dressed for the day, you no longer feel the cloth against your skin.  It’s still there, but your brain has begun to filter out the sensation on your skin.  The same can go for pain that is ignored for a short time.

In sum, if actual pain lasts longer than a few minutes during an activity, it’s best to stop and figure out why it hurts.  If it’s just that satisfying feeling of mild to moderate muscle burn that we get from a good workout, it’s ok to keep going, provided that you’re not changing how you perform the movement.

Wouldn’t it be great if instead of hearing ‘No Pain No Gain’ shouted at the gym or on the field, we instead started to hear ‘No Work No Gain’?  Hey, it’s not as catchy, but at least it’s accurate.