Time to Ditch"No Pain, No Gain" for injury recovery ?

Is it time to rethink the " no pain, no gain " mantra to allow a better recovery for injuries ?

Or are there times when it is still valid to push through the discomfort ?

Man deadlifting weights in gym

Anyone involved in any sort of sport or activity has probably heard the mantra "no pain, no gain." It’s a phrase often worn as a badge of honour. But when you’re dealing with an injury, is this tough-love approach actually helpful?

As a physiotherapist, I get this question all the time. My answer is clear and important: No, "no pain, no gain" is not a valid principle for rehabilitation. In fact, blindly following it can be counterproductive, derailing your recovery and even leading to re-injury. The truth is, successful injury rehabilitation isn’t about silencing your body’s alarm system with brute force; it’s about learning to interpret its signals and working with your body, not against it.

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Why "No Pain, No Gain" is a Risky Rehab Strategy for some injuries

At its most basic core, pain is an output from your brain designed to protect you. It’s a sophisticated alarm system signalling that tissues may be under threat or experiencing damage. In the acute phase of an injury—think a fresh ankle sprain, a muscle tear, or the initial weeks after surgery—this alarm system is particularly sensitive. Ignoring sharp pain during this vulnerable period is like disabling the smoke detector while a fire is smouldering. You’re likely to:

1. Increase Inflammation: Aggravating the injured area, turning a small issue into a bigger one

2. Re-Injure: Causing micro-tears in healing muscles, tendons, or ligaments, or even a more significant setback

3. Provoke Fear of Movement: If every exercise causes sharp pain, it’s natural to start guarding and avoiding movement. This can lead to stiffness, developing bad movement habits and muscle weakness, which are all major hurdles to recovery and can lead to real fear avoidance of normal activity.

In the early stages after an acute injury (like a fresh sprain or strain) or surgery, pain is a direct indicator of harm. Pushing into significant pain at this point almost always means you’re causing further damage.

A Better Guide: The Traffic Light System for Sensation

So, if we shouldn’t chase pain, what should we feel? I teach my patients to use a simple "traffic light" system to navigate their sensations during exercise following injury or surgery.

🟢 GREEN LIGHT: Safe to Proceed

• No Pain: This is the gold standard, especially in early rehab.

• Stretch or Tension: A feeling of pulling or tightness in the muscle or around the joint. This is the "good hurt" you might feel during a gentle stretch.

• Muscle Fatigue or Burn: The feeling of your muscles working hard and getting tired, like during the last few reps of a set. This is a normal and desired sensation for building strength.

🟡 YELLOW LIGHT: Proceed with Caution

• Mild to Moderate Ache or Discomfort: This is the grey area where judgment is key. A low-level, dull ache (let’s say a 0-3 on a pain scale of 10) that settles quickly after you finish exercising (within 30-60 minutes) can sometimes be acceptable. We often need to gently push into this zone for certain conditions, like tendinopathies or chronic arthritis, to stimulate tissue adaptation and build resilience.

🔴 RED LIGHT: STOP!

• Sharp, Stabbing, or Shooting Pain: This is a clear stop signal. Do not push through it.

• Pain that Lingers or Worsens: Any pain that intensifies during the exercise or is significantly worse the next morning.

• Radiating Pain: Pain that travels down your arm or leg (like sciatica)

" ...successful rehabilitation isn’t about silencing your body’s alarm system with brute force. It's about a smarter approach to rehab "

So Is It Okay to Feel Some Discomfort ?

While sharp pain is always a no-go, there are specific times where working into the "yellow zone" is a deliberate part of the plan:

1. Tendon Issues (Tendinopathy): Tendons LOVE and NEED graduated load. They thrive on it. The mantra for a problematic tendon is "load it, don't rest it." To stimulate the tendon to remodel and become stronger, exercises must create a moderate, predictable ache (typically a 3-5/10) during the activity that settles quickly. This specific sensation is a key part of the therapeutic effect.

2. Chronic Pain: For long-standing issues, the tissues are often far less fragile than your nervous system believes. The goal becomes gently pushing boundaries to desensitise the system and rebuild confidence in movement.

3. Restoring Range of Motion: This is where physios earn our reputation for being bullies! After surgery, such as a joint replacement or a period of immobilisation, joints become stiff. Regaining movement requires stretching that is unequivocally uncomfortable—a strong feeling of tension—but it should never cross the line into a sharp or tearing sensation. We like to call it ' encouragement '

4. Regaining Strength: In the later stages of rehab, when building strength is the focus, the last few reps of a set should be challenging and create muscle fatigue. This "burn" is a form of productive discomfort, distinct from harmful pain.

The True Principle: "No Change, No Gain"

The fundamental law of tissue adaptation is progressive overload. To get stronger, more resilient, and more co-ordinated, you must systematically and safely challenge your body. This doesn’t mean beating it into submission with pain; it means incorporating change.

This "change" can be:

• Increasing Load: Adding more weight or resistance.

• Increasing Volume: Doing more repetitions or sets.

• Improving Complexity: Progressing from a stable squat to a single-leg squat on an unstable surface.

This progressive overload must be applied within the context of your traffic light system, guided by your physiotherapist’s expertise and your own body’s feedback.

A Final Word of Encouragement

Navigating the fine line between effective effort and harmful overload is precisely why you need a physiotherapist or sports therapist. We provide the essential framework for your recovery by:

• Providing an Accurate Diagnosis: Understanding what the injury is will dictate how we should load it.

• Prescribing Individualised Exercises: We select the right exercises, with the right dosage, for your specific stage of healing.

• Empowering You with Knowledge: We teach you the traffic light system, turning you from a passive patient into an active manager of your own health.

  
  

So let’s retire the outdated and dangerous "no pain, no gain" adage. Embrace a smarter, approach to healing. True recovery is built not on pain, but on the pillars of knowledge, patience, and progressive, purposeful effort. If you’re ready to start your journey with a guide who understands the difference, book an appointment with us today. Together, we’ll gain the results, without the unnecessary pain.