No Pain, No Gain?

Regina Lehnert, PT, Cert. MDT

February 2010

 The phrase: “No pain, no gain” is often associated with physical exercise, weight training, sports activity or Physical Therapy treatment.  As a Physical Therapist, I am often asked if this is truth or myth. The answer is not a simple one and has many considerations.

Pain is a subjective, unpleasant sensory experience associated with actual or potential damage to the tissues of the body.    There is pain that is associated with exercising and workouts that is acceptable and normal.  Delayed onset muscle soreness (DOMS) is a dull ache of the muscles following a strenuous workout.  This soreness is thought to be caused by microscopic damage to the muscles and connective tissues.  This soreness generally occurs within one to two days of a new workout regime or increased time or intensity of an existing routine.  The soreness gradually subsides within three to five days.  The body gradually repairs the damage and builds stronger muscles and tissues as a result.

Pain during a workout may be normal as well.  This is the “burn” that may be felt after several repetitions of an exercise or during an aggressive cardiovascular workout such as a bike ride or run. This temporary pain should cease shortly after you stop the activity.  If not, the signs of a possible injury should be considered.

Exercise and participation in sports activities can also lead to injury. There are many danger signs of a possible injury: sudden or severe pain, swelling, extreme tenderness, extreme weakness in a limb, inability to place weight on a leg or foot, inability to move a joint through its full range of motion, numbness or tingling, and visible dislocation or broken bone.  Should any of these danger signs occur, you should stop exercising immediately and seek treatment.

“No pain, no gain” is not always necessary during Physical Therapy intervention.  Certain diagnoses, such as shoulder impingement, should receive treatment that is pain free. Care is taken to avoid compromise of those tissues that are generally inflamed and located within a narrowed joint space. Exercise should be performed within a range of motion that does not further injure these tissues.  On the other hand, treatment for adhesive capsulitis (frozen shoulder) requires that the tightened capsule of the shoulder joint be stretched which can be quite painful.  Physical Therapists monitor the pain elicited carefully and on an individualized basis in regards to the patient diagnosis.

Individuals receiving treatment in Physical Therapy are generally there as a result of damaged tissues.  These tissues often present with some of the signs of injury listed above.  As a result, therapy revolves around healing of these tissues.  Depending on the stage of recovery, therapy may involve pain – such as that associated with stretching tightened tissues or strengthening excessively weakened muscles. In other cases, therapy will focus on decreasing the swelling or inflammation of an injured area – in this case, pain should be avoided as the injury heals.  Once the swelling or inflammation has subsided, stretching or strengthening of the tissues begins. This may result in some level of pain as new exercises are introduced.

There are many ways to avoid injury and or pain during exercise. A routine physical examination before the initiation of a new exercise program or sport may identify conditions that would affect your participation. A gradual progression into the exercise routine with gradual increases in intensity and duration can assist in the avoidance or minimization of pain. Maintaining an appropriate diet and adequate water intake will assist in avoiding possible dehydration and muscle cramping during physical activity. Cross-training, or changing your exercise routine and wearing appropriate footwear and clothing can also assist in injury prevention.  Listen to your body and be aware of the danger signs of a possible injury.

Some pain is acceptable and considered normal with exercise and physical activity.  Individuals initiating a new exercise program, changing intensity of a current program or participating in a new sport will likely experience some pain that is associated with a gain. In the case of Physical Therapy, each patient diagnosis is considered and in some cases avoidance of pain during activity is the goal and required for recovery.  In these cases, pain hinders recovery and does not lead to a gain.  The complicated response is that “No Pain, No Gain”…is not always true.

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