You’re doing your exercises. Your knee, your shoulder, your back, whatever it is – it aches a little. Is that fine? Or are you making it worse?
Most people never get a straight answer. So they either push through everything, or stop the second anything feels off. Both are guesses.
The myth: “if it hurts, stop”
That’s the line most generic programs give you. Post-op handouts. Physio apps. Even some physios.
It sounds safe. For most injuries, it’s the wrong advice.
Some pain during rehab is part of how tissue adapts. Tendons and muscles need load to get stronger, and load without any discomfort usually means you’re not doing enough.
The truth: it comes down to irritability
Irritability is how much pain a stimulus produces, and how long that pain sticks around. Ten minutes of sitting that triggers 2 days of back pain? Highly irritable. Pain that shows up during a hike but disappears the second you stop? Low irritability.
Irritability tells you your dose – how much, how often, how long. Get the dose right and you’re stimulating healing. Get it wrong and you’re aggravating the injury.
Three rules tell you if your dose is right.
Rule 1: tolerable pain during activity is okay.
Mild discomfort while you’re doing the exercise is fine, sometimes even useful. It’s stimulating the area, and stimulation is part of healing. The exception is bone stress injuries, like stress fractures, which should stay pain-free. If the pain during the activity feels genuinely intolerable, the dose is wrong.
Rule 2: it settles fast once you stop.
Pain should drop back to your baseline within 20 to 30 minutes. Some cases stretch to an hour. If you need ice, meds, or a TENS unit to calm it down, that’s a sign you pushed too hard.
Rule 3: you’re not worse the next day.
This one catches people out the most. You can pass Rules 1 and 2 and still wake up worse. That’s latent worsening, and it means yesterday’s total load, the exercise plus whatever else you did, was too much. A long drive or an extra hike you tacked on counts too.
Miss any one of these rules and you’ve missed a healing stimulus, or set yourself back a few days. Nothing catastrophic, just wasted time you didn’t need to waste.
What to do this week
Before your next session, write down your baseline pain, then check it again 24 hours later. That covers Rule 3.
During the exercise itself, rate the discomfort. If it’s tolerable and it’s not a bone stress injury, keep going. If it settles within half an hour, you’re in Rule 2 territory. If tomorrow you’re the same or better, you’ve nailed the dose.
If you’re consistently failing one of these rules and can’t work out why, that’s almost always a dosing issue you can adjust yourself or with help. That’s exactly the kind of thing we work through with people at The Physio Hub in Collingwood, dialing in the right dose so you’re making progress instead of guessing.
If you’re dealing with something specific, like rotator cuff pain that keeps stalling or patellofemoral pain that won’t settle, these same three rules are usually the missing piece.
Contact us if you have any questions or need help with your injuries
Matt Sheldon, Registered Physiotherapist, The Physio Hub- Collingwood.