Good pain or bad pain? How to tell the difference

It's the question everybody asks in rehab, and it's a good one. If you stop every time something feels uncomfortable you'll never build anything. If you push through everything you'll end up back where you started.

Here's how to tell the difference.

Pain that's usually fine

• A dull ache during the exercise that stays at a level you'd describe as manageable
• Discomfort that settles within an hour or so of finishing
• Muscle soreness a day or two later that feels like the soreness after a workout
• Symptoms that are the same or better the following morning
• Stiffness first thing that eases as you get moving

Loading sensitive tissue is often mildly uncomfortable, and that's expected. It doesn't mean damage.

Pain worth paying attention to

• Sharp, catching or stabbing pain during a movement
• Pain that builds through a session rather than warming up and easing
• Symptoms clearly worse the next morning than before you started
• Pain that wakes you at night
• Swelling after activity
• Giving way, locking or catching in a joint
• Pins and needles, numbness or weakness

That doesn't always mean stop completely. It usually means the load was too much for today, so we adjust rather than abandon.

The 24 hour rule

The most useful test is not how it feels during the exercise. It's how it feels the next morning.

Pain during a session tells you the tissue is sensitive. How it responds a day later tells you whether it could handle what you asked of it.

Same or better the next day means the load was about right. Clearly worse for more than 24 hours means it was too much, and we scale back rather than stop.

Why this matters

People who stop at every twinge tend to end up doing less and less, and gradually lose the capacity that would have solved the problem.

People who ignore everything tend to keep flaring things up and never get a clear run at rehab.

Knowing which is which is what lets you keep training while things settle, and it's one of the more useful things you can take away from a course of treatment.

If you're not sure

Ask. Working out whether a symptom is worth respecting or worth working through is a large part of what we do, and it's a much better use of an appointment than guessing for another month.