Training through pain vs. training around pain: how to tell the difference
Training through pain vs. training around pain: how to tell the difference.
Athletes are told to "listen to their body." It is one of the most commonly repeated phrases in sports and fitness culture, and it is almost entirely unhelpful without a framework for what that actually means.
The question we hear most often from patients at Root Physical Therapy is a version of the same thing: should I train through this, or should I stop?
The answer is almost never one or the other. In the majority of cases, the right approach is a third option — training around the pain. Modifying what you do, not abandoning it entirely. Continuing to load the body in ways that do not provoke the injury, while the injured tissue recovers.
This post outlines the clinical framework we use to help patients navigate that decision. It is grounded in current pain science research, and it applies whether you are a competitive Muay Thai fighter at Muók Boxing, a recreational lifter at Root Strength, or someone who simply wants to keep exercising while managing a nagging injury.
The problem with "push through it"
The athletic instinct is to dismiss pain as weakness. And in certain contexts, that instinct is correct — some discomfort during training is normal, expected, and not a signal to stop. Muscle fatigue, moderate soreness during a heavy set, and the general discomfort of pushing your cardiovascular system are all physiological responses to appropriate load.
But the instinct fails when the pain represents an actual tissue-level injury — a tendon that is being overloaded beyond its capacity to adapt, a joint that is being stressed in a direction it cannot tolerate, or a bone that is accumulating microdamage faster than it can remodel. In those cases, "pushing through" does not build resilience. It extends the injury timeline, deepens the tissue damage, and often converts a condition that would have resolved in weeks into one that takes months.
Research published in the British Journal of Sports Medicine has consistently demonstrated that early load modification — not complete rest, but intelligent adjustment of training — produces significantly faster recovery timelines than either ignoring the pain entirely or stopping all activity (Silbernagel et al., 2007; Cook & Purdam, 2009).
The problem with "just rest"
The opposite instinct — stopping everything — is equally problematic. Complete rest removes the stimulus that tissues need to heal. Tendons, muscles, bones, and cartilage are mechanosensitive. They adapt to load. When load is removed entirely, they lose capacity.
A 2020 systematic review and meta-analysis published in The Journal of Pain examined the phenomenon of exercise-induced hypoalgesia (EIH) and found that aerobic exercise produces a large analgesic effect in healthy individuals — meaning that appropriate exercise actually reduces pain perception, not just during the activity but afterward (Wonders et al., 2020). Complete rest forfeits this benefit.
Additionally, prolonged rest after musculoskeletal injury is associated with deconditioning, kinesiophobia (fear of movement), and delayed return to full activity. A 2025 meta-analysis in Brain Sciences found that pain neuroscience education combined with physical therapy significantly reduced both pain intensity and disability — supporting the conclusion that understanding pain, rather than simply avoiding the activities that provoke it, leads to better outcomes (Sánchez-Robalino et al., 2025).
The clinical takeaway: Neither "push through it" nor "stop everything" is the right answer for most injuries. The right answer is usually a structured modification of training that keeps you active while respecting the injury's healing timeline. This is what we mean by training around the pain.
The framework: how we assess pain in active patients
When an athlete or active patient presents at our clinic with pain during training, we assess three variables to determine the appropriate approach.
1. Pain behavior during activity
We ask: does the pain warm up and decrease during the session, or does it worsen? Pain that diminishes with movement is generally more favorable — it suggests the tissue is responding to increased blood flow and loading without further irritation. Pain that escalates during a session suggests ongoing tissue provocation and usually requires more significant modification.
2. Pain response in the 24 hours after activity
The post-session window is more informative than what happens during the workout. If pain returns to baseline within 24 hours, the training load is generally within the tissue's tolerance. If pain is elevated the following morning and remains elevated beyond the next training session, the load exceeded tissue capacity and needs to be reduced.
This principle is well-established in tendinopathy research. Silbernagel and colleagues (2007) developed a pain monitoring model for Achilles tendinopathy that has since been applied broadly across musculoskeletal conditions. The core threshold: pain during activity is acceptable at up to 5/10 on a numeric scale, provided it settles to baseline within 24 hours and does not progressively worsen session over session.
3. Functional trajectory over weeks
Individual sessions fluctuate. What matters clinically is the week-over-week trend. Is the patient able to do more this week than last week — more weight, more volume, more variety of movement — without increased pain? If the trend is improving, the current approach is working. If the trend is flat or worsening despite modification, the condition needs reassessment.
Training through pain vs. training around pain: a decision framework
| Signal | Train through | Train around | Stop and reassess |
|---|---|---|---|
| Pain level during activity | 0–3/10, warms up | 3–5/10, stable | 5+/10, escalating |
| Pain after activity | Returns to baseline same day | Returns to baseline within 24 hrs | Elevated next morning |
| Week-over-week trend | Improving or stable | Stable with modification | Worsening despite modification |
| Swelling | None | Minimal, resolves quickly | Persistent or increasing |
| Movement quality | Normal mechanics | Minor compensation | Significant compensatory patterns |
What "training around pain" actually looks like
Training around pain is not a vague instruction to "take it easy." It is a specific, structured approach. Here are the most common modifications we prescribe:
Load reduction, not load elimination
A patient with patellar tendinopathy does not need to stop squatting. They need to reduce the load to a level the tendon can tolerate — often 50–60% of their working weight — and progress gradually from there. The tendon heals under load. Without load, it weakens.
Movement substitution
A patient with shoulder impingement on the bench press can often train a floor press, a neutral-grip dumbbell press, or a landmine press without pain. The shoulder is still training. The specific angle that provokes symptoms is temporarily removed. The same principle applies to combat sports athletes — a fighter with a hand injury at Muók Boxing can continue kicking drills, clinch work, and conditioning while the hand heals.
Volume adjustment
Sometimes the movement itself is fine, but the accumulated volume is the issue. Reducing sets or frequency — for example, moving from four training sessions per week to three — can bring total load below the injury threshold while maintaining the training stimulus.
Tempo and range modification
Slowing the tempo of an exercise or limiting the range of motion to a pain-free arc allows the tissue to be loaded in a controlled way. This is particularly effective for tendon conditions, where slow eccentric loading has strong evidence for promoting tendon remodeling (Malliaras et al., 2013).
Pain is not damage — but it is information
Modern pain science has established that pain is an output of the nervous system, not a direct measure of tissue damage. The relationship between what you feel and what is happening structurally is more complex than most people assume. MRI studies consistently show disc herniations, rotator cuff tears, and meniscal changes in people with no pain at all — and conversely, severe pain in people with no identifiable structural pathology (Brinjikji et al., 2015).
This does not mean pain should be ignored. It means pain should be interpreted in context. A 3/10 ache in a tendon that is gradually getting stronger week over week is a very different signal than a 3/10 ache in a tendon that has been getting worse for three months. Same number, different meaning. The clinical context — not the pain number alone — determines the appropriate response.
This is why a physical therapy assessment matters. A clinician can differentiate between pain that reflects active tissue damage and pain that reflects sensitization, deconditioning, or fear-avoidance — all of which require different management approaches.
The pain monitoring rule we use clinically: Pain during training is acceptable at up to 5/10, provided it returns to your baseline within 24 hours and does not worsen week over week. If it exceeds any of those three thresholds, the current approach needs modification. This framework is adapted from the Silbernagel pain monitoring model (2007), which has been validated across multiple tendinopathy and overuse conditions.
When to stop and seek assessment
Training through or around pain is appropriate for many musculoskeletal conditions. It is not appropriate for all of them. The following presentations warrant pausing training and seeking a clinical assessment before continuing:
- Pain that escalates during every training session regardless of modification
- Pain that wakes you from sleep
- Pain that worsens week over week despite reduced load
- Significant or persistent swelling after training
- A sudden pop, shift, or giving way during a movement
- Numbness, tingling, or radiating pain into an extremity
- Pain following a specific traumatic incident (fall, collision, awkward landing)
None of these necessarily mean something is seriously wrong. But each one warrants a professional evaluation to rule out conditions that require a different management approach. In Washington State, you do not need a physician referral to see a physical therapist — you can book directly.
How we apply this at Root Physical Therapy
Our clinical team evaluates pain in the context of your full training history, movement patterns, and goals. We do not treat a "shoulder" or a "knee" — we treat the person attached to it, including the training they do, the work they perform, and the activities they want to get back to.
Because Root Physical Therapy is located inside Root Strength — a 9,000 sq ft training facility in Georgetown — we can observe how you actually move under load, not just how you move in a clinic. Your treatment plan is coordinated with the training environment you use. There is no gap between rehab and training. That integration is why active patients and athletes choose us.
If you are managing pain during training and are not sure whether to push, modify, or stop — that is exactly the kind of question our team answers every day.
Not sure if your pain needs attention?
Schedule an assessment with our Doctors of Physical Therapy. We will evaluate what is happening, give you a clear clinical picture, and build a plan that keeps you training while the issue resolves.
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- Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. American Journal of Sports Medicine. 2007;35(6):897–906. doi:10.1177/0363546506298279
- Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine. 2009;43(6):409–416. doi:10.1136/bjsm.2008.051193
- Wonders KY, Drury DG. Current barriers and future directions to exercise-induced hypoalgesia research. The Journal of Pain. 2020;21(11-12):e1. (Meta-analysis of exercise-induced hypoalgesia showing large analgesic effects of aerobic exercise.)
- Rice D, Nijs J, Kosek E, et al. Exercise-induced hypoalgesia in pain-free and chronic pain populations: state of the art and future directions. The Journal of Pain. 2019;20(11):1249–1266. doi:10.1016/j.jpain.2019.03.005
- Sánchez-Robalino A, Sinchi-Sinchi H, Ramírez A, et al. Effectiveness of pain neuroscience education in physical therapy: a systematic review and meta-analysis. Brain Sciences. 2025;15(6):658. doi:10.3390/brainsci15060658
- Malliaras P, Barton CJ, Reeves ND, Langberg H. Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Medicine. 2013;43(4):267–286. doi:10.1007/s40279-013-0019-z
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015;36(4):811–816. doi:10.3174/ajnr.A4173
- Geneen LJ, Moore RA, Clarke C, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2017;4:CD011279. doi:10.1002/14651858.CD011279.pub3
- Naugle KM, Fillingim RB, Riley JL. A meta-analytic review of the hypoalgesic effects of exercise. The Journal of Pain. 2012;13(12):1139–1150. doi:10.1016/j.jpain.2012.09.006