Pain ≠ Damage in Rehab

One common misconception we hear a lot as physical therapists is that pain always means damage. While pain can certainly be an indicator that there is something wrong, it does not always relate to actual tissue injury or harm. Being able to understand and distinguish this is a key component of a successful recovery journey. Let's discuss how we make this distinction and how it can change the way we think about pain during movement and exercise with rehab. 

What Is Pain

Pain is a complex, protective response from your nervous system. Think of the sensation of pain as an alarm system on a car. When your body perceives a threat, it sends pain signals to alert you, like a car alarm would if a burglar smashed one of your car windows. This response is incredibly useful when you’ve just injured yourself, such as spraining your ankle or cutting your finger. In these cases, pain is your body’s way of alerting and protecting you from further harm by providing appropriate and useful feedback. 

However, our body’s “alarm system” can become faulty or hypersensitive, sending pain signals even when the tissue has healed or when there’s no significant injury. This would be like your car alarm going off when a leaf blew against the door. This is common in chronic pain conditions, where pain persists longer than expected. One thing that must be addressed during rehab is that you may feel pain, but it doesn’t necessarily mean you’re causing further harm or that your body isn’t healing.

Pain During Rehabilitation: What’s Normal?

It’s normal to experience some discomfort or pain when rehabbing new or old injuries. The key is to differentiate between types of pain and to understand what’s acceptable versus what may be concerning.

You’ve probably heard the saying “No Pain, No Gain” right? When rehabbing injuries there are some forms of beneficial pain.This occurs during interventions like manual therapy (“hurts so good” type of feeling) and during some exercises in rehab. But in order for this pain to be “productive”, it needs to be within tolerable limits, and these are all individual to the patient. We like to use a level of 3-4/10 as a general guideline for how intense of pain we find to be tolerable during rehab. This type of discomfort is a normal part of the healing process, especially when you’re rebuilding strength, retraining how you process pain, and when working through new ranges of motion. This can be a sign that your muscles are working and your tissues are improving. But as mentioned previously, there is a certain limit of pain that is acceptable and when it begins to become more intense than a 4/10 and/or does not go away after a day or two, you and your physical therapist may need to make some adjustments to your plan. 

Why Pain Isn’t a Perfect Indicator of Damage

Pain is multifactorial and influenced by a variety of factors, including your emotional state, stress levels, and previous experiences with pain. For example, if you’re feeling anxious about re-injury, your body might interpret normal sensations as painful. Similarly, if you’ve been dealing with pain for a long time, your nervous system can become more sensitive to even small changes in movement or pressure.

During rehabilitation, it’s essential to understand that some pain is part of the recovery process. Just because something hurts doesn’t mean you’re causing damage. As a physical therapist, we will help you navigate these sensations safely, providing the right balance of challenge and protection to guide you through recovery. 

Building Resilience and Trusting Your Body

The ultimate goal when rehabbing an injury is to help you regain confidence in your body’s ability to move without fear of pain or injury. By understanding that pain doesn’t always mean harm, you can push through certain discomforts that are part of the healing process, rather than avoiding movement altogether. Over time, this helps desensitize your nervous system and rebuilds your strength, endurance and mobility, getting you back to living your life with less pain.