Should You Avoid Pain When Exercising?

"No pain, no gain." It is one of the most enduring phrases in exercise culture — and one of the most misapplied when it comes to rehabilitation. On the other side of the coin, many patients are told to stop the moment any discomfort arises, which can inadvertently reinforce fear of movement.

The clinical reality is more nuanced than either extreme suggests. Understanding how clinicians think about pain during exercise can help you make better decisions about your own rehabilitation.

Pain During Exercise Is Not Always a Warning Sign

Pain is the body's alarm system — but like any alarm, it can be overly sensitive, particularly after injury or in the context of chronic pain. The nervous system can become sensitised, responding to loads and movements it would previously have managed without producing a pain signal.

In this context, pain during exercise does not reliably indicate that tissue damage is occurring. Research into pain science over the past two decades has consistently demonstrated that pain is influenced by many factors — including the nervous system's threat assessment, psychological state, previous pain experiences and even expectations about what an exercise will feel like.

This means that avoiding all pain during rehabilitation — while intuitively protective — can actually impede recovery by reinforcing avoidance behaviour and preventing the progressive loading that builds tissue capacity.

The Traffic Light Framework

One of the most clinically useful approaches to managing pain during exercise is a simple framework that categorises discomfort into acceptable and unacceptable ranges.

Green — Acceptable

Mild discomfort or a sense of familiar ache during exercise that:

• Does not exceed 4/10 on a pain scale during the activity
• Does not significantly worsen during the session
• Returns to baseline within a few hours of completing exercise
• Does not leave you worse off the following day

Pain in this range is generally considered acceptable to continue through in a rehabilitation context.

Amber — Monitor Carefully

Pain that rises above 4/10, or discomfort that is unfamiliar or difficult to classify. This does not necessarily mean stopping — but it warrants closer monitoring and may indicate that the load or range needs to be modified.

Red — Stop and Reassess

Symptoms that should prompt stopping exercise and seeking clinical assessment:

• Sharp, stabbing or severe pain during exercise
• Neurological symptoms — numbness, tingling, weakness
• Pain that significantly worsens during the session
• Pain that remains elevated 24 hours after exercise
• Any new or unfamiliar symptoms that concern you

The 24-Hour Rule

One of the most practical guidelines for managing exercise progression in rehabilitation is the 24-hour rule: how are your symptoms the morning after exercise?

If your pain has returned to its pre-exercise baseline within 24 hours, the load applied was likely within your current tolerance. If pain is significantly elevated the following day, this is a signal that the session was too demanding — and that the next session should be modified before progressing.

This rule is not about achieving zero pain. It is about ensuring that exercise is not consistently loading the system beyond what it can recover from, which would impede rather than support progress. This is closely related to the broader question of when to rest and when to keep moving.

Why Avoiding All Pain Can Slow Recovery

Clinicians who work with persistent pain and rehabilitation consistently observe a pattern: patients who are highly pain-avoidant tend to have worse outcomes than those who develop a more confident relationship with discomfort during activity.

This happens for several reasons:

Under-Loading

If exercise is always stopped before any discomfort is reached, the progressive loading stimulus needed to build tissue capacity is never applied. Tissues adapt to the demands placed on them — without adequate demand, adaptation stalls.

Reinforcing Fear

Consistently treating pain as a signal to stop reinforces the belief that pain means harm. Over time, this can make the nervous system more reactive to movement — increasing pain sensitivity even in the absence of tissue change. This is one of the mechanisms behind why some patients are not getting better despite doing everything they are told.

Loss of Function

Avoiding activity to avoid pain can lead to a progressive loss of function — reduced fitness, strength and movement confidence — that makes return to meaningful activity increasingly difficult.

How Clinicians Guide Exercise Progression

Rather than using pain alone as the guide, evidence-informed clinicians use a combination of:

• Objective measures of capacity — strength, range, functional tests
• Symptom monitoring — using frameworks like the traffic light model
• Load management principles — matching training demand to current capacity and recovering adequately between sessions
• Patient education — helping patients understand what their symptoms mean and how to interpret them

This kind of guided approach is particularly important in the early stages of rehabilitation, when the patient may not yet have the experience to interpret their own symptoms accurately. Our team at Elevate Health Clinic in Bella Vista provides this kind of structured, supervised rehabilitation for patients managing pain during exercise.

Frequently Asked Questions

Is it okay to exercise if I have pain?

This depends on the nature and context of the pain. For many musculoskeletal conditions, some level of discomfort during exercise is acceptable as part of a progressive rehabilitation programme. Sharp pain, neurological symptoms or pain that significantly worsens warrant reassessment.

How much pain is too much during exercise?

A commonly used clinical guide is keeping pain within the 0–4 range on a 10-point scale. Pain above this level, or pain that remains elevated 24 hours after a session, often suggests the load needs to be reduced before progressing further.

What if exercise makes my pain worse?

If exercise consistently worsens your pain, this is a signal to reassess your programme — not necessarily to stop exercising. Adjusting the load, range or type of exercise is usually more appropriate than cessation.

References

1. Moseley GL & Butler DS. (2015). Fifteen years of explaining pain: the past, present, and future. Journal of Pain, 16(9), 807–813.
2. Lewis J & O'Sullivan P. (2018). Is it time to reframe how we think about pain? British Journal of Sports Medicine, 52(24), 1543–1544.
3. Zusman M. (2008). Associative memory for movement-evoked chronic back pain and its extinction with musculoskeletal physiotherapy. Physical Therapy Reviews, 13(4), 261–271.
4. Gatchel RJ, et al. (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin, 133(4), 581–624.

You wake up stiff. You struggle to put your shoes on. By mid-afternoon, sitting is unbearable — but standing hurts too. If that sounds familiar, you're one of the 4 million Australians dealing with lower back pain right now.

The good news? Most lower back pain responds quickly to the right approach. The bad news? Most people are doing the wrong things — resting too much, chasing the wrong diagnosis on scans, or skipping the treatment that actually works.

This guide cuts through the noise. As a chiropractor and physiotherapist who has treated thousands of back pain patients in Bella Vista and Earlwood, here's what you actually need to know.

What Actually Causes Lower Back Pain?

Most people assume back pain means something is structurally broken. In reality, 90% of lower back pain is classified as non-specific — no single structural finding explains it.

Muscle and Ligament Strain

The most common cause. Overloaded or fatigued muscles from prolonged sitting, poor lifting or sudden awkward movements. Usually resolves in days to weeks with the right approach.

Facet Joint Dysfunction

The small joints between each vertebra become irritated or restricted. This causes a deep, aching pain — often worse in the morning, better once you get moving. Responds very well to chiropractic adjustment.

Disc Injury (Bulge or Herniation)

The intervertebral discs act as shock absorbers. Under repeated stress they can bulge or herniate — sometimes pressing on nerves and causing leg pain (sciatica). Important: disc bulges are extremely common and often completely painless. Research shows 40% of people over 40 have disc bulges on MRI with zero symptoms.

Sacroiliac Joint Dysfunction

The joint connecting your spine to your pelvis. When irritated, it causes deep buttock pain that often mimics sciatica — but comes from a completely different source.

The Biggest Mistake People Make

Getting a scan and chasing the finding. Imaging has its place — but structural findings frequently don't explain your pain. Research consistently shows that findings on MRI don't reliably predict pain or recovery. We regularly see patients with "normal" scans in severe pain, and patients with significant disc degeneration who are completely pain-free.

Treatment should be guided by your clinical presentation — not your scan result.

What Actually Works for Lower Back Pain

Stay Active

Bed rest was standard advice for decades. We now know it makes things worse. Movement promotes disc nutrition, reduces muscle deconditioning and helps your nervous system recalibrate its pain response. Gentle, consistent movement is non-negotiable.

Manual Therapy

Hands-on treatment — spinal manipulation, joint mobilisation, soft tissue therapy — has strong evidence for both acute and chronic lower back pain. It reduces pain, restores movement and gets you back to function faster than passive rest alone.

Targeted Exercise

Generic gym exercises won't cut it. You need a program targeting the specific muscles failing you — typically the deep stabilisers (transversus abdominis, multifidus) and the posterior chain (glutes, hamstrings). Progressive loading of these structures is the most durable long-term solution.

Pain Education

Understanding that pain does not equal damage is genuinely therapeutic. Fear-avoidance behaviour — avoiding movement because you're scared of making things worse — is one of the primary drivers of chronic back pain. When patients understand their pain, they recover faster.

Exercises That Actually Work

Avoid crunches and sit-ups — they generate excessive disc compression. These are better:

Bird-Dog

From four-point kneeling, extend one arm and the opposite leg while keeping the spine neutral. Hold 3–5 seconds, 8–10 reps each side. Activates the multifidus and erector spinae with near-zero spinal compression.

Glute Bridge

Lying on your back, feet flat on the floor, push your hips to the ceiling by squeezing your glutes. Hold 2–3 seconds at the top. Glute weakness is one of the most overlooked contributors to back pain.

Dead Bug

Lying on your back, arms vertical, knees at 90 degrees. Slowly lower one arm and the opposite leg toward the floor while keeping your lower back flat. Return and repeat. Challenges the deep stabilisers without loading the spine.

McGill Side Bridge

Side-lying with elbow under shoulder, lift your hips to create a straight line. Hold 10–30 seconds. Targets the quadratus lumborum and obliques — key lateral stabilisers of the lumbar spine.

When Should You See a Professional?

See a chiropractor or physiotherapist if:

• Pain has lasted more than 2 weeks without improvement
• Pain is radiating into your leg
• You have numbness, tingling or weakness in a leg
• Pain significantly limits your daily function
• You've had multiple recurrences

Seek urgent medical attention if you experience loss of bladder or bowel control, numbness in the saddle area (inner thighs), or progressive leg weakness. These are red flags for cauda equina syndrome — a rare but serious emergency requiring immediate hospital care.

Frequently Asked Questions

How long does lower back pain take to heal?

Acute lower back pain typically improves within 2–6 weeks with appropriate management. Chronic lower back pain (lasting more than 12 weeks) takes longer — often 3–6 months — but responds well to a combined manual therapy and exercise approach.

Should I use ice or heat for lower back pain?

For acute injury in the first 48–72 hours, ice can reduce localised inflammation. After that, heat is generally more effective — it reduces muscle spasm, increases tissue extensibility and improves blood flow to the area.

Is walking good for lower back pain?

Yes — walking is one of the most evidence-supported interventions for lower back pain. It activates deep stabilisers, promotes disc hydration through cyclic loading, and helps reduce fear-avoidance behaviour. Aim for 20–30 minutes at a comfortable pace daily.

Can a chiropractor fix lower back pain?

Chiropractic adjustment has strong evidence for both acute and chronic lower back pain. At Elevate Health, we combine spinal manipulation with soft tissue therapy and exercise prescription — addressing the joint mechanics, the muscular system and the movement patterns driving your pain.

Will I need surgery?

The vast majority of lower back pain — including disc herniations and nerve compression — resolves with conservative (non-surgical) treatment. Surgery is considered only when conservative care has failed after 6–12 weeks, or in rare cases of progressive neurological deficit.