Q: What do Benjamin Franklin and Jane Fonda have in common?
A: No pain, no gain
A phrase popularised by Jane Fonda in her famous 80’s exercise videos but can be credited to Benjamin Franklin (1978); “He that lives upon hope will die fasting. There are no gains, without pains”. Same words, different message – confusing?
Here we discuss:
- Should you really need to feel pain to make progress when exercising/doing rehab programme?
- Is there is a difference between good and bad pain?
- What should I do if something doesn’t feel right?
First let’s discuss pain. The International Association for Study of Pain (IASP) defines pain as:
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
It further states that …
“pain is always subjective, and each individual learns the application of the word through experiences related to injury in early life.”
Pain is subjective which makes it difficult to generalise. However, there are some accepted principles of wisdom to think about when you are exercising, which might help to guide you.
Recent studies show that rehab does not need to be entirely pain free to be effective. Sometimes trying to rehab without any pain is difficult and would make the process very slow indeed. A meta-analysis (big study of studies) by Smith et al. (2017) on chronic musculoskeletal injuries found that, “pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcome”.
But how much is too much?
Studies comparing the recovery of people with soft tissue injuries compared groups exercising with no pain v pain up to a 4/10 (pain scale of 0= no pain & 10 = worst pain you can imagine).
There were no negative effects on rehab times in the group allowing pain up to the 4/10 threshold (Hickley et al. 2019). They also found that those allowing a low level of pain when training made greater strength gains during the same time.
Tendon injury studies have highlighted some clear guidelines as laid out by Silbernagel et al. (2007) showing that progressive loading (strengthening) of 5/10 pain and higher, have beneficial effects on recovery. There are however some clear rules that apply as shown in the image. Pay attention to how your body feels! You should be progressing week on week, if not then perhaps you are doing too much.
- Pain on any activity of up to 4/10 in most cases is fine as long as the pain subsides and is reducing over time. Use the model above as a guide.
- Your pain during and after an exercise should be tolerable.
- Your injury should be improving week on week, if it’s worsening then rest and reduce the intensity of your exercises.
- You do not have to exercise with pain, you can still make progress without, but do not be afraid of some discomfort.
- Above all listen to your body AND your therapist, as always some exceptions apply.
Hickey JT, Timmins RG, Maniar N, Rio E, Hickey PF, Pitcher CA, Williams MD, Opar DA. Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial. J Orthop Sports Phys Ther. 2019 Jun 28:1-35. doi: 10.2519/jospt.2019.8895. Epub ahead of print. PMID: 31253060.
Smith BE, Hendrick P, Smith TO, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017;51(23):1679-1687. doi:10.1136/bjsports-2016-097383