Should you train through pain?

Tim Stevenson
Jan 9
4 min read

Nottingham shoulder physiotherapy clinic session

Pain is complicated and when it shows up during training or rehab, it raises one of the most common questions in the gym and clinic: should you train through pain?

The honest answer is both yes and no.

If someone tells you it’s always one or the other, they’re oversimplifying a complex problem. Pain isn’t automatically a stop sign, but misunderstanding it, or ignoring what it’s telling you, can quickly send your progress backwards.

Pain doesn't always mean damage

Traditional thinking says pain equals injury. But modern pain science tells a different story.

Pain is an output of your nervous system, not a direct measure of tissue damage. You can have pain without damage and damage without pain.

Your pain experience is influenced by many factors:

Fatigue and sleep
Stress and emotional state
Previous injuries
Beliefs and fear around movement

That’s why the same exercise might feel fine one day and painful the next even though nothing structurally changed.

What the Research Shows

Recent studies comparing mildly painful exercise to pain-free exercise during rehab found something surprising; those who allowed a small amount of controlled pain often recovered better function and confidence in movement.

Why? Because exercise does far more than rebuild muscle or strength. It can also:

Reduce pain sensitivity
Desensitize the nervous system
Rebuild trust in movement
Improve coordination and control

Pain that’s low, predictable, and settles quickly is usually a sign of safe adaptation, not harm.

🧠 Research snapshot: Smith et al., BJSM 2019 – Pain that is tolerable and settles quickly is considered safe.

When training through pain is ok

During injury rehab, it’s often safe and beneficial to train through low-level pain, as long as it follows these simple rules:

✅ Pain stays ≤ 4/10

✅ Pain doesn’t escalate during your session

✅ Pain settles quickly after training

✅ Pain isn’t worse the next day

When pain behaves like this, it usually reflects a load response rather than new tissue damage. The tissue is being challenged, not threatened.

Exercise in this range activates natural mechanisms like exercise-induced hypoalgesia, where the body temporarily reduces pain sensitivity. Over time, your nervous system learns that movement is safe again.

When pain is a warning sign

Of course, not all pain is safe. “Bad” pain typically looks different and your body will often make it clear.

Red flags for pain that needs attention:

Pain escalates during the session
Pain lingers for hours afterward
Pain is worse the next day
Movement quality changes or becomes restricted
Symptoms worsen over time

This kind of pain doesn’t always mean damage, but it’s a sign your system is under too much threat. It’s time to back off, reassess, and possibly get guidance from a coach or clinician.

A Real-World Example

Last year, I dealt with a complex shoulder issue that started as a mild pull-up niggle. After a tough mountain biking trip and a stressful month, the pain flared into my neck and upper trap.

It stopped me training properly for weeks until I began structured rehab. My recovery wasn’t pain-free, but the pain was predictable, low-level, and appeared only in weak positions.

As strength and control improved, the pain faded.

That process reminded me that rehab isn’t about avoiding pain entirely it’s about retraining your system to move with confidence again.

It's not just about strength

Many assume that pain relief comes purely from getting stronger. However, recent research shows no direct causal link between strength gains and pain reduction in common conditions like tendinopathy, rotator cuff pain, or osteoarthritis.

Rehab works through multiple pathways and strength is just one. Movement and load also help to:

Reduce fear of movement
Improve confidence and pain self-efficacy
Shift beliefs about what pain means
Trigger positive neurological and biochemical changes

That’s why the best rehab is not just physical. It’s neurological and psychological, too.

So to summarise...

✔️ Safe pain: Low-level, predictable, and settles quickly — usually a sign of adaptation.

🚫 Bad pain: Escalates, lingers, or changes how you move — deserves respect.

Training through pain isn’t about toughness. Avoiding all pain doesn’t build resilience either. The key is smart load management and understanding your signals.

At the shoulder, this is especially important. Confidence and control often matter more than structure or strength alone.

So... Should You Train Through Pain?

✅ Yes, when it’s low, stable, and improving over time.

❌ No, when it escalates, lingers, or disrupts your movement quality.

Recognising the difference and acting accordingly is what separates smart rehab from setbacks.

If you’re unsure, work with a rehab coach or clinician who understands load progression and pain science. The goal isn’t just to remove pain; it’s to restore function, confidence, and performance.

🎥 watch our full video: “Should You Train Through Pain? The Truth About Rehab, Injury, and Performance.” And don’t forget to subscribe to the Dynamic Shoulders YouTube channel for more evidence-based insights.