Is Pain During Exercise Normal? The Pain-Monitoring Traffic Light

Below 5Pain allowed during exercise in the pain-monitoring model (on a 0–10 scale)

Next morningPain that increases after exercise is expected to settle by the next morning

Week to weekPain and stiffness should not increase over the weeks

7 studiesExercise that allowed some pain gave slightly better results in the short term

Check yourself

Your traffic light today

1. How much pain do you have during exercise?2

0 · none10 · unbearable

2. Your pain and stiffness the next morning?

3. This week, compared with last week?

This tool is not a diagnostic tool; it helps you adjust exercise for long-lasting musculoskeletal pain.

Three zones

GreenPain 0–2

Carry on comfortably. If there is no problem the next day either, you can slowly increase the load.

YellowPain 3–4

Acceptable. If the pain settles by the next morning and does not increase from week to week, carry on at the same load.

RedPain of 5 or more, pain that has not settled by the next morning, or pain that increases from week to week

Reduce the load, but do not stop completely. If it does not improve, ask a specialist.

What does the research say?

38 people with Achilles tendon problems: there was no significant difference in pain and function between those who continued activity while monitoring their pain and those who stopped activity for the first 6 weeks. In the model, pain during exercise was not allowed to reach 5; pain that could reach 5 after exercise was expected to settle by the next morning and not to increase from week to week.
7 studies, 385 people: in long-lasting musculoskeletal pain, exercise that allowed pain gave slightly better results than pain-free exercise in the short term; there was no difference in the medium and long term.

You can find out why pain does not always mean damage on the understanding pain page.

Stop straight away

Chest pain, dizziness, palpitations or unusual breathlessness (call 112 if it does not settle)
Sudden, sharp pain or a “popping” feeling during exercise, followed by swelling
New numbness, tingling or weakness
A hot, red and swollen joint

Frequently asked questions

Should there be no pain at all during exercise?

Not necessarily. In a review of studies on long-lasting musculoskeletal pain, exercise programmes that allowed some pain gave slightly better results than pain-free programmes in the short term; in the medium and long term there was no difference. According to the authors, pain during exercise need not prevent a good outcome.

My pain was worse the next day. What should I do?

If the pain had not settled by the next morning, reduce the load at your next session: fewer repetitions, a lighter weight or a shorter time. Rather than stopping completely, try to find the level at which the pain stays within acceptable limits.

Isn’t complete rest safer?

Not always. In a study of 38 people with Achilles tendon problems, there was no significant difference in pain and function between those who continued activity while monitoring their pain and those who stopped activity for the first 6 weeks.

Do these rules apply to all pain?

No. This model is used for long-lasting pain coming from tendons, joints and muscles. If you have a new injury, have recently had surgery or have a hot and swollen joint, follow the advice of your doctor or physiotherapist. With symptoms such as chest pain or dizziness, stop exercising straight away.

Sources

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. Am J Sports Med. 2007;35(6):897–906.
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.