No Pain, No Gain: A Physical Therapist’s Perspective

Alex Blank, DPT

At some point in time we have all heard the phrase “no pain, no gain”.

Maybe it was shouted by a coach, a teammate, or anyone who has tried to motivate us in a time of physical or emotional discomfort.

Originally this saying was not reserved to only physical pain but also meant to represent how you must FEEL the effort you are putting forth in order for progress to occur.

As a former collegiate wrestler I think back fondly on those moments where I was forced to look deeply within myself and find strength that I did not know was there in order to push past personal anguish.

As a physical therapist, I reflect on these memories and wonder if I would have condoned this mentality during training.  I am here to share my thoughts on this old adage as well as provide guidelines to help outline a more balanced approach to pursuing physical activity.


In this article I hope to address the following:

  • qualifying traits of physical discomfort vs. pain,
  • understanding when ‘enough is enough’,
  • and outlining common pitfalls that may be unknowingly steering you to a ‘no pain, no gain mentality’.

Discomfort vs. Pain

To open this discussion, we need to draw a hard line between what is considered discomfort and what is considered pain. Discomfort can be expected with moderate to vigorous bouts of exercise; however, pain should never be present. If you have minimal experience with exercise or have not exercised in a while, it is important to understand what you are feeling during exercise is appropriate. I start my screening process for pain vs. discomfort by asking my patients a series of questions.

The following questions, if answered affirmatively would indicate pain during activity:

  • Is your discomfort sharp/ reproducible with a certain movement?
  • Does it come on before / during activity/ or linger after activity?
  • If it is present before activity/ does it get worse as activity persists?
  • Does the discomfort ease with modified movements?

The following questions are those that would indicate more fatigue related discomfort and thus are acceptable within tolerable limits:

  • Does it feel like more of a mild ache that progresses with exercise (i.e. muscle burn)?
  • Do you feel it in the muscles that you are intending to exercise?
  • Did soreness increase 24-72 hours after activity.

If present after activity, does it get better with light stretching/ movement?

Clearly defining what pain is during exercise is essential in making sure that the movements you are doing are not actively causing you harm. We will continue to explore the adage of “no pain no gain” by moving away from the literal sense of pain and begin to make a case for how more isn’t necessarily better.


How to know when enough is enough?

As a physical therapist I look at exercise as medicine. Like all medication, exercise has a desired dosage where it is most effective. Underutilized and we do not get the positive effects and if over utilized, we run into unnecessary side effects. Too much of anything can lead to negative consequences.  When consistently pushing beyond physical limits, our body will give us indications that it is being overworked.

Examples of those signs include:

  • Chronic/ nagging injuries
  • Loss of appetite
  • Excessive Fatigue
  • Decreased performance
  • Increased perceived effort during physical activity

Most of the people I treat present with symptoms that came on without a known onset.

Typically, this can be a sign of: pushing too hard during workouts, exercising too frequently, exercising for too long, or doubling down on the same type of exercise too often. If during your training you are experiencing any of the things mentioned above you may have exceeded the dosage of exercise that would be beneficial to your body and therefore are not ‘gaining anything from the pain’. The next section examines how the essence of the “no pain, no gain” mentality is more common than we think and that it may be moving us further away from balance.

Moving away from balance:

One thing I encounter when speaking with people about how they approach physical activity is that this mindset of “no pain, no gain” is not reserved to hard- core exercisers. In fact, many people who begin/ resume an exercise program become victim to this mindset without even realizing that they are thinking that way. Even if you do not begin a workout program with the intention that you are going to find your physical limits, there are many external factors that influence our exercise habits towards a level of activity that is beyond what our body would benefit from.


Below is a list of things that I find to be contributory to a mentality that can lead to working out harder than we should:

High intensity workout craze:

Over the last few years “boot camp classes/ HIIT classes/ and workouts that combine weight lifting with interval training have caught fire. I feel that if the person has the physical capacity to do these exercises it can be a great thing in moderation. What has come with this trend is the mentality of “let’s get one more rep”… “Push yourself”…. “Gut it out”…. That feeling of succeeding against physical or mental fatigue is incredible. However, that feeling can become addicting and as a result there can be an expectation to achieve that with every workout. As a result, the focus of exercise becomes seeking a feeling rather than moving for the sake of health.

Weight loss:

Many people begin to exercise with the intention to lose weight. I believe that where exercise is a key part of weight loss, exercise goals should be kept separate from weight loss goals. If you begin to exercise with weight loss in mind every workout becomes about how it is going to help you lose the weight. This again has the potential to move to a place of pushing beyond your physical capacity because keeping pace with weight loss goals is driving the bus.


“No pain, no gain” is a powerful motivator in times when we have a specific / finite goal in mind.

Athletes looking to edge out their competition, military members who need to be in top physical shape to ensure their own safety, etc. However, when we look to the individuals who are doing physical activity for the sake of longevity, I do not believe this adage has a place. We should ask ourselves not what we can do today but rather, what will be able to do tomorrow. As a result, I encourage you to explore what exercises feel appropriate for you, pay attention to how your body feels before/ during/ after exercise, and move for the sake of moving without ulterior motives pushing you to do more than you are capable of.

By no means do I feel that everyone falls into the category of over doing it.

However, if you feel that every time you start an exercise program with the best of intentions only to be sidelined by injury or burnout then it may be time to reevaluate the approach. If at any time you feel like you need help striking that balance we are here to help guide you out of pain, through exercise, and into greater health.


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