Pain is not only a common part of training and physical activity but it’s a common part of life. The high likelihood is that if you are quite active, you train hard or regularly, or even if you are of a certain age, pain is likely a frequent occurrence. Therefore, waiting for pain to subside is neither intuitive or productive.

Having a basic knowledge of pain is important, because not all pain means the same thing. Some pain is a normal response to loading the body, while other pain is a signal to modify, pause, or rethink how you’re training. Understanding where your pain may be coming from can help you make better decisions about whether it’s wise or acceptable to keep exercising, and how to do so safely.

Pain doesn’t automatically mean you should stop training

Pain is produced by the nervous system to protect you. While it often reflects tissue stress, it’s also influenced by fatigue, stress, recovery, past injuries, and how sensitive your nervous system is on the day.

That’s why pain:

Doesn’t always mean injury
Doesn’t always reflect damage severity
Can fluctuate independently of tissue healing

The key question for training isn’t “Do I have pain?”
It’s “What type of pain is this, and how should I respond to it?”

1. Somatic pain: pain from muscles, joints, and tissues

This is the most common pain experienced during training.

Common training-related examples:

Muscle soreness or strain
Tendon pain during loading
Joint pain with squats, running, or lifting
Post-exercise stiffness

What it often feels like:

Achy, sore, sharp, or localised
Predictable with certain movements or loads
Settles with rest or modification

Is it acceptable to train with somatic pain?

Often yes, with boundaries.

Somatic pain commonly reflects how tissues are responding to load. In many cases, continuing to train with modified intensity, volume, or range is not only acceptable but beneficial.

Generally acceptable if:

Pain stays mild to moderate (e.g. ≤3–4/10)
Symptoms settle within 24–48 hours
Movement quality remains good
Pain does not progressively worsen week to week

Caution if:

Pain is sharp and worsening
Swelling or loss of function increases
Pain persists or escalates after each session

2. Neuropathic pain: pain related to nerve irritation

This type of pain requires more caution during training.

Common training-related examples:

Sciatic pain during deadlifts
Arm pain or tingling during overhead work
Numbness or burning during cycling or gripping

What it often feels like:

Burning, electric, shooting
Pins and needles or numbness
Pain travels along a limb

Is it acceptable to train with neuropathic pain?

Sometimes, but carefully.

Nerves are less tolerant of compression and stretch than muscles or tendons. Continuing to train through nerve pain can sometimes worsen symptoms if loads or positions are not adjusted. Additionally, neural pain types don’t always trigger symptoms immediately, so there is no clear incentive to stop. This latency of pain makes it worth exercising much more caution.

Training may be acceptable if:

Symptoms are mild and not progressive
No increasing numbness or weakness
Pain does not spread further down the limb
Load and positions are modified

Avoid pushing through if:

Numbness or weakness increases
Pain becomes constant or severe
Symptoms worsen during or after sessions

3. Nociplastic pain: pain from a sensitised system

Where it comes from:
Altered pain processing in the nervous system without clear tissue damage or nerve injury. This is a pain type that is often misunderstood but exercise is critical to re-expose the nervous system to safe, normal movement experiences, which helps dial down sensitivity over time.

Common examples:

Persistent low back or neck pain
Fibromyalgia
Chronic widespread pain
Long-standing tendon pain that hasn’t settled as expected

What it often feels like:

Pain that seems disproportionate to activity
Diffuse or poorly localised
Sensitive to stress, fatigue, poor sleep, or emotional load
Symptoms fluctuate day to day, despite similar training

Common training-related examples:

Long-standing back or neck pain with normal scans
Pain that flares unpredictably with exercise
Widespread soreness not linked to specific movements

Helpful thing to know:
This pain is real, but it doesn’t mean your body is broken. The nervous system has become overprotective. Rehab focuses on gradually rebuilding confidence with movement, improving capacity, and calming the pain system rather than “fixing” damaged tissue.

Is it acceptable to train with nociplastic pain?

Yes, and often necessary, but not aggressively.

With nociplastic pain, avoiding exercise entirely often worsens sensitivity over time. The goal is graded exposure, not pushing through high pain.

Training is usually encouraged when:

Pain is monitored and kept tolerable
Progression is slow and predictable
Flare-ups are expected but short-lived
Focus is on consistency over intensity

Less helpful approaches include:

“No pain, no gain” mindsets
Large jumps in volume or intensity
Constantly testing limits

4. Inflammatory pain: pain driven by inflammation

Often this type of pain is easily explained, either by acute trauma (e.g. a twisted knee) or perhaps a disease process (e.g. rheumatoid arthritis). Inflammatory pain responds differently to training load.

Common training-related examples:

Joint pain and stiffness after rest
Flare-ups during high-volume phases
Swelling or warmth in joints

What it often feels like:

Deep ache and stiffness
Worse in the morning or after inactivity
Improves with gentle movement

Is it acceptable to train with inflammatory pain?

Yes, but intensity matters.

Complete rest can increase stiffness and pain, but excessive loading can worsen inflammation.

Training is usually appropriate when:

Movement is low-impact and controlled
Volume and intensity are reduced during flares
Recovery is prioritised

Caution if:

Swelling and pain escalate after sessions
Fatigue and pain accumulate across days

5. Referred pain: pain felt away from its source

Referred pain can complicate training decisions.

Examples:

Shoulder pain driven by the neck
Knee pain originating from the hip
Buttock pain linked to the lower back

Is it acceptable to train with referred pain?

Often yes, once the source is understood.

Training the painful area alone may not resolve symptoms, but full training cessation is rarely necessary.

Key training takeaways

Pain does not automatically mean stop
Different pain types respond differently to load
Most people can continue exercising with smart modifications
The goal is long-term training consistency, not short-term pain elimination

Understanding your pain helps you train with your body rather than against it. The goal is not to eliminate all sensation, but to find the right balance between protection and progression.

A physiotherapist can help you determine what level of pain (if any) is safe, how to modify training appropriately, and how to progress with confidence. With the right guidance, movement can remain a powerful and safe tool for recovery, even when pain is part of the journey.

Chris Dillon

APA Sport & Exercise Physiotherapist