By Dr. Brett Poniros, DC, CSCS
One of the most common questions people ask when starting rehab is whether it should be completely pain free.
For years, the dominant message in healthcare and fitness has been that pain during rehab is bad — a sign that something is being damaged. While that idea is well-intentioned, it oversimplifies a much more nuanced clinical reality.
In many cases, designing rehab with the sole goal of avoiding any discomfort slows progress and limits meaningful improvement.
Here is why: pain is not the same thing as injury, tissue damage, or harm. Pain is a protective signal influenced by many factors — past experiences, stress levels, sleep quality, inflammation, and overall health status. When we treat it as the ultimate measure of what is safe, we tend to keep intensity far too low to create real adaptation.
Without enough challenge, tissues do not build capacity. Strength does not improve. And confidence in movement remains fragile — often becoming the biggest barrier to full recovery.
That does not mean pain should be ignored or pushed through blindly. There is an important clinical distinction between productive discomfort and genuine warning signs.
Productive discomfort is normal in many rehabilitation contexts, particularly when rebuilding tolerance to movement and loading that has been avoided for weeks, months, or years. This is especially true for chronic pain conditions, tendon issues, osteoarthritis, and post-injury deconditioning — the same "environment, not just the joint" thinking we apply in Osteoarthritis: More Than Just Wear and Tear. Tissues need exposure to load to adapt, and that exposure does not always feel perfectly comfortable at first.
This is not just a theory. In a randomized controlled trial of patients with Achilles tendinopathy, one group was allowed to continue running and jumping during rehab as long as their pain stayed at or below a 5 out of 10 and settled back down by the next morning, while a second group avoided load-bearing activity entirely for the first six weeks. Both groups improved significantly, and the researchers "could not demonstrate any negative findings" for the group that kept training under pain guidance.[1] Avoiding all discomfort was not what protected the tendon — following clear, sensible pain rules was.
Warning signs are different. Pain that rapidly escalates, lingers for days, consistently worsens overall symptoms, or meaningfully changes how someone moves is a signal that the dosage is off — not that the approach is correct and simply hard.
Good rehab does not glorify suffering. It does not rely on pushing through sharp, aggressive, or unpredictable pain. It uses discomfort as information — not as something to fear, and not as something to chase.
The real question in rehab is not whether it should be pain free. The question is whether it is challenging enough to drive change without overwhelming the system.
Avoiding all discomfort leads to staying in a narrow bubble of "safe" movement that never actually expands. Over time, this reinforces the belief that the body is fragile — and that belief alone can limit recovery as much as the original injury. It's one of the same recovery traps we cover in 4 Common Recovery Mistakes That Are Keeping You in Pain: stopping all activity almost always slows healing rather than protecting it.
Real function, real resilience, and real confidence require progressively challenging strength, range of motion, and tolerance to load. That process almost always involves some degree of discomfort along the way.
This is where working with someone who understands the nuance matters.
Our approach to chiropractic care and rehab is built around this balance. We do not chase pain. We do not avoid it at all costs. We assess what the joint, tissue, and nervous system can handle — then apply the right amount of stress to promote adaptation.
When done well, rehab builds capacity, not fear. The right rehab does not eliminate sensation. It uses it wisely.
Dr. Brett Poniros, DC, CSCS is the founder of Apollo Performance Chiropractic & Training in Pleasantville, NY.
