Good Pain vs. Bad Pain

As former athletes and trained physical therapists, we often have a solid understanding of what pain or discomfort is acceptable to push through and what pain should signal us to stop. However, a lesson I learned early in my career is that most patients don’t possess this knowledge—even if they insist they do. While high school, collegiate, or professional athletes might have a better grasp of this concept, it’s wise to approach every patient interaction assuming they may not know the difference.

Why This Matters

Consider this common scenario: a patient returns for their second session and says, “I was in so much pain after our last session.” Without further exploration, you might be tempted to adjust your treatment to avoid causing additional pain. However, in many cases, the “pain” they experienced was simply muscle soreness from a strength program—not actual pain indicating harm. Therefore, it’s crucial to fully understand what the patient is experiencing before altering your clinical approach.

Educating Patients on Good Pain vs. Bad Pain

One of the key concepts I teach almost every patient is how to distinguish between pain that’s acceptable to work through and pain that signals the need to stop.

I typically explain it this way:

“If you feel mild soreness, stiffness, or achiness during an exercise, and it goes away when you relax, it’s generally okay to continue. However, if the pain becomes more intense, sharp, or doesn’t go away when you stop the movement, that’s your body telling you to discontinue the exercise.”

This simple explanation can make a significant difference in a patient’s understanding. Each patient comes with their own background and experiences—some might have a good sense of what “good” pain is, while others may have no idea. Regardless of their experience level, educating them on this concept:

• Provides a clear framework for evaluating pain during exercise.

• Reduces anxiety about whether they’re doing the right thing.

• Builds confidence in their ability to manage their own recovery.

Best Practices for Patient Communication

I highly recommend having this discussion with your patients early in their treatment. Clearly outlining:

• What types of discomfort are normal (e.g., mild soreness, stiffness)

• What types of pain require caution (e.g., sharp, persistent pain)

• When to discontinue a movement

Explaining the “why” behind these guidelines helps patients feel more in control of their recovery and fosters trust in the therapist-patient relationship.

Final Thoughts

Helping patients understand the difference between good pain and bad pain is a small but impactful step toward improving their outcomes. By setting clear expectations, you empower them to stay engaged in their recovery process without unnecessary fear or confusion. Ultimately, this approach not only aids in their physical progress but also strengthens the therapeutic alliance, making for a more successful and positive experience for both parties.