What’s the Difference Between Good Pain and Bad Pain?

Pain is part of the privilege of endurance sports. It's how you know you're pushing your limits. But how do you know when it's really time to stop? We ask a PT for her advice.

Good pain versus bad pain
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A coach might yell it to a team during their conditioning practice, or maybe a spin instructor smiles encouragingly at you and says it to encourage you to keep it up. The point is, “no pain, no gain” is ubiquitous, catchy, and not all together wrong. It all depends on what the actual pain is, and if you’re feeling something nefarious or simply uncomfortable. 

So, let’s ask the first question: Is all pain created equal? 

The answer is no, thank goodness. Can you imagine if every bug bite felt like a bone break? Our body has created a finely tuned modulating system to identify the painful source, communicate that to the brain, and then your brain issues a series of commands to handle the pain. We’re not focusing on those pathways in this article, but suffice to say there are countless variations in how your brain is interpreting different types of pain: sharp pin pricks, an unexpected toe jam, or a repetitive exposure to a painful source will all trigger interpretations and responses by your brain. 

Do we need pain to get better?

Progressive overload is the concept that stress to your musculoskeletal system is required to force your system to adapt to the demand and get stronger. To increase your ability to generate force, applying a 2.5-5% training volume increase per week sees optimal strength gains (within a safe limit). After that time period, though, some studies suggest shifting some of the fundamental exercises and elements of your training block to continue to progress. The body craves novelty and new stressors. In a very simple way, the term “no pain, no gain” could very much be the pithy version of “no increase in demand on your system, no change in your body.”

Related: How to Keep Your Knees Happy

What kind of pain is okay? 

Endurance athletes are in one of the top risk categories for injury, especially for injuries like tendinopathies and other syndromes associated with overuse. Some of that risk can be ascribed to the fact that we have to work hard to continue to progressively overload our systems when our sports demand so much repetitive motion. But when you feel that niggle of pain, do you need to rest? Can you keep going? Let’s break down some major differences between what good pain and bad pain look like and how you can identify it. 

Good pain is pain due to stress to the system. If you’re in the middle of a tempo ride and feel your legs screaming at you, you’re probably right where you should be to cash in on your workout and progress your program. Not many endurance athletes have trouble identifying truly “good” pain. 

Bad pain is another simple category. Maybe you just sprained your ankle or fell off your bike. Or perhaps, after a week of high mileage, that irritable Achilles tendon suddenly swells and you feel like you can’t move it for a few days. You’re confident you have an injury of some sort and you’re going to check with your coach or PT before continuing your training.

There is another category. Let’s call it the “Don’t Panic” category. You start to notice your left low back is getting irritable after taking a hard turn on a trail. Or maybe the night after your big ride you notice that your right glute/hamstrings are seizing up. Things might even feel sharp. You’re starting to wonder if you should ping your coach or PT and ask what you should do. Is this the start of a major injury? This is the category that is paramount in identifying so that you can minimize your injury risk while not derailing your training. 

The good pain versus bad pain checklist

Use the following checklist to decide if you’re in the “Don’t Panic” category or if you’ve drifted into the bad pain category: 

  • How intense were/are my symptoms?

It can be frustrating to go to the doctor’s and be asked, on a scale of 0 to 10, how much pain you have. One person’s 10/10 could be another’s 4/10 (but more on that another time!).

What you can think of instead is this: How intense are your symptoms, with 0 being you don’t notice any difference side to side, 2-3 meaning you notice a difference but it’s more uncomfortable than painful, and 10 being seek urgent help. If you’re under a 3/10, you don’t need to pump the brakes. You can continue your ride/training.

  • At the beginning of my training session, was my pain achy, sharp, or something else?

Regardless of your type of pain, sensation will cause your body to subconsciously compensate for your form to protect that area. 

If you have sharp pain at a certain spot and during a certain motion, it’s time to stop and reassess again in a few minutes. 

If your aching pain is under 3/10, you can continue for now.

  • During/immediately after exercise, my pain changed to sharp or sharper. 

A change in the nature of your symptoms can indicate a few things about your joint and tendons. A substantial change to the sharp pain category is an indicator to get it checked out before continuing. 

  • Eight hours after my exercise, has my pain gotten better, stayed the same, or gotten worse?

If your sensation is persistent but otherwise unchanging, make a note. It’s not an immediate red flag, but if it continues for four or more days, you should get it checked out. 

  • The next day, how intense is my sensation? Is it still painful, or is it just noticeably tight?

Overnight discomfort that is painful the following day (not just mildly sore or slightly noticeable) is an indicator to stop and get it assessed. 

  • Did swelling or the sensation cause my form to change while training?

This is key. If you have 1/10 symptoms in your knee but it is the size of a bowling ball, there’s no way you’re loading evenly as you ride/run/weight bear on it, and your brain is communicating to your leg to shut down systems that might cause pain. You have to stop and treat the low hanging fruit before getting back out there.

Having some irritation to a joint that lasts one to two weeks is acceptable. In fact, when we are rehabilitating tendinous injuries, some irritation can be helpful in remodeling the tissue. With that in mind, focusing on how intense the sensations in your body are is the best way to begin realizing whether the pain is good pain or bad pain—and when you might need to seek help from a healthcare professional.

Related: Preventing Injuries Through Strength and Conditioning, with Jess Elliott