Physical therapy should NOT be extremely painful. If you are experiencing extreme pain during or after therapy it’s likely that you are doing the wrong exercises or interventions, going to hard, or are just in a highly tissue irritable state. 

It’s incredibly important to tell your therapist that what you are doing is causing severe pain so that they can adjust whatever program they have you on. If you don’t tell us, we won’t know (even though you think we should). 

I’ve now worked with 100’s of clients over the years and I still can’t predict who will flare up vs. who will not. Some people have such severe issues and they are in several different locations of their body, that one issue might improve, while another gets worse. 

For example, I recently had a client with low back and cervical spine pain. We worked on this for 3 weeks and she was feeling much better. Unfortunately, the things we were doing aggravated a wrist injury she had sustained many years ago and she decided that she would not like to continue PT at this time due to the wrist issue. 

We had solved her initial issue but created another one. This is the challenge with pain. It’s very hard to predict. 

In the remainder of this article, I’ll discuss different conditions and also a few key principles I use when dealing with my own pain and injuries and how I transfer this to patient care. 

back pain cartoon man black shirt bending over grabbing back in pain

Is pain during the rehab process ever okay?

Pain during physical therapy is normal however it should never be severe. 

There is a caveat to this. If you are the type of person that enjoys pushing through pain, and, you don’t have worsening symptoms 24 hours later, then it’s okay to push through a bit higher levels of pain, assuming this is not recovering from a surgery. 

When recovering from surgery where something has been reattached, it’s best to listen to your body versus push through.

If this is pain unrelated to a surgical repair then you are generally clear to push through if you feel comfortable with that. 

If you’re the type of person that shies away from all pain then I would not recommend this approach to you. 

When should we pay attention to pain and when should we ignore it?

word attention in white with red backdrop

I hear this all the time; “my shoulder blade hurts and I don’t know what I did.” 

“What should I do?”

This is the wrong initial question to ask. 

The better question to ask is “my shoulder blade has been hurting the past 24 hours and i’m not exactly sure what caused it, is there anything I should do or just wait it out and see if it goes away in the next couple days?”

It’s a much longer question but it gets to the core of the issue. 

We don’t always need to intervene. 

Yes, you heard that right. 

While doing something often feels better, sometimes doing nothing is the correct approach. 

Not doing nothing as in resting, but not changing up anything that we are doing. Still go to the gym, work, etc. and live your life while it resolves. 

What about when the pain doesn’t go away?

Now this is a different story. If you have pain that you were thinking would just go away but now it’s been around for a few weeks and it’s not getting any better despite you trying a few interventions on your own, that’s when I would say this has become a pattern that likely needs addressing. 

An example: 

My client Nic had been getting lower back spasms every couple of months which would then take a few weeks to resolve. 

This kept happening more frequently and this was soon a pattern that he couldn’t shake. 

This is different than if you’ve been alive for 50 years, have one instance of a lower back spasms, and then it doesn’t happen again for 7 years. 

Pay attention to patterns, and ignore one-time occurrences. 

When should you seek professional help?

I recommend seeking professional help if the pain or injury you’re experiencing has become a pattern that you are unable to solve on your own. 

Waiting a couple weeks or even a month to try and address it on your own is perfectly reasonable assuming it’s not a fracture, infection, or some other internal organ issue. 

If you’re pretty convinced it’s a musculoskeletal problem, most of those don’t require immediate intervention and you should be okay waiting it out.


Again, if it’s been between 2-4 weeks and it’s not getting better, seek out professional help. 

If you want to get help sooner, that’s completely reasonable as well as they may be able to help you control symptoms better than if you were doing it only on your own. 

What types of pain/injury can be most painful during rehab?

  • Post-surgical, particularly total knee replacements and rotator cuff repairs. These tend to be some of the more painful surgeries and recovery processes. But, remember they should never cross into the severe and unbearable levels. 

  • Tendinosis/itis — these are usually very easy to flare-up and can go from 0-100 really quickly. I recommend a “low and slow” approach with these, starting with light weight, low intensity, and progress slowly over time.

Key Takeaways

  • Physical therapy and recovery from pain/injury should not be severely painful
  • It’s okay to wait a few weeks to see if you heal on your own
  • Don’t wait months to work with a professional as this will likely exacerbate the problem
  • Some conditions are more painful than others but none should be severely worsened by physical therapy or other interventions.