Does Exercise Really Have to Hurt to Work?
10 Tips for Avoiding Pain


If you are an adult, you have probably got some experience with exercise under your belt. You may have joined a gym, taken a few classes, or even hired a trainer. But for most people, sticking with a regular workout routine is a challenge. Lack of time is the number one reason people give for not working out. But beneath that arguably flimsy excuse lies the indisputable fact that exercise is uncomfortable.

The Discomforts of Exercise

The discomforts of exercise come in many forms. There is the social discomfort of breaking a sweat while wearing revealing form-fitting clothes in public. There is the discomfort of not really knowing what you are doing and feeling like an outsider. And then there are the physical discomforts of breathlessness, muscle burn, and a pounding heart. And lets not forget delayed onset muscle soreness, or DOMS, those muscle aches that show up the next day, making rolling out of bed seem impossible.

But at the end of the day, discomfort is the secret sauce that makes exercise effective, a principle called progressive overload.

Discomfort vs Pain

Fear of pain is the main deterrent that keeps people from exercising. But the truth is, to become fit and realize your goals, you have to step outside your comfort zone. It is human nature to avoid pain and discomfort at all costs, but once you accept the fact that you will experience discomfort in the early stages of exercise, you will be ready to power through to the stage where discomfort abates, and you begin to realize the benefits of regular exercise. You may even begin to enjoy it!

However, before you get started, it is important to be able to distinguish between discomfort that leads to positive results, and pain that leads to injury.

Discomfort during exercise includes:

Elevated heart rate and respiratory rate: As uncomfortable as they may be, these two are pretty much self-regulating, a function of both pulmonary and cellular respiration. You will not be able to continue if the exercise gets too challenging.

Burning in the muscles: When your muscles take on new challenges, you may feel a burning sensation. This indicates that the muscle fibers are being challenged, and there may even be some micro tears in the muscle fascia that lead to DOMS. This is a normal stage in the adaptation process. This too is self-regulating. As your muscles reach volitional fatigue, they will be unable to continue contracting until after a brief rest.

Tension in the joints: During stretching or resistance training, you will likely feel tension in your joints and muscles. This is normal, and will result in improved range of motion in the long run, with more fluid movement.

Pain during exercise includes:

Chest pain or tightness: Pain and tightness in your chest, jaw or arm can indicate a cardiac event that should not be ignored. If this occurs, stop exercising, lie down, and ask for help.

Shortness of breath, wheezing or coughing: These are symptoms of exercise-induced asthma, a narrowing of your airways brought on by exercise. If symptoms appear every time you exercise, speak to your health care provider about managing your symptoms.

Low back pain: Pain in your low back during exercise indicates poor exercise technique, lifting too much weight, or both. Stop exercising if your back hurts and seek the advice of a trainer or therapist. Lifting too much, too soon, can lead to long-term pain and injury.

Joint pain: Like low back pain, sharp pain in the joint itself indicates poor execution and/or too much weight. Seek professional guidance.

10 Tips for Avoiding Pain During Exercise

Warm up.

A thorough general warm-up of light cardio for 5 to 10 minutes before working out will prepare your joints and muscles for more strenuous work.

Stay focused.

Paying attention to your muscles and joints as they move will alert you to pain and help you get better results.

Maintain control.

Do not use momentum or gravity to move your weight.

Start small.

Easing into a new workout routine will minimize DOMS and give your body time to adapt to new challenges.


Your muscles need oxygen to contract. Establish a rhythmic breathing pattern during each exercise. Never hold your breath during exercise.

Stay hydrated:

Drink plain filtered water before during and after exercise to prevent dehydration and promote healthy muscle recovery.

Strengthen your core.

Strong abdominal and core muscles protect your back, promote good form, and reduce your risk of injury.

Be consistent:

An erratic workout schedule can keep you from getting results and keep you in the discomfort zone.

Take time to recover:

Give your muscles and joints 48 to 72 hours between sessions to rest and adapt.

Get professional help:

A trainer or therapist can teach you safe technique, and they can design an effective program that gets results.

Exercise Program Design at NYDNR

Many exercise programs fail because they are uncomfortable, painful and poorly designed. Enduring the discomfort of exercise without seeing tangible results makes it difficult to stay motivated and consistent. The physical therapy team at NYDNR will design an exercise program tailored to your individual needs and preferences. We will help you learn how to perform exercises safely and effectively, to help you reach your goals without pain.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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