No pain, no gain” might be the worst phrase ever uttered in the gym. Asking the question, “Is it soreness or pain?” is a close second. At the end of the day, both pain and soreness are unpleasant. Attempting to delineate between the two is meaningless for most of us. For trained people who are highly attuned to each response their body has after exercise, sure, they can tell the difference. For everyone else, any kind of discomfort is typically a deterrent to continue making treks to the gym or lacing up running shoes.
Pain is not necessary to obtain benefits from exercise. Though exercise does need to be challenging, as our bodies adapt when they are pushed, pain doesn’t have to be part of the equation.
Physical Activity vs. Exercise
Physical activity and exercise come in many forms. I use the term “physical activity” with intention, as the term “exercise” may trigger negative memories. Perhaps the last time someone exercised, or “worked out,” they experienced extreme soreness, injury, or simply hated it. This negativity is likely exacerbated if the person does not care about sports or athletic competition.
Negativity toward exercise poses a challenge to trainers, coaches, and physical therapists, as exercise is at the heart of our programs and treatments. I speak from experience as a doctor of physical therapy and orthopedic certified specialist. Without exercise, people cannot access many of the physiologic changes they seek. We can’t facilitate muscle hypertrophy (muscle growth), or enhance VO2 max (endurance) exclusively through positive thoughts, sleep, and diet. Healthy lifestyle changes certainly play a part, but without the stimulus-induced through moderate and high-intensity physical activity, we rapidly approach a dead end.
Intensity and Enjoyment Matter
Here are exercise frequency and intensity recommendations from some of the leading health organizations:
- American Heart Association: 150 minutes of moderate or 75 minutes of vigorous exercise per week
- American College of Sports Medicine: 150 minutes of cardiovascular exercise plus 2–3 sessions of strength training
- Centers for Disease Control: 150–300 minutes (5 hours) a week of moderate-intensity physical activity, or 75–150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination. Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes of moderate-intensity physical activity a week
My primary takeaway from these recommendations is their focus on the level of exercise intensity. They don’t specify frequency or mode of activity — but instead allow the individual to design a program that meets a necessary threshold. Note the use of the words moderate and vigorous. Unless you are severely deconditioned or suffer from intermittent claudication, a cramping leg pain that develops when walking due to inadequate blood flow, a 30-minute leisurely walk does not count toward your weekly exercise threshold. Yes, a walk around the neighborhood is certainly better than nothing — but to reap all possible benefits of exercise, it is far from sufficient.
Here’s why: Low and even borderline moderate-intensity exercise does not markedly change the collagen content of connective tissue, which is necessary for healing and recovery from exercise. To achieve the net growth of targeted connective tissue, our bodies require high-intensity loading, such as squats or jumping exercises (plyometrics). Similarly, when attempting to develop strength or power, high-intensity activity is necessary.
A quick refresher: Strength is the maximal force we can generate; it is necessary for tasks such as getting up from the floor (function) or deadlifting (performance). Power, on the other hand, is the speed at which we can generate force — it is necessary to catch yourself if you trip over a step (function) and when dunking a basketball (performance). Someone who is deconditioned, either because of a medical condition or lack of exercise, will see rapid changes in both, but this is mostly a “nowhere to go but up” phenomenon. The improvements in strength and power are primarily neural adaptations and will quickly plateau if the exercise intensity remains low. Further improvements require high intensity, such as performing weight training exercises near maximal effort.
If someone is deconditioned and decides to start walking for 20 minutes a day, that is a step in the right direction, but not enough. It is a starting point that should be built upon. Intensity can be increased through difficulty (walking faster or along a route with more hills) or duration.
People often imagine exercise as a regimented, challenging, and sometimes painful experience — but this does not have to be the case. One of the reasons CrossFit is so successful is that members join a community that supports one another. The exercises are challenging but the variety is high, they can be scaled to each individual, and the community can even foster an atmosphere of enjoyment.
Exercise can improve power and balance to reduce fall risks, enhance cognition and memory, improve healing times for tissue injury, dampen pain severity and sensitivity, and combat depression and anxiety. While consistent movement and activity can offer some of the listed health benefits, people require consistent moderate and vigorous-intensity to achieve them all.
Delayed onset muscle soreness — also known as DOMS — is the prototypical soreness experienced after exercise. Not all people experience DOMS in the same way. Some, myself included, relish the feeling of extreme soreness following a workout, and welcome the subsequent two days of waddling about. Others view soreness as a sign their pain is worsening, and look to medication to eradicate it, and perhaps avoid future exercise. This is an understandable response. Soreness is uncomfortable and makes movement more challenging. When we are in pain, soreness can worsen the overall experience.
One way to mitigate this is to help our body become familiar with a given activity. The repeated bout effect is a protective response in which our body has a blunted inflammatory response following an activity we are familiar with. Take squats as an example. If you have skipped these for six months, you are likely to waddle for 3–4 days and avoid all stairs following a squat session. You will notice, however, the severity and duration of the soreness wane with subsequent leg workouts, even as intensity climbs.
Instead of gritting through, or worse, avoiding activity altogether, here are a few strategies to decrease the frequency and severity of DOMS.
- Slowly increase activity
- Increase the activity of movements you are used to first. For example, if your exercise is primarily neighborhood walks, increase your walking speed and duration before jumping on a bike. If you want to lift weights, start with light weights and low resistance bands during basic movements.
- Start with slow-moving or stationary/isometric exercises (think wall sits)
- Gradually increase intensity over multiple sessions, not within sessions.
- Stretching does not work
Your recovery will also be impacted by your overall health. Diet, sleep, and stress can all influence how well you perform and recover from exercise. If you are getting ready to start a new exercise program or a physical therapy plan of care, ensure that your sleep and nutrition are prioritized.
At the end of the day, if you maintain a consistent physical activity regimen, you will experience DOMS less frequently and at a lower intensity. Keep in mind, if you do experience pain or soreness (which might be the same thing), that does not mean damage has occurred. Research is clear that pain does not equate to damage. Pain is a complex phenomenon, and one of the worst things we can do for it is to stop moving. Movement is the best medicine.
The Problem with “No Pain, No Gain”
It is surprising to many that exercise can have a pain reduction, or analgesic, effect. Our bodies possess a highly efficient endogenous pain inhibiting system that adapts to exercise.
Exercise and conditioned pain modulation use similar mechanisms. Exercise leads to modulation of nervous system function with enhanced inhibition and reduced excitation of pathways responsible for the pain experience. This comes with a large asterisk: People who suffer from chronic pain have a loss of condition pain modulation. They experience the opposite effect because of a lack of inhibition and increased excitability of neuronal pathways. This leaves us with a conundrum. Though exercise can elicit a hypoalgesic effect, the people in the greatest need of the hypoalgesic effect possess a faulty pain-reducing mechanism. As with minimizing DOMS, patience is the name of the game here. A gradual increase in intensity, which is centrally regulated and relative to the individual, will reduce the increase in excitability.
So What Does This All Mean For You?
Research shows that our motivation, interest, and enthusiasm toward exercise can influence both the likelihood of sticking with the exercise program and the amount of success you experience. If you hate running, don’t run. There are many alternatives available to you: Biking, swimming, hiking, lifting weights, tennis, and yoga are all great options. Find an activity that doesn’t feel like exercise but still challenges your body. Walks in the park are great for mental health and are a starting point for physical changes, but eventually, you need to challenge your body. Build up the activity gradually, ignore the “no pain, no gain” advice, and find the exercise that is right for you.