Training with Pain:
Why Avoiding Discomfort
Isn't Always the Answer

Reconceptualising Pain: An Output, Not an Input

To understand how to train with pain, we first need to understand what pain actually is. Historically, pain was viewed as a direct measure of tissue damage — if your knee hurt, it meant your knee was injured; if it hurt more, it meant more damage. This model is now known to be incomplete.

Groundbreaking research led by Professor Lorimer Moseley has fundamentally shifted this paradigm.¹ We now understand that pain is an output of the brain, not an input from the tissues. It is a protective mechanism designed to change behaviour and keep us safe. The brain weighs multiple inputs — sensory information from the body, past experiences, beliefs, fear, and stress — to determine whether the body is in danger.² If the brain concludes there is a threat, it produces pain to make you stop what you are doing.

"Pain does not always equal tissue damage. You can have significant pain with no tissue damage, and you can have significant tissue damage with no pain."

— Moseley & Butler, Pain Science Research

When recovering from an injury, the nervous system often becomes hypersensitive. It starts producing pain signals long before you reach the limits of your tissue's physical capacity. In these cases, stopping exercise entirely when you feel a twinge can actually be counterproductive — leading to deconditioning, increased fear of movement, and a lower threshold for pain in the future.³

The Tendon Conundrum: Why Rest Is Rarely the Answer

Nowhere is this concept more relevant than in the management of tendon pain, or tendinopathy. Achilles and patellar tendinopathies are incredibly common among athletes and gym-goers. The traditional approach was to rest until the pain subsided, then slowly return to activity. But anyone who has tried this knows the frustrating reality: the pain almost always returns as soon as loading resumes.

Professor Jill Cook and Craig Purdam, leading researchers in tendon pathology, proposed the "continuum model" of tendinopathy.⁴ They identified that tendons exist on a continuum from normal, to reactive (an acute response to overload), to tendon dysrepair, and finally to degenerative tendinopathy. A key finding of their research is that rest is actually detrimental to tendon health. Tendons need load to maintain their structure and capacity.⁵ When you rest a painful tendon, it loses capacity — and when you return to your previous level of activity, the tendon is now less capable of handling that load, leading to a reactive response and more pain.

The "Acceptable Pain" Model

If pain doesn't always equal damage, and loading is necessary for recovery, how do we know how much pain is acceptable during training? Researchers and clinicians have developed a pain-monitoring model to guide rehabilitation, particularly for tendinopathies.⁸ This model suggests that experiencing some pain during exercise is acceptable, provided it stays within certain parameters.

Graded Exposure: Building Resilience in the Gym

At Injury Active Clinic, we apply these principles of pain science and load management within our small-group performance gym. We understand that recovering from an injury or managing chronic pain can be daunting, which is why our 6-week training programmes are designed around the concept of graded exposure.

Graded exposure involves gradually and systematically reintroducing the body to movements and loads that it previously found threatening or painful.⁹ By starting at a manageable level and slowly increasing the challenge, we teach the brain that these movements are safe — reducing the protective pain output over time.

How We Manage Pain in Small Group Classes

In our small group classes, our coaches and allied health professionals work together to ensure you can train effectively, even if you are managing a niggle or an ongoing condition.

Empowering Your Training Journey

Pain is a complex, multi-faceted experience. While acute, sharp pain should always be respected and investigated, the dull, aching pain of a tendinopathy or a chronic musculoskeletal issue often requires a fundamentally different approach. Avoiding pain entirely can lead to a downward spiral of deconditioning and increased sensitivity.

By understanding that pain is a protective output of the brain, and by utilising strategies like the pain-monitoring model and graded exposure, you can safely train with pain. At Injury Active Clinic, our goal is to bridge the gap between rehabilitation and high performance. Whether you are dealing with a stubborn tendon issue or looking to build robust, resilient strength, our team across Melbourne is here to guide you.