No Pain, No Gain?


Pain is … well, a “pain” for athletes. It can compromise your training routine and keep you out of the sports that you love. If you ignore it or push through it, you can cause more damage and increase the time you will need to recover. We have all heard the “No Pain, No Gain” or the “Pain is Weakness Leaving the Body” adages, but these motivational quotes can give young athletes, or, for that matter, athletes of all ages, the wrong idea. Eventually this can lead to significant injuries that require extended down time to heal. 

So how do you know what is “normal pain” vs. “abnormal pain”? What is unimportant muscle and joint discomfort or an injury waiting to get worse? Here at the Nirschl Orthopaedic Center for Sports Medicine and Joint Reconstruction we follow the pain phases of founder and renowned orthopaedic surgeon, Dr. Robert Nirschl.

These guidelines help athletes, parents, coaches, and trainers to better understand the type and intensity of pain they are dealing with, how to adjust their training routines or when it is time to follow-up with a sports medicine physician.

Nirschl Pain Phases

Phase 0:  No pain or soreness.
Phase 1:  Stiffness or mild soreness after activity, usually gone in 24 hours.
Phase 2:  Stiffness or mild soreness before activity that is relieved by warm-up. Symptoms are not present during activity but return after, lasting up to 48 hours.
Phase 3: Stiffness or mild soreness before specific sport or occupational activity. Pain is partially relieved by warm-up. It is minimally present during activity but does not cause activity alteration. 
Phase 4: Pain is similar to but more intense than Phase 3 pain. Phase 4 pain causes the athlete to alter performance of the activity. Mild pain may also be noticed with activities of daily living. 
Phase 5: significant (moderate or greater) pain before, during, and after activity, causing alteration of activity. Pain occurs with activities of daily living but does not cause a major change in them.
Phase 6: Phase 5 pain that persists even with complete rest. Phase 6 pain disrupts simple activities of daily living and prohibits doing household chores.
Phase 7: Phase 6 pain that also disrupts sleep consistently. Pain is aching in nature and intensifies with activity.

If an exercise or activity causes Phase 3 pain or more, this should be considered indications of injury. You need to modify or adjust the activity if possible or stop the activity completely, check with your therapists or doctor, and work in a “pain free” range.

Some ideas are as follows:

  1. Decrease the length of time of the exercise/activity and/or
  2. Decrease the intensity at which you are performing the activity
  3. Decrease the speed you are performing the exercise/activity
  4. Alter the technique of the activity

If you are unable to find a “pain free” way to complete your exercise, it is a good indication that there is an underlying injury that needs evaluation. It is important that you follow up with a sports medicine physician to get an accurate diagnosis. A physical therapist will design a program to get you back to your full work out without further damage.

Remember “No Pain, No Gain” can sometimes put you on the sidelines for a very long time. Listen to what your body is telling you and take the proper actions to keep you healthy and strong. The pain phases may be a helpful guide. If you are unsure check with your doctor.

Nirschl Orthopaedic Center is a leader in sports medicine and general orthopedic services. In addition Virginia Sportsmedicine Institute physical therapy has been rated one of the top sports medicine clinics in the area. If you have an orthopaedic injury, schedule an appointment with one of our doctors today. Visit our websites at and to learn more about our services. For more info on orthopaedic issues visit our blog at Follow us on Twitter: @nirschlortho

Nirschl Orthopaedic Center for Sports Medicine & Joint Reconstruction
1715 N. George Mason Drive, Suite 504
Arlington, Virginia 22205

© Jane Voigt Tennis 2013