Training Through an Injury: When It Helps and When It Hurts
Key pointers
- Short answer: most injuries get better faster when you keep training with the painful variable changed, not when you stop completely. Good sports physical therapy tells you which variable to change and when pain means stop.
- Complete rest usually backfires: you lose strength and tissue tolerance, you get scared of the movement, and you come back weaker to the same sport.
- Train around, not through. Change the load, range, speed, volume or exercise that hurts. Keep everything else.
- Use a traffic light. Tolerable pain that settles within 24 hours is green. Pain that climbs set to set or next day is yellow. Sharp pain, swelling, giving way or numbness is red.
- At Pursuit, every visit is 60 minutes one-on-one with Dr. TJ, in a gym built to keep you training while you heal.
- No referral needed in Massachusetts; Pursuit is out-of-network and provides superbills.
Your knee hurt during squats on Tuesday. By Thursday you’d decided to be smart and took two weeks off. You came back feeling fine, squatted the same weight, and it hurt again.
That’s the rest trap. For most injuries, rest doesn’t heal anything. It lowers what your body can handle, so the first session back overloads it again.
This article covers when training helps an injury, when it hurts one, and how sports physical therapy decides the difference instead of guessing.
Why complete rest usually backfires
Rest makes sense for a fracture or a fresh ligament tear. For most of what walks into a clinic, it costs more than it gives.
- You detrain fast. Strength starts to drop within a couple of weeks of not lifting. Conditioning drops sooner.
- Tendons and joints lose tolerance. Tissue adapts to what you ask of it, in both directions. Unload a tendon for a month and it handles less than it did before. That’s why “it felt fine until I started again” is so common.
- Fear sets in. The longer you avoid a movement, the more your brain tags it as dangerous. People come back guarding, which often creates a second problem.
- You lose the season. Four weeks off in-season isn’t rest. It’s a lost spot, lost fitness and a harder return. Hockey players with hip and groin pain can usually keep skating with changes.
Training through vs training around
Training through means doing the same thing that hurts, the same way, and hoping. That’s how a small problem becomes a long one.
Training around means keeping the stimulus while changing the one variable that provokes pain. There are five to choose from:
1. Load. Drop the weight to a tolerable level. A squat at 60% that doesn’t flare the knee beats a week on the couch.
2. Range. Shorten the movement. Box squats, floor press, half-depth lunges.
3. Speed. Slow it down. Tendons tolerate slow, heavy work far better than fast, bouncy work early on.
4. Volume. Fewer sets, fewer sessions, same exercise. Then build back.
5. Exercise. Swap the pattern. Trap bar for straight bar deadlift, landmine press for overhead press, bike for running.
Change one or two variables, not all five. Your body still needs a reason to adapt.
How sports physical therapy decides: the traffic-light framework
Pain during rehab isn’t automatically bad. What matters is how much, and what it does over the next 24 hours.
| Light | What you feel | What it means | What to do |
|---|---|---|---|
| Green | Mild pain, stays tolerable during the session, back to baseline within 24 hours | The tissue is being loaded within what it can handle | Continue. Progress slowly next session |
| Yellow | Pain climbs set to set, or is clearly worse the next morning | You’ve exceeded current tolerance | Reduce one variable: load, range, speed or volume. Retest next session |
| Red | Sharp pain, new swelling, the joint gives way, numbness or tingling, pain at night | Possible structural injury or nerve involvement | Stop that activity and get assessed |
“Tolerable” is roughly a 3 out of 10. If you’re changing how you move to get through the set, you’re past it.
What training around looks like by body region
Knee. Patellar tendon pain usually tolerates slow, heavy squats and leg press but not jumping. Keep the strength work, pull the plyometrics, add isometrics for pain. See patellar tendonitis: why rest alone won’t fix it.
Shoulder. Overhead pressing hurts; rows, landmine presses and carries usually don’t. Work the ranges it tolerates and earn overhead back.
Back. Most low back flare-ups tolerate walking, lighter hinging and carries within days. Bed rest beyond a day or two typically makes it stiffer.
Ankle. A sprain needs early loading: walking, balance work, calf raises, then hopping. Skipping that is why sprains repeat. Read why ankle sprains repeat after ‘walk it off’.
Hip and groin. Common in hockey players. Skating usually needs to be modified, not stopped, while adductor strength is rebuilt.
Keep the rest of you strong, in season or out
An injured left knee doesn’t mean a month off for your right leg, your upper body or your conditioning. Single-leg work on the healthy side, upper body lifting and bike intervals keep you fit and keep your head in training mode.
That’s why rehab here runs alongside strength and performance training. The injured part is one program. The rest of you is another.
In-season, the question is rarely “play or don’t play.” It’s “what’s the smallest change that keeps you safe and effective?” That usually means pulling the most provocative drill from practice, keeping games where possible, and cutting mid-week volume. The plan changes weekly.
Where a hard return decision is needed, return-to-sport testing replaces guesswork with side-to-side strength and hop measurements.
How Pursuit keeps you training through an injury
Every visit at Pursuit PT & Performance in Hopedale is a full 60 minutes with Dr. Tarandeep Jaidka (TJ). For an athlete who wants to keep training, that hour looks like this:
- Decide if it’s safe. Red flags and structural injuries are screened first. If you need imaging or a doctor, you’ll hear it on day one.
- Find the variable. We test load, range and speed in the actual lift to find exactly what provokes pain and what doesn’t.
- Rewrite your week. Your program gets modified, not canceled, with the traffic light built in.
- Load the problem. Rehab happens with barbells, sleds and space to sprint, because that’s what you’re going back to. That’s what sports physical therapy means here.
- Progress every week. Program updated weekly, text support between visits, testing before you add back what you pulled.
Post-surgical athletes follow a different path through ACL and post-surgical rehab, where the protocol sets the pace.
When you must stop and get assessed
Training around has limits. Stop and get checked if any of these apply:
- A suspected fracture or stress fracture: localized bone pain, pain hopping on that leg, pain that doesn’t warm up
- An acute ligament tear: a pop, rapid swelling, the joint giving way
- Post-surgical protocols: your surgeon’s timeline overrides everything in this article
- Numbness, tingling or weakness in an arm or leg
- Night pain, fever, unexplained weight loss or feeling generally unwell: see a doctor
- Pain that has kept climbing for two or more weeks despite reducing load
Frequently asked questions
Is it OK to work out with an injury?
Usually, yes, if you change the variable that hurts and pain settles within 24 hours. Sharp pain, swelling or giving way means stop and get assessed.
How much pain is acceptable during rehab?
Roughly a 3 out of 10: present but not distracting, and back to baseline by the next day.
Will training through an injury make it worse?
Training through, doing the same painful thing unchanged, often does. Training around, changing load, range, speed, volume or exercise, is how most injuries heal faster.
Do I need a referral in Massachusetts?
No. Massachusetts allows direct access, so you can book with us directly. Learn more in do you need a referral to see a physical therapist in Massachusetts.
Do you take insurance?
We’re out-of-network. We provide superbills you can submit to your insurer.
Where are you located?
We’re at 3b Condon Way, Hopedale, MA. Patients come from Milford, Franklin, Hopkinton, Holliston, Medway and across the MetroWest and Greater Boston area.
Modify the plan. Don’t abandon it.
Rest is a decision, not a default. Most injuries heal better with the right load than with none. Book a full hour with TJ and leave knowing what to keep, what to change, and when to stop.
Book an appointment, no referral needed.
