Exercising With Pain: Acute Pain, Persistent Pain and Muscle Soreness

If you’re unsure whether to rest or keep exercising with pain, you’re not alone. Pain can occur because of a recent injury, an ongoing health condition or simply because you have challenged your body in a new way.

The right response depends on what is causing the pain, how it behaves and whether there are any signs that require further assessment.

Understanding the differences between acute pain, persistent pain and delayed-onset muscle soreness can help you make safer and more confident decisions about movement.

What Is Acute Pain?

Acute pain usually begins recently and may be associated with an injury, surgery, illness or inflammation. It often acts as a protective warning, encouraging you to reduce or change an activity while the affected area recovers.

Examples include:

An ankle sprain after a fall
A muscle strain during sport
Pain after surgery
Sudden back pain after lifting
A painful and swollen joint following an injury

Acute pain is generally present for less than three months, although time alone does not tell us whether an injury has healed or whether an activity is safe.

Can You Exercise With Acute Pain?

Complete rest is not always necessary. For many injuries, appropriately modified movement can help maintain mobility, strength and confidence while supporting recovery.

However, there is no universal rule that pain must remain below a particular number. A “safe” amount of discomfort depends on:

The type and severity of the injury
The tissue involved
How recently the injury occurred
Whether you have received a diagnosis
Your health and medical history
The type and intensity of exercise
How your symptoms respond during and after activity

During rehabilitation, mild and predictable discomfort may sometimes be acceptable. Sharp, rapidly increasing or unfamiliar pain is more concerning.

It may be appropriate to reduce the weight, range, speed, duration or number of repetitions rather than stopping all movement. A physiotherapist can help determine which activities are useful and which should temporarily be avoided.

Don’t Rely on the Pain Number Alone

Pain scales can be helpful, but they are only one part of the picture.

When deciding whether to continue, also consider:

Pain quality: Is it an expected ache or something sharp, catching or unstable?
Movement quality: Can you move normally, or are you significantly compensating?
Function: Is the activity becoming easier or increasingly difficult?
Swelling or bruising: Is it increasing?
Your response afterwards: Do symptoms settle reasonably, or does the activity cause a substantial and lasting flare-up?
Your rehabilitation plan: Does the response match what your clinician advised you to expect?

The frequently used “3 out of 10” and “settles within 24 hours” rules can be useful in some rehabilitation programs, but they are not appropriate for every condition or injury.

What Is Delayed-Onset Muscle Soreness?

Delayed-onset muscle soreness, commonly known as DOMS, is the aching and stiffness that can develop after unfamiliar or unusually demanding exercise.

It commonly begins within 12–24 hours, feels strongest over the following day or two and then gradually settles. It is especially common after activities that place muscles under load while they lengthen, such as lowering weights, walking downhill or returning to squats after a break.

DOMS commonly feels like:

A general ache through the exercised muscles
Tenderness when the muscles are pressed
Temporary stiffness
Mild weakness or heaviness
Discomfort when stretching or using the muscles

DOMS is usually a normal short-term response to unfamiliar exercise. However, it is not required for an effective workout and does not prove that you have built strength or completed a better training session.

Can You Exercise With DOMS?

Gentle movement is generally fine and may temporarily reduce stiffness. Options might include walking, easy cycling, mobility exercises or training a different muscle group.

If the muscles are very sore, temporarily reduce the intensity or allow more recovery time before training the same area heavily again.

Pain that is sharp, localised to a joint, associated with significant swelling or becoming progressively worse may not be ordinary muscle soreness and should be assessed.

What Is Persistent or Chronic Pain?

Persistent pain – also called chronic pain – is pain that continues or recurs for more than three months.

It may be related to an ongoing health condition or changes within the body. In other situations, pain continues beyond the expected recovery time from an initial injury. Persistent pain is influenced by a combination of biological, psychological and social factors.

This does not mean that the pain is imaginary. The experience is real.

However, persistent pain does not always provide an accurate measure of tissue damage. In some people, the nervous system becomes more sensitive or protective over time. Stress, sleep, health, previous experiences and concerns about movement can also affect how pain is experienced.

Can You Exercise With Persistent Pain?

For most people, appropriately selected physical activity is an important part of managing persistent pain.

Exercise may help you:

Maintain or rebuild strength
Improve mobility and physical capacity
Return to meaningful activities
Support sleep, mood and general health
Increase confidence in your body
Reduce the impact pain has on everyday life

The aim is not always to avoid every increase in symptoms. Instead, it is to find an amount of activity that your body can manage and gradually build from there.

Tips for Exercising With Persistent Pain

Start from a manageable baseline

Begin with an amount you can complete reasonably consistently, including on a more difficult day. Starting below your maximum capacity often makes it easier to progress without repeatedly triggering major flare-ups.

Build gradually

Increase one element at a time, such as duration, resistance, speed or frequency. Large and sudden increases are more likely to aggravate symptoms.

Expect some variation

Persistent pain naturally fluctuates. A temporary increase does not necessarily mean you have caused new damage, but it may indicate that the activity needs to be adjusted.

Focus on function as well as pain

Notice what you are becoming able to do – not only whether the pain has disappeared. Improvements in walking, lifting, sleeping, working or participating in family life are meaningful signs of progress.

Choose meaningful movement

Exercise does not have to take place in a gym. Walking, gardening, swimming, cycling, dancing and structured strengthening can all be valuable when they suit your goals and capacity.

Seek individual guidance when needed

Generic online exercise programs may not account for your condition, current ability or previous injuries. A physiotherapist can help you find an appropriate starting point and adapt the plan as your capacity changes.

Acute Pain, Persistent Pain and DOMS: Key Differences

Type	Typical pattern	What it may represent	General approach
Acute pain	Recent onset, generally less than three months	Injury, surgery, illness, inflammation or threatened tissue injury	Identify the cause and use appropriately modified movement
Persistent pain	Continues or recurs for more than three months	Multiple contributing factors, sometimes including ongoing disease or increased nervous-system sensitivity	Individualised, gradual and consistent activity
DOMS	Develops after unfamiliar or demanding exercise and settles over several days	A temporary response to exercise loading	Gentle activity or reduced training while symptoms settle

When Should You Stop and Seek Advice?

Stop exercising and seek appropriate medical or physiotherapy advice if pain is accompanied by:

Significant trauma, deformity or rapidly increasing swelling
Inability to bear weight or use the affected area
New or worsening weakness, numbness or loss of coordination
A hot, red and swollen joint, particularly with fever
Chest pain, breathing difficulty, faintness or unexplained sweating
Severe muscle pain, swelling, weakness or dark urine after intense exercise
New bladder or bowel changes or numbness around the groin
Pain that is severe, unexplained or progressively worsening

If you are uncertain about a new pain, an assessment can help clarify what is happening before you continue or progress your exercise.

Movement Can Help – But It Should Fit You

Exercise can be a powerful part of recovery and persistent pain management, but it should not feel like a punishment or a test you must push through at all costs.

The goal is to understand your symptoms, choose an appropriate starting point and gradually build your capacity. Some discomfort may be acceptable in certain situations, while other symptoms require rest, modification or further assessment.

If pain is making you uncertain or afraid to move, our physiotherapists can assess your symptoms and help you develop an individualised plan.

Book a physiotherapy appointment and take the next step towards moving with greater confidence.

References

International Association for the Study of Pain. Terminology and definitions of acute and chronic pain.
International Association for the Study of Pain. Definitions of Chronic Pain Syndromes.
Healthdirect Australia. Chronic pain and options for managing chronic pain.
Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard.
Cheung, K., Hume, P., & Maxwell, L. (2003). Delayed onset muscle soreness: treatment strategies and performance factors. Sports Medicine, 33(2), 145–164.