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Start Here7 min read · Dr. Nevin Saju, PT, DPT
The short answer
Most of the time, keep training but change the dose. Complete rest calms pain but lowers your capacity, so the injury often returns when you go back. Use the traffic light rule: symptoms that settle in a day or two are fine, symptoms lasting 3 to 4 days mean scale back, and red flags mean stop and get assessed.
“They told me to rest it.”
That's one of the first things I hear on calls. Sometimes it's “four weeks of therapy and just see how it goes.” Sometimes it's someone who did exactly what they were told: “I rested six weeks, and it came right back on the first run.”
Then comes the real question, the one they've been carrying around for weeks. “Am I okay to keep running?” Or lifting, or playing, or whatever it is they love.
Most people are stuck between two bad options. Shut everything down and lose fitness, or push through and hope for the best. There's a better middle path, and it's simpler than you'd think.
Should I rest an injury or keep training?
In most cases, keep training, but change the dose. Complete rest calms pain down, but it also lowers what your body can handle, so the injury often comes right back when you return to normal training.
That's the rest trap. Pain settles because the tissue isn't being loaded. Meanwhile, capacity quietly drops. Research shows pain going away and tissue capacity coming back are two separate processes. In one study of people with Achilles tendon pain, only 4 out of 16 whose pain had fully resolved had actually restored full muscle and tendon function on testing. Then you go back to your old training, the demand outpaces the capacity you lost, and the pain returns.
Your tissues need load to adapt. Research shows the right amount of physical stress drives collagen production, muscle growth, and bone remodeling. Too little stress does the opposite. Complete unloading weakens muscle and tendon and reduces bone density. Movement also keeps fluid moving through the tissue, maintains your conditioning, and lowers your nervous system's sense of threat. Rest can't do any of that.
Back pain is a good example. Research comparing 2 days of bed rest to 7 days found no benefit to the longer rest, and longer bed rest led to more disability. Guidelines now recommend staying active instead.
This doesn't mean the doctor or therapist who told you to rest was wrong. Rest isn't wrong. It's incomplete. A short break can help things calm down. The problem is when rest becomes the whole plan.
It also helps to understand what pain is telling you. Pain is an alarm, not a damage report. After an injury, the alarm system can stay extra sensitive, so normal movement can hurt without causing harm. Hurt doesn't always mean harm. And pain often shows up where your body is overworking to compensate, not where the problem started. That's a capacity issue, which I dig into in why stretching isn't fixing your tightness.
The real risk usually isn't doing too much. It's doing nothing and calling it recovery.
Your body isn't broken. It just can't handle what you're asking of it yet.
Rest isn't wrong. It's incomplete.
The traffic light rule
This is the simplest way I know to decide, day by day, whether to keep going, scale back, or stop.
Green
Symptoms settle within a day or two. Keep going, and progress gradually.
Yellow
Symptoms hang around 3 to 4 days. Scale your volume down. Don't stop completely.
Red
Red flags show up, or symptoms get worse week after week. Stop that activity and get assessed.
How to use it: check in three times. During the activity, right after, and the next morning. Research on pain monitoring, tested in Achilles and patellar tendon problems and groin strains, allows mild to moderate pain during exercise, up to about 5 out of 10, as long as next morning pain and stiffness don't climb above that and things aren't getting worse from week to week.
The next morning tells you the most. A little soreness that fades as you move around is green. Stiffness that lingers for days is yellow. The trend matters more than any single day. If week three feels worse than week one, that's your signal to change something.
The goal isn't zero pain. It's moving forward without the alarm getting louder.
Not sure which color you're in?
How to change the dose instead of stopping
Don't take the bar away. Change the dose. You have more levers than “all” or “nothing.”
1
Lower the volume.
For a runner, that might mean shorter runs or one fewer run a week. For a lifter, fewer sets or reps on the movement that's flaring.
2
Lower the intensity or slow it down.
Use lighter weight, an easier running pace, or flatter routes. Slow tempos, like three seconds up and three seconds down, keep loading the tissue while reducing peak forces.
3
Shrink the range.
Train in the range that feels okay. Floor press instead of full bench press, a box squat instead of a deep squat. It's the same approach I describe for a back tweak from deadlifting.
4
Space out heavy days.
Research shows tendons take up to about three days to remodel after heavy loading. Put 2 to 3 easier days between your hardest sessions for the irritated area.
5
Build back gradually after any break.
Jumping straight back to your old training after time off is a classic spike, and spikes in training are a major driver of overuse injuries. I break that down in why running injuries keep coming back when you build mileage. Whether it's physical therapy for runners or physical therapy for lifters, the goal is the same: a progression your body can keep up with.
When rest is the right call
Real rest or offloading is the right move in some situations:
- Right after an acute injury. After a significant strain or tear, a few days of relative rest helps protect the tissue during early healing.
- Bone stress injuries and fractures. Pinpoint bone tenderness, pain at rest, or pain with hopping need offloading so the bone can heal.
- Ruptures and dislocations. A full tendon rupture or a dislocated joint needs protection, sometimes with immobilization or surgery.
- After surgery. Follow your surgeon's protection phase before loading the area.
- Medical issues. A blood clot, serious infection, or other medical problem needs clearance before you train.
Even then, rest is a phase, not the whole plan.
When to see a doctor first
Get evaluated by a physician right away if you have:
- Trouble bearing weight, pinpoint bone tenderness, severe pain when hopping, or a visible deformity
- A sudden pop with immediate severe weakness or a visible dent in the muscle
- Swelling, warmth, redness, or tenderness in one calf
- Numbness in the groin or saddle area, changes in bladder or bowel control, or leg weakness that's getting worse
- Constant pain at night, fever, chills, unexplained weight loss, or a history of cancer
- Left shoulder pain with chest pressure or shortness of breath. Treat this as an emergency.
Common questions
How much pain is OK when exercising?
Mild to moderate pain, up to about 5 out of 10, is generally acceptable during rehab loading according to research on pain monitoring. The key is that it settles by the next morning and doesn't build week to week. Sharp, escalating pain is a stop sign.
Why does my injury come back after I rest it?
Rest calms the pain, but it doesn't rebuild strength or tissue capacity, and it actually lowers it. When you return to your old training, the demand is now higher than what the tissue can handle. Research on hamstring strains shows 59% of repeat injuries happen within the first month back.
How long should I rest an injury?
Usually less than you think. After an acute injury, a few days of relative rest can help. For back pain, research found 2 days of bed rest was as effective as 7. After that, modified training beats complete rest for most injuries.
Should I train through pain?
Train with it, not through it. Mild pain that settles within a day or two is fine. Pushing through sharp or worsening pain is how a manageable injury becomes a stubborn one.
You can also read what others have said about getting back to training without the flare-ups.
Keep reading
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Written by
Dr. Nevin Saju, PT, DPT
Founder of Revenant Physical Therapy in Farmers Branch. Three open-heart surgeries taught him what it takes to trust your body again. Now he helps runners, lifters and active adults do the same. More about Nevin →
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