You can reduce pain during physiotherapy by communicating openly with your therapist, pacing your exercises within a safe discomfort range, using ice or heat after sessions, staying hydrated, and practising steady breathing throughout each movement. Some soreness during and after physiotherapy is a normal part of the recovery process, because your body is adapting to new movement patterns, rebuilding strength in weakened muscles, and restoring range of motion in stiff joints. A 2021 Cochrane Review led by Hayden et al. found that exercise therapy produced a pooled mean pain improvement of 7.3 points out of 100 in patients with chronic low back pain, confirming that the short-term discomfort of therapeutic exercise leads to measurable long-term pain relief.

This article explains why physiotherapy sometimes hurts, how to tell the difference between productive discomfort and harmful pain, what to say to your therapist, and practical strategies you can use before, during, and after each session to keep pain manageable. Every technique covered here is backed by clinical evidence and reflects what we see working with patients every day.

How to Reduce Pain during Physiotherapy

Reducing pain during physiotherapy starts with understanding that mild discomfort serves a purpose, and that you have direct control over how much pain you experience in each session. Your physiotherapist adjusts the intensity of every technique based on what you report, which means your voice is the single most important tool for pain management in the treatment room. Research published in Manual Therapy found strong evidence that increased pain levels during exercise are directly linked to poor adherence and early dropout from physiotherapy programmes. A study cited by Medbridge reported that 55% of patients with chronic knee and low back pain self-discharged before completing their care plan, often because they did not feel in control of their discomfort.

Pain during physiotherapy does not mean something is going wrong. Therapeutic discomfort signals that tissues are being challenged past their current capacity so they can adapt and grow stronger. The distinction between productive discomfort and harmful pain is the foundation of every strategy that follows. Understanding that distinction puts you in the driver’s seat of your own recovery.

Is It Normal to Feel Pain during Physiotherapy Exercises?

Yes, it is normal to feel pain during physiotherapy exercises, particularly in the early stages of treatment when your body is adjusting to movements it has not performed in weeks, months, or sometimes years. The most common source of this discomfort is delayed onset muscle soreness (DOMS). DOMS refers to the tenderness and stiffness that develops 8 to 24 hours after muscles are worked beyond their current capacity, according to research published in Cureus. DOMS peaks between 48 and 72 hours after the session and typically resolves within 72 to 96 hours.

DOMS occurs because therapeutic exercises create microscopic tears in muscle fibres. These microtears trigger a repair response that rebuilds the fibres thicker and stronger than before. The soreness you feel is the inflammatory phase of that repair cycle, not a sign of injury. According to Cedars-Sinai, DOMS is more common when a muscle has not been challenged in a while, which is exactly the situation most physiotherapy patients are in when they begin treatment.

Tissue stiffness from injury, surgery, or prolonged immobilisation also contributes to discomfort during physiotherapy. Scar tissue forms around damaged areas and restricts movement. When your physiotherapist mobilises a stiff joint or stretches contracted soft tissue, the sensation can feel intense. That intensity usually subsides within a day or two as the tissue loosens and blood flow improves. Patients recovering from surgery, managing chronic conditions, or returning from a sports injury all experience this adaptation phase. The key is recognising that adaptation requires temporary discomfort, and that temporary discomfort leads to lasting improvement.

What Is the Difference between Good Pain and Bad Pain in Physiotherapy?

The difference between good pain and bad pain in physiotherapy is that good pain feels like a dull ache, muscle fatigue, or a deep stretch that fades within 24 hours, while bad pain feels sharp, burning, or shooting and either persists beyond 48 hours or worsens with each session. A widely used clinical guideline called the 3 out of 10 pain rule helps patients and therapists distinguish between the two. On a scale where 0 is no pain and 10 is the worst pain imaginable, scores of 0 to 3 represent the productive zone where tissues are being challenged without being harmed. Scores of 4 to 5 signal a caution zone where you may need to reduce intensity, range, or repetitions. Scores of 6 and above mean the exercise is too aggressive and you should stop.

Good pain during physiotherapy includes muscle soreness after strengthening exercises, a stretching sensation during massage therapy or soft tissue work, mild discomfort when trying new range-of-motion activities, and a dull ache during resistance training. Good pain signals that your muscles, tendons, and ligaments are responding to the therapeutic load.

Bad pain during physiotherapy includes any sensation that is intense, piercing, or burning during or after a session. Swelling, redness, or a feeling of instability in a joint after treatment also qualifies as bad pain. New pain in areas unrelated to your original issue is a warning sign that something has been overstressed. Research published in the South African Journal of Physiotherapy found that 33.9% of low back pain patients missed scheduled appointments specifically because sessions felt too painful, highlighting how important it is to recognise and communicate about bad pain early rather than endure it silently.

• Sharp, stabbing, or shooting pain during or after a session
• Pain that lasts longer than 48 hours without improvement
• Swelling, redness, or increased warmth at the treatment site
• Numbness, tingling, or loss of sensation
• Reduced movement or function compared to before the session
• Pain that worsens progressively with each appointment

Any of the warning signs listed above should be reported to your physiotherapist immediately. These signs may indicate that the treatment intensity needs adjustment, that a different approach is required, or that further assessment is necessary before continuing.

What to Do When Pain Is Unbearable

When pain is unbearable during a physiotherapy session, stop the exercise immediately and tell your physiotherapist what you are feeling. Pain at 7 or above on the 0-to-10 numeric rating scale, classified as severe pain by clinical standards, means the activity is exceeding your tissue’s current tolerance. Pushing through severe pain does not speed recovery. Pushing through severe pain risks re-injury, increases nervous system sensitisation, and can make future sessions more painful rather than less.

Your physiotherapist can modify the exercise on the spot. Modification options include reducing the range of motion, decreasing resistance, slowing the speed of the movement, or switching to a different exercise that targets the same muscle group with less load. Pain that reaches unbearable levels during physiotherapy is never something you are expected to tolerate. The goal of every session is to challenge your body within a window that promotes adaptation without causing harm. Communicating pain levels openly is what keeps the session inside that window.

What Should You Tell Your Physiotherapist about Pain?

You should tell your physiotherapist exactly where the pain is, how intense it is on a 0-to-10 scale, what type of sensation it produces, and when it started. Specific descriptions give your therapist the information they need to adjust treatment in real time. Saying “I feel a sharp pain on the outside of my knee when I bend past 45 degrees” is far more useful than saying “it hurts.” The location narrows the structure involved. The intensity guides how much to modify. The type of sensation, whether dull, sharp, burning, or tingling, helps differentiate between muscle fatigue and a potential problem. The timing, whether during the movement, after the movement, or hours later, indicates whether the issue is mechanical or inflammatory.

Your physiotherapist also needs to know how your pain behaves between sessions. Reporting whether soreness resolves within 24 hours, lingers for two days, or worsens overnight gives a clear picture of whether the current treatment intensity is appropriate. The 24-hour rule is a practical clinical guideline: pain from physiotherapy should return to your baseline level within 24 hours after a session. Pain that stays elevated beyond 24 hours suggests the session pushed too hard, and the next session needs to be scaled back.

What Not to Say to Your Physical Therapist

The most counterproductive thing you can say to your physical therapist is “I’m fine” when you are not fine. Hiding pain prevents your therapist from calibrating your treatment correctly. Downplaying discomfort might seem polite, but it leads to sessions that are too intense for your current stage of healing. That over-intensity causes more soreness, more dread before the next appointment, and a higher risk of early dropout.

Avoid withholding information about pain that occurs between sessions as well. Skipping an appointment without explaining why removes your therapist’s ability to adjust the plan. A systematic review published in Manual Therapy identified that low self-efficacy, anxiety, and poor communication about pain barriers were strongly associated with poor adherence to physiotherapy. Your therapist’s job is to work with what your body can handle today, not what you think it should handle. Honest reporting, even when the news is “that exercise made things worse,” is what allows treatment to progress safely.

Why Does Physiotherapy Hurt More at First?

Physiotherapy hurts more at first because your muscles, joints, and connective tissues have not yet adapted to the demands of therapeutic exercise, and your nervous system is still sensitised from injury or prolonged inactivity. Muscles that have been inactive lose both strength and flexibility. When those muscles are loaded again during physiotherapy, the microtear-and-repair cycle of DOMS produces more soreness than it will once the muscles have been conditioned through several sessions.

Joints that have been immobilised, whether by a cast, a brace, or simply by avoiding movement due to pain, develop adhesions in the surrounding connective tissue. Adhesions are bands of scar-like tissue that form between surfaces that should glide freely. Breaking down adhesions through joint mobilisation and manual therapy produces a temporary increase in discomfort at the treatment site. That discomfort diminishes as the tissue regains its normal glide and the joint moves through a fuller range of motion.

The nervous system itself contributes to heightened pain in early sessions. Chronic pain conditions alter how your brain and spinal cord interpret sensory input, a process called central sensitisation. Central sensitisation lowers your pain threshold, meaning stimuli that would not normally hurt begin to register as painful. Exercise rehabilitation gradually reverses central sensitisation by retraining the nervous system to interpret movement as safe rather than threatening. The reversal takes time, which is why the first few sessions often feel harder than the sessions that follow.

How Does Physiotherapy Reduce Pain?

Physiotherapy reduces pain through multiple mechanisms that operate at the muscular, neurological, and psychological levels simultaneously. The most well-documented mechanism is exercise-induced hypoalgesia (EIH), a short-term reduction in pain sensitivity that occurs during and immediately after exercise. A meta-analysis published in the Journal of Pain found that a single bout of aerobic exercise produced a large hypoalgesic effect (g = -0.85) in healthy individuals. Research from Frontiers in Neuroscience demonstrated that pressure pain thresholds increased by 20 to 24% following a single exercise session, meaning the body required more force to register pain after movement.

EIH works through the release of endorphins and the activation of descending inhibitory pathways from the brain to the spinal cord. Endorphins are neurotransmitters that reduce transmission of pain signals by preventing the release of substance P, a chemical linked to heightened pain sensitivity. Endorphin release during physiotherapy services explains why many patients feel less pain at the end of a session than they did at the beginning.

Manual therapy techniques, including joint mobilisation, myofascial release, and soft tissue massage, reduce pain through the gate control theory of pain. Proposed by Melzack and Wall in 1965, gate control theory explains that non-painful sensory input, such as the touch and pressure of a therapist’s hands, activates large-diameter nerve fibres that inhibit pain signals at the spinal cord level. The non-painful input essentially “closes the gate” on pain transmission, reducing the brain’s perception of discomfort. This mechanism underlies the effectiveness of hands-on treatment, acupuncture, and modalities like transcutaneous electrical nerve stimulation (TENS).

Pain-Reduction Mechanism	How It Works	Evidence
Exercise-Induced Hypoalgesia (EIH)	Endorphin release and descending inhibition reduce pain sensitivity during and after exercise	Large effect size (g = -0.85) for aerobic exercise; 20-24% increase in pain thresholds (Journal of Pain; Frontiers in Neuroscience)
Gate Control (Manual Therapy)	Non-painful touch activates large nerve fibres that block pain signals at the spinal cord	Melzack and Wall, 1965; validated by TENS and IFC research (Physiopedia)
Central Sensitisation Reversal	Graded exercise retrains the nervous system to interpret movement as safe, raising pain thresholds over time	150+ published EIH articles including 4 systematic reviews in 2020 (Coventry University narrative review)
Muscle Strengthening	Stronger muscles absorb more load, reducing stress on joints and pain-sensitive structures	Cochrane Review: 7.3-point mean pain improvement (out of 100) with exercise therapy (Hayden et al., 2021)
Improved Joint Mobility	Mobilisation breaks adhesions and restores normal joint mechanics, reducing friction-related pain	Combination therapy (exercise + manual therapy) showed largest function improvement (SMD = -1.02) in shoulder pain RCTs (2025 network meta-analysis)

Sources: Journal of Pain (2020 meta-analysis), Frontiers in Neuroscience (2016), Physiopedia, Coventry University (2022), Cochrane Library (Hayden et al., 2021), network meta-analysis published in Journal of Clinical Medicine (2025)

Over weeks of consistent physiotherapy, these mechanisms compound. Muscles grow stronger and absorb more mechanical load, reducing stress on joints. Connective tissue regains elasticity. The nervous system recalibrates its pain thresholds upward, and movements that once triggered pain become routine. A 2025 bibliometric analysis published in Healthcare found that chronic pain physiotherapy research publications grew from 249 in 2015 to 751 in 2025, reflecting the expanding evidence base behind these mechanisms.

How to Get Rid of Physical Pain Quickly after a Session

You can get rid of physical pain quickly after a physiotherapy session by applying ice or heat, staying hydrated, moving gently, practising controlled breathing, and resting. Each of these strategies targets a different component of post-session soreness. Using them together produces faster relief than relying on any single method.

1. Apply ice or heat within the first 30 minutes. Ice reduces inflammation and numbs sore tissue. Heat relaxes tight muscles and improves blood flow. The choice depends on the type of discomfort you are experiencing (see the section below).
2. Drink water before and after your session. Hydration helps flush metabolic waste products from muscle tissue and reduces cramping. A meta-analysis in Frontiers in Physiology confirmed that massage combined with hydration significantly reduced DOMS soreness at 24, 48, and 72 hours post-exercise.
3. Walk or do gentle stretches for 10 to 15 minutes. Light movement maintains blood circulation through sore muscles, which speeds the delivery of nutrients needed for tissue repair. Avoid strenuous activity, but also avoid sitting completely still.
4. Practise slow, deep breathing. Controlled breathing activates the parasympathetic nervous system, which lowers muscle tension and reduces the brain’s perception of pain. The Google AI Overview for this topic highlights breathing as a key during-session strategy, and the same principle applies after sessions.
5. Rest and allow recovery time. Soft tissues generally require 6 to 8 weeks to heal fully, and each session’s microdamage needs adequate downtime for repair. Prioritise sleep, because tissue repair hormones peak during deep sleep cycles.

These five steps address the immediate inflammatory response, the metabolic environment in your muscles, the nervous system’s pain processing, and the body’s structural repair timeline. Together, they form a reliable post-session routine that most patients at our Markham clinic find effective within the first week of treatment.

Can Ice or Heat Help after Physiotherapy?

Yes, both ice and heat can help after physiotherapy, but they work through different mechanisms and suit different types of discomfort. Ice, applied for 15 to 20 minutes at a time with a cloth barrier between the pack and skin, constricts blood vessels and reduces swelling in acutely inflamed tissue. Ice is most effective in the first 48 to 72 hours after an intense session or when you notice localised swelling at the treatment site.

Heat, applied via a heating pad or warm compress for 15 to 20 minutes, dilates blood vessels and increases blood flow to stiff, tight muscles. Heat suits chronic stiffness, persistent muscle tension, and general achiness that does not involve visible swelling. Many patients benefit from alternating ice and heat in a contrast therapy approach, beginning with ice to calm inflammation and following with heat to promote circulation. Your physiotherapist can recommend which method fits your specific condition. Laser therapy is another option that stimulates cellular repair and reduces inflammation without the temperature extremes of ice or heat.

How to Train Your Brain to Stop Pain

You can train your brain to stop amplifying pain signals through pain neuroscience education, graded exposure to movement, mindfulness-based breathing, and reframing how you interpret discomfort. Pain is not simply a measurement of tissue damage. Pain is an output produced by the brain based on sensory input, past experiences, emotional state, and perceived threat level. When the brain interprets a movement as dangerous, it amplifies the pain signal to protect you, even when the movement is safe. This amplification is central sensitisation, and it is reversible.

Graded exposure is the physiotherapy strategy that retrains the brain’s threat assessment. Your therapist introduces movements at a low intensity and gradually increases the demand over multiple sessions. Each successful repetition without injury teaches the brain that the movement is safe, and the pain signal decreases over time. A narrative review from Coventry University confirmed that exercise-induced hypoalgesia research now includes over 150 published articles, with the evidence base expanding rapidly.

Kinesiophobia, the fear of movement due to anticipated pain, is one of the strongest predictors of poor physiotherapy outcomes. The systematic review by Jack et al. published in Manual Therapy found that anxiety, helplessness, and fear were strongly associated with treatment non-adherence. Addressing kinesiophobia directly, by understanding that pain during movement does not equal harm, is a critical part of recovery. Controlled breathing during exercises reduces the nervous system’s fight-or-flight response. Inhaling for four counts, holding for two, and exhaling for six helps shift the body from a sympathetic (stress) state to a parasympathetic (recovery) state, which measurably lowers perceived pain intensity.

Should You Stop Physiotherapy If It Hurts?

No, you should not stop physiotherapy just because it hurts, as long as the pain stays within the productive 0-to-3 range on the numeric rating scale. Stopping treatment because of manageable discomfort is one of the most common reasons patients fail to complete their rehabilitation programmes. Data from Medbridge shows that 55% of patients with chronic musculoskeletal conditions self-discharge before finishing treatment. A randomised controlled trial published in NPJ Digital Medicine found a 34.3% dropout rate in conventional physiotherapy for chronic low back pain, compared to 15.7% in a digital programme that gave patients more control over pacing.

The distinction that matters is between modifying and quitting. Modifying means telling your therapist the exercise is too intense and having them reduce the load, slow the pace, or change the approach. Quitting means cancelling future appointments and returning to the movement patterns that caused the problem in the first place. Chiropractic care and other complementary treatments can be layered in alongside physiotherapy to manage flare-ups without abandoning the rehabilitation plan entirely.

Pain that falls in the 4-to-5 caution zone means adjustments are needed, not that treatment should stop. Pain at 6 or above during an exercise means that specific exercise stops, but the session can continue with alternative movements. The only scenario where you should stop physiotherapy altogether is when your therapist and physician determine that a different intervention is needed, which is a clinical decision, not a pain-level decision.

How Many Days Should Physiotherapy Be Done?

Physiotherapy should typically be done 2 to 3 days per week during the initial stages of recovery, with rest days between sessions to allow tissues to repair and adapt. The ideal frequency depends on your specific condition, the intensity of each session, and how your body responds between appointments. Your physiotherapist sets the schedule based on your initial assessment and adjusts it as you progress.

Rest days are not wasted days. Tissue adaptation, the process that makes each subsequent session less painful than the one before, happens during recovery, not during the session itself. Loading a muscle today and allowing it to repair tomorrow produces stronger tissue by the third day. Skipping the rest day disrupts this cycle and can increase, rather than decrease, pain levels at your next appointment. We recommend pairing in-clinic sessions with a home exercise programme of low-load movements on non-treatment days to maintain blood flow and physiotherapy frequency that supports consistent progress.

Soft tissues generally require 6 to 8 weeks to heal from moderate injury, which establishes the typical minimum duration for a physiotherapy programme. Some conditions resolve faster; chronic conditions or post-surgical rehabilitation may require longer. Your physiotherapist reassesses your progress regularly and adjusts both frequency and duration based on measurable improvements in strength, range of motion, and pain levels.

Does Physiotherapy Get Easier over Time?

Yes, physiotherapy gets easier over time because your muscles grow stronger, your joints regain mobility, your pain thresholds rise, and your nervous system adapts to interpret therapeutic movement as safe rather than threatening. The first two to three sessions are typically the most uncomfortable. After that, each session builds on the adaptation from the one before. Muscles that were dormant begin to recruit more efficiently. Connective tissue that was stiff begins to glide more smoothly. The brain’s threat assessment of previously painful movements gradually downgrades.

Exercise-induced hypoalgesia compounds with repeated sessions. Research confirms that pressure pain thresholds increase by 20 to 24% after a single exercise bout, and that repeated bouts over weeks produce cumulative gains in pain tolerance. Patients in our Markham clinic commonly report that movements which caused significant soreness in week one feel routine by week four.

Occasional flare-ups may still occur, particularly when your therapist increases the difficulty of your programme to match your growing capacity. Flare-ups at this stage tend to be milder, shorter, and more predictable than early-treatment soreness. Recognising flare-ups as a sign of progression rather than regression helps maintain motivation through the middle weeks of treatment, which is where most dropouts occur.

What Are the Four Types of Physiotherapy?

The four types of physiotherapy are orthopaedic, neurological, cardiopulmonary, and geriatric, and each type involves different pain expectations during treatment. Orthopaedic physiotherapy focuses on musculoskeletal injuries and conditions, including fractures, sprains, post-surgical rehabilitation, and chronic joint pain. This is the type most commonly associated with DOMS and the 3/10 pain rule discussed throughout this article. Physiotherapy uses within the orthopaedic category include joint mobilisation, therapeutic exercise, and soft tissue release.

Neurological physiotherapy addresses conditions of the nervous system such as stroke, multiple sclerosis, and Parkinson’s disease. Pain during neurological physiotherapy tends to involve fatigue and muscle spasticity rather than the microtear-based DOMS of orthopaedic treatment. Cardiopulmonary physiotherapy targets heart and lung conditions, where discomfort presents as breathlessness and cardiovascular fatigue rather than musculoskeletal pain. Geriatric physiotherapy addresses the movement challenges of ageing, including balance deficits, osteoarthritis, and fall prevention, with pain managed through gentler loading and longer adaptation timelines.

Understanding which type of physiotherapy you are receiving helps you calibrate your pain expectations. Orthopaedic rehabilitation after knee surgery produces different soreness than cardiovascular reconditioning after a heart procedure. Your physiotherapist explains what type of discomfort to expect before your programme begins, so you can distinguish normal adaptation from a warning sign. Pelvic floor therapy and custom orthotics represent additional specialised branches where pain management looks different again.

Frequently Asked Questions

How Long Does Soreness Last after Physiotherapy?

Soreness after physiotherapy typically lasts 24 to 72 hours, depending on the intensity of the session and the condition being treated. DOMS peaks between 24 and 48 hours and resolves within 72 to 96 hours, according to clinical research published in Cureus. Soreness that persists beyond 48 hours at the same intensity, or soreness that worsens rather than gradually fading, should be reported to your physiotherapist before your next session.

How to Help Someone in Extreme Physical Pain?

To help someone in extreme physical pain, encourage slow and steady breathing, help them find a comfortable supported position, apply ice to the affected area if swelling is present, and contact their healthcare provider for guidance. Avoid moving the person’s injured area or encouraging them to “push through” the pain. Pain at 7 or above on the 0-to-10 scale requires professional assessment, not home management alone.

Is It Safe to Exercise When Sore from Physiotherapy?

Yes, it is safe to exercise when sore from physiotherapy, as long as the exercise is low-intensity and does not aggravate the treated area. Light walking, gentle stretching, and low-load movements promote blood circulation and speed recovery from DOMS. Avoid high-intensity activity or heavy loading of the same muscles that are sore until the soreness subsides.

What Causes Sharp Pain during Physiotherapy?

Sharp pain during physiotherapy can be caused by excessive load on an injured structure, nerve irritation, joint instability, or inflammation that has not been adequately addressed before the session. Sharp pain differs from the dull ache of DOMS and should be communicated to your physiotherapist immediately. The exercise causing sharp pain should be stopped and modified before continuing.

When Should I See a Doctor Instead of Continuing Physiotherapy?

You should see a doctor instead of continuing physiotherapy if you experience new neurological symptoms such as numbness, tingling, or weakness that were not present before, if your pain worsens significantly over several sessions despite modifications, if you develop unexplained swelling or warmth in a joint, or if you have symptoms that suggest a condition beyond the scope of physiotherapy such as infection or fracture. Your physiotherapist will refer you when medical assessment is warranted.

Can Physiotherapy Make an Injury Worse?

Physiotherapy can temporarily increase discomfort, but it should not make an injury worse when administered by a licensed physiotherapist who adjusts treatment based on your feedback. The risk of worsening an injury increases when patients hide their pain levels, skip rest days, or attempt exercises beyond the prescribed intensity. Communicating openly and following your physiotherapist’s programme as designed prevents setbacks.

Putting It All Together

Pain during physiotherapy is common, manageable, and in most cases a sign that your body is doing exactly what it needs to do to heal. The 3 out of 10 pain rule gives you a clear framework for gauging whether discomfort is productive or excessive. Communication with your physiotherapist, consistent use of post-session strategies like ice, heat, and hydration, and an understanding of the neurological mechanisms behind pain reduction all contribute to a smoother recovery experience.

The evidence is clear that patients who stay engaged with their physiotherapy programme, even through the uncomfortable early weeks, achieve better outcomes than those who stop treatment early. If you are dealing with pain during your current rehabilitation or are considering starting physiotherapy for the first time, our team at KC Rehab is ready to help you build a plan that respects your pain thresholds while pushing your recovery forward. Call us at 905-205-1668 or book an assessment online.