When a Little Pain is Okay: The 3–4 Rule in Rehab
By: Kelsie Mazur, DPT
If you’ve ever been in physical therapy, you’ve probably asked yourself: “Does this pain mean I should stop, or is it the good kind of pain?” This is one of my favorite questions, because the answer isn’t always what you think. Not all pain is “bad.” In fact, sometimes pain is a sign that you are nudging your body in the right direction and we have solid research to support this idea.
The Pain-Monitoring Model
There’s a well-known study by Silbernagel and colleagues (2007) (Silbernagel et al in 2007) that looked at people with Achilles tendon pain: a stubborn, often nagging condition. The researchers split patients into two groups. One group rested from painful activities like running and jumping, while the other group kept moving, but with a very important rule: they could only keep going if their pain stayed in a tolerable range. Fast forward a year, and both groups had improved in almost the same way. The big takeaway was that continuing activity, even with some pain, was not harmful. In fact, it was a safe and valid approach to rehabilitation.
My Rule of Thumb: The 3–4 Out of 10 Rule
Here’s how I put this into practice at Wattage with patients. If your pain during an activity is around 3–4 out of 10 or less (something that is noticeable but not overwhelming) it is usually safe to continue. If that activity doesn’t leave you with more soreness or increased pain the next day, then it was likely a good choice for your body. This simple framework shifts the conversation. Instead of fearing all pain, we begin to recognize the difference between tolerable pain that represents progress, and pain that may be a sign to modify. One of the most important things to remember is that this process is unique to you. One person might only feel comfortable exercising with very slight pain, while someone else may feel comfortable exercising with moderate pain. There is not a right or wrong answer here, but there are strategies you can use to help determine what works best for you.
You are not only monitoring symptoms during exercise, but also immediately afterward and the following day. A simple framework I often recommend is to ask yourself three questions:
Is my pain tolerable during exercise? If it helps, use a 0–10 scale and decide the highest acceptable number for you. Some therapists recommend staying at 3/10 pain or less, while others may allow up to 5/10. The important part is that you choose a level that feels safe and reasonable.
Is my pain better, worse, or the same after exercise? Certain conditions, like patellar tendinopathy, can actually feel better once you are warmed up. It is possible that symptoms improve with activity, which is not a bad sign.
Is my pain better, worse, or the same the day after exercise? This may be the most important question. If your symptoms are significantly worse the following day, that is an indication the current level of activity may be too much, and adjustments are needed.
Why This Matters
Too often, people assume rehab means total rest. But prolonged rest can sometimes lead to weakness, stiffness, and even greater fear of movement. By using the 3–4 rule and these guiding questions, you can stay active in ways that promote recovery without increasing harm. You learn to trust your body, build confidence, and maintain function throughout the rehab process. This structured self-check helps you find your own safe and productive zone, rather than relying on rigid rules. What I love most about this approach is that you are in the driver’s seat. You are learning how to monitor your body, adapt your activity, and trust your own judgment. My role is to guide you, but your role is to listen and respond to what your body tells you. So the next time you wonder, “Should I stop because it hurts?” remember: if your pain is tolerable, if it does not linger or worsen afterward, and if you feel no significant flare-up the next day, then you are likely right where you need to be.
Bottom line: Pain does not always mean stop. Sometimes, it means you are making progress.
Let’s chat. Book an assessment and let’s get you back to feeling good in your body.
No referrals, no waiting, just answers. Did you know that we offer free 1-on-1 injury screens? Wattage Physical Therapy will take an in depth look at your ergonomics, posture, muscle tone, muscle weaknesses, and movement patterns to create a plan for YOU. If this article intrigues you, you can directly email me, Kelsie at Kelsie@wattagept.com. I would be happy to help you start the process of living a life free from pain.