Przejdź do treściA well-chosen exercise dose is not judged only by what happens while you are moving. What happens several hours later and the following morning matters just as much: whether pain has returned to its previous level, stiffness lasts longer, swelling appears, and everyday activities feel easier or harder.
Why is pain during exercise not enough?
Pain during exercise is useful information, but it does not always tell you whether the load was safe and appropriately dosed. With chronic tendon problems, mild symptoms during training may be acceptable. After a recent injury, surgery or an unstable fracture, however, even an exercise that feels easy at the time may exceed the restrictions set for that stage of healing.
The delayed response matters too. Tissues and the nervous system continue to respond for hours after exercise. If pain or stiffness is clearly worse the next day, swelling increases, or walking, gripping or climbing stairs becomes more difficult, the individual session may have been too demanding or the interval between sessions too short.
What is worth comparing before exercise and the next morning?
- Pain: not only its intensity, but also its location and character.
- Stiffness: whether it lasts longer than usual and limits the first movements after rest.
- Swelling: whether it is new or clearly greater than before.
- Function: for example walking, stairs, squatting, raising the arm or grip strength.
A simple, repeatable observation is often enough. Note these four elements before training, shortly afterwards and again the next morning. One worse day does not mean rehabilitation has failed, but a recurring pattern can help you adjust the programme more sensibly.
The pain-monitoring model has limits
The best-known pain-monitoring model was studied in people with Achilles tendinopathy. In a small randomised trial, 38 patients either continued running and jumping according to predefined symptom-monitoring rules or temporarily stopped those activities; both groups followed the same rehabilitation programme. Continuing activity within the pain-monitoring model did not worsen outcomes, but this study did not establish a universal rule for every tendon problem, injury or operation.
Current guidance for midportion Achilles tendinopathy recommends tendon-loading exercise as first-line treatment, at a dose tolerated by the patient. That does not mean that one pain threshold or a single “24-hour rule” applies to every diagnosis. A programme after ligament reconstruction, fracture fixation or tendon repair must account for tissue healing and the specific restrictions given by the orthopaedic surgeon.
How can the exercise dose be reduced safely?
If the reaction after training is consistently excessive, it is usually more useful to change one variable than to stop moving altogether. You can reduce resistance, repetitions, range of motion, pace or session frequency. Changing one element at a time makes it easier to understand what is actually affecting symptoms. More on this approach: Conservative Treatment Is Not the Same as Waiting.
It is also worth recording the sequence of events: what you did, when symptoms appeared and how long they lasted. This can make a consultation more informative and helps distinguish random fluctuation from a repeatable response to loading. See also: Symptom Timeline — Why Does the Order Matter?
When should you not wait until the next day?
Stop the exercise and seek prompt assessment if there is sudden severe pain, new marked weakness, loss of sensation, a pale or blue limb, rapidly increasing swelling, deformity, or fever with redness and warmth around the affected area. After surgery or a recent injury, individual restrictions on movement and weight bearing take priority over general exercise advice.
The key point
Rehabilitation is a process of dosing load, not a test of endurance. Symptoms during exercise, the response over the following hours and the next-morning baseline together give a more useful picture than a single pain score. Monitoring this pattern can help adjust a programme, but it does not replace a diagnosis or the instructions of the treating clinician or physiotherapist.
References
- Chimenti RL, Neville C, Houck J, et al. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024. J Orthop Sports Phys Ther. 2024;54(12):CPG1–CPG32. doi:10.2519/jospt.2024.0302.
- Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35(6):897–906. doi:10.1177/0363546506298279.
- Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train. 2020;55(5):438–447. Full text.
Content prepared by: Tomasz Poboży - orthopaedic surgeon.