One of the most difficult decisions in sport is knowing when to push through pain and when to stop. Get it wrong in either direction and you pay the price — either by missing weeks of training for something that needed 2 days’ rest, or by turning a minor injury into a serious one by playing through it. This guide gives you a practical framework for making that call, and tells you which injury warning signs should always send you to a physiotherapist immediately.
Not All Pain Is the Same
Pain during sport exists on a spectrum. Understanding the type of pain you’re experiencing is the first step to making a smart decision.
Muscle soreness (DOMS): Delayed-onset muscle soreness — the ache that peaks 24–48 hours after unfamiliar or intense exercise — is not injury. It’s a normal adaptation response to novel load. It’s symmetrical, diffuse, and improves with gentle movement. You can train through DOMS, though you may want to reduce intensity.
Tissue strain pain: Sharp, localised pain that occurs during or immediately after a specific movement. This suggests structural strain — muscle, tendon, or ligament — that needs assessment. Whether you can continue depends on severity.
Nerve pain: Burning, shooting, or electric pain that radiates from a central point along a predictable pathway. This should stop play immediately pending assessment.
Bone pain: Deep, localised, boring pain at a specific bony point that worsens with activity and is present at rest. Always requires medical assessment to exclude stress fracture.
The 0–10 Pain Scale: A Practical Guide
A simple pain-scale framework helps guide the push-through decision in real time:
0–2/10: Mild, doesn’t affect movement or performance. Generally safe to continue with monitoring.
3–4/10: Noticeable pain that doesn’t affect normal movement patterns. Continue with caution; reduce intensity if pain increases; reassess after the session.
5–6/10: Moderate pain that may alter your gait or technique. Stop or significantly reduce the session. Altered movement patterns during pain cause compensatory injuries elsewhere.
7+/10: Severe pain. Stop immediately. Ice and elevate if appropriate. Seek assessment.
Crucially: if pain increases during activity (rather than warming up and settling), stop. Continuing into worsening pain turns a Grade I strain into a Grade II or III.
Injuries That Always Require Immediate Assessment
A “pop” or “snap” followed by immediate swelling — particularly in the knee (ACL, meniscus), ankle (ligament rupture), or Achilles tendon (rupture). Never play on after this.
Inability to weight-bear after a lower limb injury — the Ottawa Ankle and Knee Rules are validated criteria for fracture risk assessment. Your physiotherapist can apply these and advise on whether imaging is required.
Joint deformity or gross swelling — suggests fracture or significant ligament disruption. Requires emergency assessment.
Head injury or concussion — any suspected concussion means immediate removal from play. The SCAT5 protocol applies: no same-day return to play, and a graduated return-to-sport protocol (minimum 5 days) before return to contact sport.
Neurological symptoms — weakness, widespread numbness, bilateral symptoms, or loss of bladder/bowel control. Emergency assessment required.
Chest pain or palpitations during exercise — cardiac cause must be excluded before return to sport. Medical emergency if ongoing.
The 24-Hour Rule for Minor Injuries
For minor soft tissue injuries where you’ve been able to finish the session at reduced intensity: the 24-hour response is diagnostic. If pain, swelling, and stiffness are improving at 24 hours with basic first aid (POLICE: Protection, Optimal Loading, Ice, Compression, Elevation), you’re likely dealing with a Grade I strain that can be managed conservatively. If pain is the same or worse at 24 hours, see a physiotherapist — you’re likely dealing with a Grade II injury or more that needs formal assessment and a structured rehabilitation plan.
Return to Sport After Injury
The goal of rehabilitation isn’t to return to training — it’s to return to training with the capacity to stay there. Returning too early is the single biggest cause of recurrent sports injuries. Use these principles:
Return to full training when you can perform all the physical demands of your sport without pain modification. For team sports, this means full training, not just “light duties.” For running-based sports, this means pain-free running at full speed, with change-of-direction and reactive tasks. For strength sports, this means the full competition movement pattern at the required load.
Validated return-to-sport tests — hop tests (single, triple, crossover), strength symmetry testing (>90%), and psychological readiness scales — should be completed before return to competition for significant joint injuries.
Sports Injury Physiotherapy in Burwood
Burwood Physio treats sports injuries at all levels — from junior and recreational athletes to masters competitors and gym-goers. We provide accurate diagnosis, structured rehabilitation, and sport-specific return-to-play programmes. Same-week appointments, HICAPS on-site. Call 02 8322 9022 or book online.
Related: Ankle Sprain Rehabilitation | Hamstring Strain Treatment | Groin Strain Treatment | ACL Rehabilitation
Reviewed by the Burwood Physio Clinical Team
BPhty (Hons) | AHPRA Registered Physiotherapists | Member, Australian Physiotherapy Association
Our clinical team has over 20 years of combined experience in musculoskeletal physiotherapy, sports rehabilitation, and pain management. All content is reviewed for clinical accuracy and updated in line with current evidence-based practice guidelines. Meet our team →
