Pain Treatment Q&A
Why does it hurt more
when I exercise?
The order of treatment matters more than exercise itself
Exercise is definitely good for you. But if you exercise before your body is ready, pain can get worse and recovery can be delayed. Let me explain the right order.
Quick Answer
If you exercise while in pain, it gets worse. Pain means there’s a ‘sensitized alarm system’ and ‘overloaded tissues.’ Exercising in this state leads to repeated irritation of already sensitive areas.
✅ Right order: Downshift → Activate → Integrate
First calm the sensitized nerves and reduce overload (Downshift), then gradually strengthen the muscles (Activate), and finally reconnect movements (Integrate). When you follow this order, exercise becomes truly helpful.
What happens when you exercise while in pain?
When chronic pain persists, two problems occur in the body:
① The alarm system becomes too sensitive
Like a fire alarm that goes off at the smallest smoke, nerves send pain signals at the slightest stimulation. This is called central sensitization.
- Even light touch feels painful
- Sharp pain from small movements
- Same movement, increasing pain
② Tissues are overloaded and unable to recover
Like a car that’s been in an accident and hasn’t been repaired yet, when tissues are overloaded, even normal movement causes problems.
- Insufficient blood flow to deliver recovery nutrients
- Nerve compression or adhesions
- Overworked muscles becoming rigid and losing function
❌ Exercising in this state = Re-alarming the sensitive alarm + Re-loading overloaded tissues
Rather than helping recovery, it causes repeated re-injury.
The right sequence for effective exercise
Exercise isn’t wrong. But it must come at the right time.
Downshift
(Calm it down)
First, desensitize the nerves and reduce the load on tissues.
- Circulation HD: Release nerve compression, restore blood flow
- Warm compress, gentle massage
- Rest and positioning to reduce load
Goal: Reduce pain from 8/10 → 3/10
Activate
(Wake it up)
Gently reactivate dormant muscles.
- Circulation PT: Activate weak muscles
- Movement correction: Find safe movement patterns
- Light stretching and strengthening
Goal: Restore muscles that ‘can’t be used’
Integrate
(Connect it)
Connect recovered muscles and movements back to daily life.
- Functional exercise: Practice movements needed in daily life
- Full-body integration: Balance whole body
- Daily activity training
Goal: Return to daily life and sports
✅ When you follow this order, exercise becomes truly helpful
If you start exercising after Downshift and Activate are complete, you won’t get worse, you’ll keep getting better.
Signs that you’re exercising too early
- Pain increases every time you exercise
- Pain remains the next day after exercising
- Pain spreads to other areas while exercising
- Certain muscles or movements feel impossible
- Exercise position feels awkward and unstable
→ If you have these symptoms, you need to go back to the Downshift stage.
You need treatment to calm the nerves and reduce tissue load, not exercise yet.
Related Questions
Q. Can’t I just push through the pain and keep exercising?
❌ No. If you keep loading already overloaded tissues, inflammation worsens, adhesions form, and pain becomes chronic. When you push through with willpower, you may end up needing longer treatment later.
Q. When is the right time to start exercising?
When you meet these criteria, you can start light exercise:
- Daily pain reduced to 3/10 or less
- Can maintain posture without pain when still
- Can perform slow movements within comfortable range
- No sharp pain or spreading pain during movement
✅ If you’re unsure, consult with your therapist. Starting at the right time is the fastest path.
Q. I’ve been told I have weak core muscles. Should I strengthen them right away?
If you have pain, it’s not because your core is weak. Your muscles became weak because of pain. When the alarm system is sensitive and tissues are overloaded, muscles naturally shut down. (This is the body’s protective mechanism.)
→ First, lower the alarm through Downshift,
→ Then, wake up the muscles through Activate,
→ Finally, reconnect movements through Integrate.
When you follow this order, “weak core” resolves naturally.
Q. Can I exercise on the same day as treatment?
It depends on the type of treatment and your condition. After Circulation HD (Downshift treatment), we may reduce the load or recommend rest. After Circulation PT (Activate treatment), you may receive home exercise guidance.
Important: The “exercises” given by the therapist are different from “exercising on your own.” Therapist-prescribed exercises are part of Activate and Integrate stages within treatment.
→ Follow the timing and intensity recommended by your therapist. That’s the safest and fastest approach.
Treatment sequence at Yonsei Shinmyung
We don’t just exercise. We find the right timing and guide you in the right order.
- Initial Assessment — Determine current stage (Downshift needed? Activate possible?)
- Downshift — Circulation HD to reduce neural sensitivity and tissue load
- Activate — Circulation PT to wake up dormant muscles
- Integrate — Movement correction to restore daily activities and sports
- Long-term Plan — Teach home exercises and prevention strategies
Related Articles
Exercise is good for you.
But timing matters.
If you do the right thing at the right time, recovery is faster and there’s no recurrence.
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