Many equate pain with injury and thus assume that pain should be a straight line when recovering. So, if pain flares up a bit, they worry that something is wrong. Maybe the injury is getting worse, or they “overdid it” the day before. In reality, pain often rises and falls during normal recovery, and these ups and downs do not automatically mean you’re injuring yourself. Pain is more complex than a simple measure of tissue damage.
Healing tissues and a sensitive alarm system
Pain is best thought of as your body’s alarm system. Early after an injury or surgery, that alarm is turned up on purpose to protect healing tissues. Even as the tissues recover normally, the alarm may remain slightly sensitive for a while. This means everyday movements, increased activity, or changes in routine can trigger pain, even when the tissues themselves are safe.
This sensitivity usually settles with time, movement and confidence. A short-term increase in pain does not automatically mean damage has occurred. It often reflects a nervous system that’s still learning what is safe again.
Next day pain
Pain that shows up later, such as soreness the next day, is often blamed on “overdoing it.” While extreme overload can contribute to flare-ups, changes in pain from one day to the next are often a normal response to increased movement. Your body adapts to activity gradually, and mild soreness or stiffness can be part of that process, especially when trying something new or returning to activities you’ve avoided.
Pain levels don’t always match how well your body is healing. You are recovering successfully, even on days when pain feels worse.
Stress, sleep and mood matter
Your nervous system doesn’t work in isolation. Poor sleep, emotional stress, worry or fatigue can increase pain sensitivity. We often say, “You’re getting on my nerves” when someone stresses us out. Biologically, that’s true. Stressful events release chemicals that make nerves more sensitive. On stressful days, the pain alarm becomes easier to trigger, which is why pain may spike during busy weeks, after poor sleep or during emotional strain without any change in the injury itself.
These influences are real and biological; they are not imagined or “in your head.”
Your body’s healing chemistry
Your body naturally produces both pro-inflammatory chemicals (which increase sensitivity) and anti-inflammatory chemicals (which reduce sensitivity) as part of the healing process. This balance shifts from day to day, like a teeter-totter. Some days you may feel more sensitive, and other days less so. These shifts are a normal part of recovery and help explain why pain often fluctuates.
Pain doesn’t equal harm
One of the most important principles of recovery is this: pain does not always mean damage. Pain is often a sign of sensitivity rather than danger. Gradually continuing to move, even with some discomfort, is often part of restoring normal function and confidence.
When to check in
While fluctuating pain is common, steadily worsening pain, new symptoms or pain accompanied by significant swelling, weakness or loss of function should be discussed with a health care provider. Otherwise, ups and downs are a normal and expected part of recovery.
Healing isn’t about eliminating every painful moment. It’s about helping your body and nervous system feel safe enough to move forward, one step at a time.
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc®. For free and easy access to the entire Prairie Doc® ® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook.
Kory Zimney, PT, DPT, PhD is a professor at the University of South Dakota, School of Health Sciences Physical Therapy Department and director of the PhD in Health Science program.
