A quick two-minute read:
You hurt your back lifting the kids or rolled your ankle on a run. You rested it, it settled, and a few weeks later life was back to normal. Then a few months on, the same niggle is back. Same spot. Same feeling. If that sounds familiar, you're not unlucky. There's usually a reason.
Pain settling and recovery finishing are two different finish lines. When you first get hurt, you naturally move less, avoid what hurts and find workarounds. Over the next few weeks the inflammation settles and the tissue works through its recovery. All of that helps the pain. None of it tells us whether your strength, control and confidence have come back.
Meanwhile, weeks of doing less have a cost. Muscles that aren't loaded get weaker, and your uninjured side often loses strength too. So you go back to the gym, the garden or chasing the kids with less capacity than you had before the injury. The demand hasn't changed. Your capacity has. That mismatch is often where the pain comes back.
At By Design, we look at three things when pain keeps returning. Capacity: is the area strong enough for what you're asking of it? Coordination: is your body using that strength well? Connection: is your nervous system still on high alert, keeping you guarded or avoiding certain movements? Rehab isn't finished when the pain settles. It's finished when all three are ready for the life you want to get back to.
Got a few more minutes? Keep reading.
Comparing sides can be misleading. Most physios compare your injured side with the other one. It's a useful starting point, and our minimum is 90% of the other side. But if both sides have weakened, 90% of a weaker leg can look better than it really is. So we also compare against norms and against what your goal actually demands. A calf that tires after a handful of heel raises isn't ready for a 10 km run, even if it matches the other one.
Workarounds and caution aren't the enemy. Leaning away from the sore side or bracing through your back is often a sensible, protective response early on. Your nervous system is doing its job. The problem is when that protection hangs around after the tissue no longer needs it. You stay guarded, you keep avoiding the movement, and the area that needs loading never gets it. That's when planned, gradual exposure to what you've been avoiding matters as much as the strength work.
Watch out for boom and bust. You feel good, so you do everything you've missed in one weekend. It flares. You rest for a week, and you're back where you started. Sudden spikes in load are one of the most common reasons tissue gets irritated. Steady, planned increases build capacity. Big swings mostly build frustration.
Finally, finish on tests, not on feel. We start with your goal, whether that's running 5 km, playing 18 holes or lifting your toddler without thinking about it. We test the sore area, the joint above and below, and the other side. Every gap gets two numbers: where you are now and where your goal needs you. We retest every three sessions so you can see your progress, not just feel it. You're done when every gap meets its target. Pain settling is an important milestone. It just isn't the finish line.
Finish the Rehab, not just removing the pain.
At By Design Physiotherapy & Strength in North Hobart, we assess capacity, coordination and connection to find what's still missing when pain keeps coming back, then build a plan around what you want to get back to.
Book a physiotherapy appointment to find out what's keeping your pain coming back.
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About This Article
Author: Marissa Seeley, Physiotherapist and Co-Founder
Clinic: By Design Physiotherapy & Strength, North Hobart, Tasmania
Publication date: 6 November 2026
Last reviewed: 6 November 2026
By Design Clinical Framework
Capacity, Coordination and Connection are three clinical assessment areas used within By Design Physiotherapy & Strength to help organise clinical reasoning and rehabilitation planning.
This is an internal clinical framework, not an independently validated diagnostic tool.
References
Ardern CL, Glasgow P, Schneiders A, et al. (2016). 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. British Journal of Sports Medicine, 50(14), 853–864. DOI: 10.1136/bjsports-2016-096278.
Wellsandt E, Failla MJ, Snyder-Mackler L. (2017). Limb symmetry indexes can overestimate knee function after anterior cruciate ligament injury. Journal of Orthopaedic & Sports Physical Therapy, 47(5), 334–338. DOI: 10.2519/jospt.2017.7285.
Hodges PW, Tucker K. (2011). Moving differently in pain: a new theory to explain the adaptation to pain. Pain, 152(3 Suppl), S90–S98. DOI: 10.1016/j.pain.2010.10.020.
Gabbett TJ. (2016). The training–injury prevention paradox: should athletes be training smarter and harder? British Journal of Sports Medicine, 50(5), 273–280. DOI: 10.1136/bjsports-2015-095788.
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This is general information only. If you're managing pain or an injury, speak with your physio about what's right for you.
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