More Is Not Better – Why “Harder Training” Often Leads to Worse Rehabilitation Outcomes

In both training and rehabilitation, there is a persistent belief that more load, more pain, and faster progression produce better results. This mindset is deeply embedded in training culture and in the broader perception of what “effective treatment” looks like. Clinical experience and research, however, consistently show that excessive loading too early is one of the main reasons for pain flare-ups, stalled progress, and dropout in rehabilitation.

This is not an argument against progression—but against the assumption that progression must always be aggressive.

When Good Intentions Clash With Biology

The body adapts to load through biological processes that require time: tissue remodeling, neural adaptation, and gradual increases in tolerance. When load exceeds the capacity of tissues or the nervous system to adapt, recovery and improvement do not occur. Instead, protective responses dominate.

In practice, this often results in:

• increased pain

• prolonged stiffness and fatigue

• reduced movement quality

• loss of confidence and motivation

These patterns are commonly observed in tendinopathies, persistent low back pain, and postoperative rehabilitation.

Pain Is Not a Marker of Quality

A persistent problem in both training and rehab is the belief that pain signals effective treatment. Modern pain science demonstrates the opposite: pain reflects perceived threat, not tissue damage alone.

Repeated overloading teaches the nervous system to expect pain, which:

• increases sensitivity

• lowers tolerance to load

• makes long-term progression more difficult

Effective rehabilitation is therefore not about avoiding all pain, but about keeping load within a range the body can learn from.

Progressive but Conservative – Not Passive

A common misconception is that lower loading equals ineffective treatment. In reality, research shows that gradual, individualized progression leads to equal or superior long-term outcomes compared with aggressive protocols.

This approach emphasizes:

• clear criteria for progression

• respect for recovery

• adjustment based on patient response, not the calendar

In many cases, increasing volume before intensity—and control before force—is the safer and more effective strategy.

The Role of the Physiotherapist

In an era of digital programs, standardized protocols, and “one-size-fits-all” solutions, clinical reasoning is more important than ever. Outcomes are not determined by exercises alone, but by dose, timing, and context.

Saying “we’ll progress more slowly” is not a sign of weak treatment—it is often a sign of professional maturity.

Summary

Harder training is not automatically better training. In rehabilitation, aggressive and poorly timed loading often produces worse long-term results. Progressive, well-tolerated loading tailored to patient response supports better confidence, less pain, and more sustainable improvement.

Sources

• Silbernagel, K. G., Hanlon, S., & Sprague, A. (2020). Current clinical concepts: Conservative management of Achilles tendinopathy. Journal of Athletic Training, 55(5), 438–447. https://doi.org/10.4085/1062-6050-356-19

• Meeusen, R., Duclos, M., Foster, C., Fry, A., Gleeson, M., Nieman, D., Raglin, J., Rietjens, G., Steinacker, J., & Urhausen, A. (2013). Prevention, diagnosis, and treatment of the overtraining syndrome. European Journal of Sport Science, 13(1), 1–24. https://doi.org/10.1080/17461391.2012.730061

• Nijs, J., Clark, J., Malfliet, A., Ickmans, K., Voogt, L., Don, S., den Bandt, H., Goubert, D., & Dankaerts, W. (2019). In the spine or in the brain? Recent advances in pain neuroscience applied in the intervention for low back pain. Clinical and Experimental Rheumatology, 37(5), 108–115.