It can be frustrating when pain settles down, only to come back again a few weeks later.
You rest it. You stretch it. You take it easy for a few days. It feels better, then as soon as you return to work, sport, gym, gardening, running or a busy week of life, the same pain seems to return.
This is something we see often at Trilogy Physiotherapy. Recurring pain does not always mean something serious is wrong. Sometimes it means the body has not built enough tolerance yet for what you are asking it to do.
In other words, the pain may have settled, but the area may not be fully prepared for the load, movement or activity you have returned to.
Pain relief and recovery are not always the same thing
One of the most common reasons pain comes back is that people stop their rehab as soon as the pain improves.
That is completely understandable. When you feel better, it is easy to think the issue is fixed.
The problem is that pain relief and full recovery are not always the same thing.
For example, your back pain may settle after a few quiet days, but if your hips, trunk and lower limbs are not tolerating your usual work, gym or sport load, symptoms may return when life ramps up again.
Your shoulder pain may feel fine after avoiding overhead movements, but if the shoulder has not rebuilt strength and control, it may flare again when you return to lifting, swimming, tennis or gym work.
This is why a good physiotherapy plan often needs to go beyond simply settling symptoms. It should also help you rebuild movement, strength, confidence and capacity.
Your body may not be ready for the load you are putting through it
Pain often returns when there is a mismatch between what your body can currently tolerate and what you are asking it to do.
This can happen after:
A sudden increase in training
Returning to sport too quickly
A busy week of sitting, driving or lifting
Restarting gym after time off
Doing more gardening, cleaning or housework than usual
Changing running volume, shoes or exercise routine
Poor sleep, stress or reduced recovery
In clinic, we often find the issue is not that someone has done something “wrong”. It is more that their body has not yet built enough tolerance for the task.
Muscles, tendons, joints and the nervous system can adapt well, but they usually need the right mix of load, recovery and progression.
Exercise therapy has been shown to help many persistent musculoskeletal pain presentations when it is tailored and progressed properly. A Cochrane review found moderate certainty evidence that exercise therapy is more effective than no treatment, usual care or placebo for pain outcomes in chronic low back pain (Hayden et al., 2021).
Rest can help, but rest alone may not fix the problem
Rest can be useful when pain is very irritable, especially in the early stages of an injury or flare up.
But if pain keeps coming back, rest alone may not be enough.
Rest may calm symptoms down, but it does not always rebuild the strength, control or load tolerance needed to stop the problem returning.
For recurrent low back pain, a Cochrane review found moderate quality evidence that exercise after recovery was more effective than no intervention for reducing the rate of low back pain recurrence at one year (Choi et al., 2010).
The WalkBack trial also found that an individualised walking and education program helped reduce recurrence of low back pain in adults who had recently recovered from an episode of non specific low back pain (Pocovi et al., 2024).
That does not mean everyone with back pain just needs to walk. It means that staying active with the right plan, progressed at the right pace, can be an important part of reducing future flare ups.
The painful area is not always the whole story
Pain often starts in one area, but the reason it keeps returning may involve more than just the sore spot.
For example:
Recurring knee pain may involve hip strength, ankle mobility, training load or running volume.
Recurring neck pain may involve shoulder strength, desk setup, stress, sleep and sustained postures.
Recurring back pain may involve trunk strength, hip mobility, lifting capacity and confidence with movement.
Recurring calf or Achilles pain may involve strength, running load, footwear and recovery.
This is why a proper assessment matters.
Best practice care for musculoskeletal pain recommends looking beyond the painful area alone. This includes screening for serious pathology, assessing physical and psychosocial factors, using imaging selectively, providing education, encouraging physical activity and exercise, and using manual therapy as an adjunct rather than the only treatment (Lin et al., 2020).
That does not mean pain is “all in your head”. It means pain is influenced by multiple systems, and your plan should consider the whole picture.
You may be treating the symptom, not the pattern
Recurring pain usually has a pattern.
It might be:
Back pain that returns after long sitting
Neck pain that flares during stressful work weeks
Knee pain that returns when running volume increases
Shoulder pain that comes back with overhead pressing
Calf pain that returns with sprinting or jumping
Hip pain that feels better with rest, then returns with sport
Finding that pattern is important.
If your knee pain returns every time you increase running, the answer may not be to simply rest every time it hurts. The plan may need to look at strength, running load, recovery, footwear and how quickly you are progressing.
If your neck pain returns after long desk days, the plan may involve strengthening, mobility, movement breaks, workstation habits and strategies to manage sustained postures.
Hands on treatment can help, but it should not be the whole plan
Hands on treatment can be helpful for reducing pain, improving movement and helping you feel more comfortable.
At Trilogy Physiotherapy, we use hands on treatment when it is appropriate, but if pain keeps returning, the long term plan usually needs more than that.
Manual therapy is often recommended as an adjunct to education, exercise and active care, rather than being the only treatment approach (Lin et al., 2020).
In simple terms, hands on treatment may help calm things down, but the bigger goal is to help your body cope better with the things you need and want to do.
Your rehab may not have gone far enough
A lot of people stop rehab at the “feels better” stage.
A more complete rehab plan may include:
Settling the painful flare up
Restoring comfortable movement
Rebuilding strength and control
Improving tolerance to work, gym, sport or daily activities
Gradually adding speed, load, impact or endurance
Creating a plan to reduce future flare ups
For neck pain, clinical practice guidelines support using exercise and manual therapy depending on the type and stage of neck pain. This may include range of motion exercises, strengthening, endurance exercises and education to support a return to normal activity (Blanpied et al., 2017).
The same general idea applies to many recurring injuries. The plan needs to match the person, the symptoms and the activity they are trying to return to.
What we look for during your physio assessment
If you come in with pain that keeps coming back, we are not just looking at where it hurts.
We may look at:
How the pain started
What makes it better or worse
What activities it keeps interrupting
Your movement and mobility
Strength differences from side to side
Balance, control or coordination
Training load or work demands
Previous injuries
Your goals and what you need to get back to
This helps us work out whether the issue is likely related to strength, mobility, load tolerance, movement patterns, recovery, or a combination of factors.
From there, we can build a plan that is specific to you.
When should you see a physio for recurring pain?
It may be worth booking a physiotherapy appointment if:
Your pain keeps returning after rest
You are avoiding sport, gym, work or normal activity
You feel weak, stiff or restricted on one side
You are unsure what exercises are safe
Your symptoms are affecting sleep, training or daily life
You have had repeated flare ups in the same area
You want a clear plan instead of guessing
Recurring pain can often improve with the right assessment, education and progressive plan.
At Trilogy Physiotherapy in Sinnamon Park, our team helps people across the Centenary Suburbs manage recurring pain, new injuries, sports injuries and everyday aches that are stopping them from moving well.
If your pain keeps coming back, book an appointment with our physiotherapy team. We can help assess what may be contributing to your symptoms and create a plan to help you move forward with more confidence. Appointments can be made online or by giving us a phone call.
Read more
How to Know If You Need to See a Physio
The Benefits of Physiotherapy for Office Workers in Brisbane
Hamstring Strains in Runners: When to Rest and When to Rehab
References
Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., Sparks, C., & Robertson, E. K. (2017). Neck pain: Revision 2017. Journal of Orthopaedic & Sports Physical Therapy, 47(7), A1 A83.
Choi, B. K. L., Verbeek, J. H., Tam, W. W. S., & Jiang, J. Y. (2010). Exercises for prevention of recurrences of low back pain. Cochrane Database of Systematic Reviews, 2010(1), CD006555.
Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 2021(9), CD009790.
Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., Straker, L., Maher, C. G., & O’Sullivan, P. P. B. (2020). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high quality clinical practice guidelines: Systematic review. British Journal of Sports Medicine, 54(2), 79 86.
Pocovi, N. C., Lin, C. W. C., French, S. D., Bailey, L., Beller, E., Biddle, S. J. H., Buchbinder, R., Carvalho e Silva, A. P., Cashin, A. G., Costa, L. O. P., Ferreira, G. E., Fowler, C., Godfrey, C., Hancock, M. J., Harris, I. A., Maher, C. G., McAuley, J. H., McCaffery, K., Smeets, R. J. E. M., Williams, C. M., & Machado, G. C. (2024). Effectiveness and cost effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia: A randomised controlled trial. The Lancet.