Episode 109Aug 12, 2026· 4:13

Two Extremes That Make Pain Worse (And What To Do Instead)

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About this episode

Physical therapist Jen Uschold covers pain neuroscience education in the context of chronic pain and movement, explaining why fear-based movement avoidance and "no pain, no gain" overexertion both worsen pain outcomes. She introduces pacing and graded exposure as the practical alternative — identifying the movement threshold the nervous system can tolerate and incrementally increasing it. She describes a patient…

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Who this episode is for

This episode may resonate with you if:

You're a physical therapist, trainer, or movement coach working with clients who refuse to exercise because they're afraid of triggering pain — and you need a clear, concise way to explain why avoidance makes things worse.

You're working with athletes or high-performers who default to 'no pain, no gain' and keep re-injuring themselves or stalling recovery — and you're looking for language to push back on that mindset.

You're a lifestyle medicine or wellness professional trying to get chronic pain patients to start moving again, and you need a practical framework — something like pacing and graded exposure — to introduce incrementally.

You're a pain science educator or clinician looking for a short, shareable episode that explains the nervous system rationale for movement — blood flow to nerves, calming the system — in plain language you can point patients to.

You're a rehab professional who has a patient stuck at a very low baseline — barely able to walk for a few minutes — and you want a concrete example of how small starting points can lead to significant long-term outcomes.

What you’ll learn

Recognize that both avoiding movement and pushing through pain can make things worse

Use pacing and graded exposure to find the movement level your nervous system can handle

Start where your nervous system is actually ready to start, not where you think you should be

Understand why movement reduces pain: nerves need blood flow to calm down

Questions this episode helps answer

Should I rest or keep moving when I have chronic pain?

answered

Jen says neither full rest nor pushing through pain works — both extremes tend to make pain worse. The alternative is pacing and graded exposure: finding the amount of movement that helps your nervous system calm and thrive.

"When it comes to pain, we see two general extremes, and unfortunately, both extremes tend to cause more pain. The first is people who avoid doing anything because it might cause pain, it has caused pain in the past, or they're afraid that it's going to cause pain. Pain is a complex whole nervous system experience, and when we avoid and stop using our nervous system and our bodies, it actually can make the pain worse."

Is it bad to exercise through pain?

answered

Jen says yes — the "no pain, no gain" approach can actually cause more pain. Pushing through, sucking it up, or just getting it done are framed as the second extreme that backfires.

"There's also a phrase that many of us are familiar with, and that is, "No pain, no gain." Well, unfortunately, this also leads to more pain. The idea of pushing through pain or sucking it up or just get it done can actually cause more pain too. So the secret sauce is pacing and graded exposure. What we're trying to do is find the amount of movement that helps your nervous system calm and thrive. And honestly, for some people, that might be just one or two minutes of walking."

How do I start exercising again when I've been in pain for a long time?

answered

Jen describes starting where your nervous system is actually ready to start — for some people that's just one or two minutes of walking — and building up gradually from there. She shares the example of a patient who began at two minutes and now sends pictures hiking across multiple countries.

"There's also a phrase that many of us are familiar with, and that is, "No pain, no gain." Well, unfortunately, this also leads to more pain. The idea of pushing through pain or sucking it up or just get it done can actually cause more pain too. So the secret sauce is pacing and graded exposure. What we're trying to do is find the amount of movement that helps your nervous system calm and thrive. And honestly, for some people, that might be just one or two minutes of walking. A few years ago, I was working with a woman and that was her starting point, two minutes. Well, now every year or so, she sends me pictures hiking in Budapest, Australia, Vienna, and all sorts of cool places. She started where her nervous system was ready to start and she built up and built up and built up. Why is movement so important for those who are struggling and navigating chronic pain? The reason is this. Our nervous system is made up of our nerves, our brain, and our spinal cord."

Why does movement help with chronic pain?

answered

Jen explains that the body's 400 nerves are all connected like one big highway and they love blood flow, which comes from movement. When the nerves get that blood flow, they calm down, the whole system calms down, and the brain becomes less likely to create pain.

"Those 400 nerves that we have, they are all connected like one big crazy highway, and they love blood flow, and we get that blood flow from movement. And when we give those nerves the movement and blood flow that they like, they calm down. And when the nerves are calmer, the entire system is calmer, and your brain is less likely to create pain. I hope that helps and is inspiring for a few of you."

Setting expectations: This episode is not a workout guide or a motivational push to exercise harder — it doesn't cover fitness routines, injury rehabilitation protocols, or general wellness tips. It's a short talk from a physical therapist explaining why both avoiding movement and pushing through pain tend to backfire, and what 'pacing and graded exposure' actually means for people living with chronic pain.

Tone & style

A patient who could only tolerate two minutes of walking started there rather than pushing harder or giving up entirely. Through pacing and graded exposure, she built up incrementally as her nervous system adapted — and now sends Jen photos from hiking trips in Budapest, Australia, and Vienna.

Expert clinical knowledge from a practicing physical therapist and pain science fellow, illustrated with a patient case from her own practice. Contains medical claims about pain and the nervous system.

toneCalm & clinical

focusJen Uschold, a physical therapist and pain science fellow, explains why both avoiding movement and pushing through pain tend to backfire — and why pacing and graded exposure is the alternative.

stylesolo_monologue

energylow

complexitybeginner

pressure Levellow

emotional Texturecalm, clinical, gently encouraging

Notable quotes

"There's also a phrase that many of us are familiar with, and that is, "No pain, no gain." Well, unfortunately, this also leads to more pain. The idea of pushing through pain or sucking it up or just get it done can actually cause more pain too. So the secret sauce is pacing and graded exposure. What we're trying to do is find the amount of movement that helps your nervous system calm and thrive. And honestly, for some people, that might be just one or two minutes of walking."

— Jen Uschold

"A few years ago, I was working with a woman and that was her starting point, two minutes. Well, now every year or so, she sends me pictures hiking in Budapest, Australia, Vienna, and all sorts of cool places. She started where her nervous system was ready to start and she built up and built up and built up. Why is movement so important for those who are struggling and navigating chronic pain? The reason is this. Our nervous system is made up of our nerves, our brain, and our spinal cord."

— Jen Uschold

"Those 400 nerves that we have, they are all connected like one big crazy highway, and they love blood flow, and we get that blood flow from movement. And when we give those nerves the movement and blood flow that they like, they calm down. And when the nerves are calmer, the entire system is calmer, and your brain is less likely to create pain. I hope that helps and is inspiring for a few of you."

— Jen Uschold

Episode transcript

Organized into 4 chapters — open any part to read the full text.

0:051. Host Intro and Podcast Takeover ExplanationFamous Ashley Grant introduces the episode and explains the ongoing mini podcast takeover series while she builds out the Patreon.0:332. Jen Uschold on the Two Extremes That Worsen PainJen Uschold introduces herself and describes two common but counterproductive extremes: avoiding all movement out of fear of pain, and pushing through pain with a 'no pain, no gain' mindset — both of which can make pain worse.2:383. Pacing, Graded Exposure, and a Patient's StoryJen explains that the alternative to both extremes is pacing and graded exposure — finding the amount of movement the nervous system can handle — and shares the story of a patient who started with two minutes of walking and now hikes internationally.3:294. Why Movement Calms the Nervous SystemJen explains that the body's 400 nerves are interconnected and depend on blood flow from movement to calm down, which in turn reduces the brain's likelihood of generating pain.

Open full transcript

Mentioned in this episode

personJen Uschold

Physical therapist and fellow of pain science who guest-hosts this episode, discussing how movement affects chronic pain and the nervous system.

personFamous Ashley Grant

Host of More Movement Please, who introduces the episode and explains she is handing the mic to guests while building out the Patreon.

websitefamousashagrant.com/fitness

Website where listeners can join the host's group and find out how to be on the show.

placeBudapest

One of the international hiking destinations where Jen's former patient now sends photos, illustrating her recovery from chronic pain.

placeAustralia

One of the international hiking destinations where Jen's former patient now sends photos, illustrating her recovery from chronic pain.

placeVienna

One of the international hiking destinations where Jen's former patient now sends photos, illustrating her recovery from chronic pain.

Key themes

Pain avoidance making things worse

Jen describes how people who stop moving entirely — out of fear that movement has caused or will cause pain — can actually end up with more pain as a result.

'No pain, no gain' also backfires

Jen argues that the opposite extreme — pushing through pain, sucking it up — is equally counterproductive and can also cause more pain.

Pacing and graded exposure as the middle path

Jen presents pacing and graded exposure as the alternative to both extremes — finding the amount of movement the nervous system can actually handle rather than avoiding or overloading it.

Starting where you actually are

Jen shares the story of a patient whose starting point was two minutes of walking, framing it not as a failure but as meeting the nervous system where it was ready to begin.

Long-term recovery from chronic pain through movement

Jen's patient who started with two minutes of walking now sends photos hiking in Budapest, Australia, and Vienna — illustrating what gradual build-up over time can look like.

Nerves needing blood flow to calm down

Jen explains that the body's 400 nerves are interconnected and depend on blood flow from movement, and that when they get it, the whole system — including pain output — calms down.

Pain as a whole nervous system experience

Jen frames pain not as a simple physical signal but as something the brain creates, shaped by the state of the entire nervous system.