What to Do When Your Recovery Isn’t Going as Planned

You’ve been putting in the work (i.e. stretching, strengthening, doing your exercises) and yet something feels off. Maybe your pain flared up, your progress stalled, or you even felt like you took a step backward.

If that sounds familiar, you’re not alone. Recovery is rarely a straight line, especially for active adults and athletes dealing with musculoskeletal issues like back pain, tendinopathy, shoulder injuries, or post-surgical rehab. Setbacks happen for many reasons and understanding why is key to getting back on track.

At Tualatin Valley Physical Therapy, we help patients who feel stuck with their recovery every day. The good news? Most plateaus, flare-ups, and regressions are not signs of failure: they’re signs your body is adapting, learning, or asking for a new approach!

Why Recovery Isn’t Linear

The body doesn’t heal in perfect increments. Progress depends on a blend of physical load, tissue capacity, mental resilience, and lifestyle factors like sleep, stress, and nutrition.

Research shows that recovery follows a non-linear pattern: pain, strength, and function often improve in bursts rather than steady lines.(1,2) For athletes and active adults, progress may temporarily stall because of training errors, overreaching, or even life stress.

Common reasons recoveries may stall include:

• Flare-ups from doing too much, too soon

• Fear of movement after pain

• Lack of sleep or increased stress

• Nutritional deficits (especially protein or energy availability)

• Skipping home exercises or inconsistent load progression

• Unrealistic recovery timelines

The Science Behind Setbacks

1. Load vs. Capacity: Finding the Sweet Spot

   • Your tissues (muscles, tendons, and joints) adapt to the loads placed on them. But if that load exceeds your tissue’s capacity by being too heavy, too frequent, or too sudden you get pain or inflammation.

   • Meta-analyses show that gradual, progressive loading is one of the strongest predictors of successful rehab.(3,4) This principle applies whether you’re dealing with a rotator cuff injury, ACL repair, or chronic tendinopathy.

   • If you push too hard, you flare up. Not enough, and your tissues weaken. The goal is to find the “Goldilocks zone” where there is enough stress to stimulate adaptation without exceeding capacity.

2. Pain Doesn’t Always Mean Damage

   • Pain is complex, it’s influenced not just by tissue state but by your brain’s interpretation of threat.(5) Fear, anxiety, or frustration can amplify pain signals even after tissues have healed.

   • This doesn’t mean pain is “in your head,” it means your nervous system is protective by nature. Understanding this helps reduce fear-avoidance and empowers you to move confidently again.

The Psychology of Plateaus

1. When people expect steady progress, any stall can feel discouraging. Yet psychological factors like catastrophizing (“I’ll never get better”) or fear of reinjury are strong predictors of prolonged recovery.(6)

2. Research shows that patients who receive pain education, reassurance, and active coping strategies recover faster and report less disability.(7)

Sleep, Stress, and Nutrition Matter More Than You Think

Lack of sleep, high stress, and poor nutrition can all impair tissue repair and pain regulation.(8,9) Adequate protein (1.6–2.2 g/kg body weight daily) supports muscle and tendon recovery, while creatine has emerging evidence for enhancing rehab outcomes.(10)

For athletes, Relative Energy Deficiency in Sport (RED-S) is when they are not eating enough to meet training demands which can delay healing and increase injury risk.(11)

Case Spotlight: From Frustration to Function

A previous patient recently shared:

“I slipped and fell at a trampoline park… and injured my shoulder. I went to a physical therapist, and I seemed to be making progress until… my progress seemed to decline, and eventually, this person recommended surgery. I decided not to go back.

While at the Washington County Chamber Wake Up, I met Dr. Ben. I told him what was going on, and he… told me his thoughts about my shoulder, so I scheduled an appointment. His intuition was correct… Dr. Ben not only got my shoulder feeling and moving better...I was motivated to start hitting the weights again.”

Their story captures what happens when recovery feels derailed: the body’s progress slows, confidence drops, and uncertainty sets in. But, with personalized load management, pain education, and graded re-exposure your function and confidence can return to being stronger than before!

Strategies to Get Back on Track

1. Reassess the Load

   • Look at your current training or activity volume. Did you add too much too quickly? Reduce intensity for a few days, then rebuild gradually. The 10% rule (no more than 10% weekly load increases) helps prevent flare-ups.(3)

2. Modify, Don’t Stop

   • Completely resting rarely helps. Relative rest where you are adjusting activity while staying active is more effective for long-term recovery.4 For example, swap running for cycling, or lift lighter with higher reps.

3. Check Sleep, Stress, and Fuel

   • Sleep is when your body repairs tissue and consolidates motor learning. Aim for 7–9 hours nightly. Manage your stress through breathwork, light cardio, or mindfulness which have all shown to lower pain sensitivity.(8)

4. Review Your Technique

   • Faulty movement patterns can overload tissues. A DPT can analyze your gait, lift form, or running mechanics to identify small technique errors with big payoffs.

5. Address Fear and Expectations

   • Setbacks can trigger frustration or fear of reinjury. Reframing pain as feedback (not failure) helps rewire the brain’s threat response. Pain neuroscience education improves outcomes and reduces disability in chronic musculoskeletal pain.(7)

6. Reconnect With Your Therapist

   • If your progress stalls, don’t assume the plan “isn’t working.” Communicate with your physical therapist and they can reassess load, add new strategies (like isometric pain modulation or graded exposure), and refocus goals based on your current capacity.

When to Seek Help

Reach out to a Doctor of Physical Therapy if you experience:

• Recurring flare-ups or pain limiting your workouts

• Loss of confidence in movement or fear of reinjury

• Trouble returning to sport despite prior therapy

• Increased pain despite rest or home exercise

At Tualatin Valley Physical Therapy, we specialize in helping athletes and active adults overcome plateaus through:
✅ One-on-one care with a Doctor of Physical Therapy
✅ Pain science education for confidence and clarity
✅ Load management & graded exposure strategies
✅ Proper motor control & movement retraining
✅ Self-management tools to stay pain-free long-term

We serve Hillsboro, and all surrounding regions, helping you get the care you need when you need it.

The Takeaway

Setbacks are not failure… they’re feedback! They reveal what your body needs to adapt, not that it’s broken. With the right strategy, education, and support, every setback becomes an opportunity to move forward smarter and stronger.

At Tualatin Valley Physical Therapy, we remove every barrier between you and the recovery you deserve. Don’t let insurance dictate your care, schedule your free 15-minute consultation or same-day appointment today.

References

1. Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?. Br J Sports Med. 2016;50(19):1187-1191. doi:10.1136/bjsports-2015-095422

2. Littlewood C, Malliaras P, Mawson S, May S, Walters SJ. Self-managed loaded exercise versus usual physiotherapy treatment for rotator cuff tendinopathy: a pilot randomised controlled trial. Physiotherapy. 2014;100(1):54-60. doi:10.1016/j.physio.2013.06.001

3. American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687-708. doi:10.1249/MSS.0b013e3181915670‌

4. Beyer R, Kongsgaard M, Hougs Kjær B, Øhlenschlæger T, Kjær M, Magnusson SP. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. Am J Sports Med. 2015;43(7):1704-1711. doi:10.1177/0363546515584760

5. Moseley GL, Butler DS. Fifteen Years of Explaining Pain: The Past, Present, and Future. J Pain. 2015;16(9):807-813. doi:10.1016/j.jpain.2015.05.005

6. Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: A systematic review. The Spine Journal. 2014;14(5):816-836. doi:https://doi.org/10.1016/j.spinee.2013.09.036

7. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract. 2016;32(5):332-355. doi:10.1080/09593985.2016.1194646

8. Haack M, Simpson N, Sethna N, Kaur S, Mullington J. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology. 2020;45(1):205-216. doi:10.1038/s41386-019-0439-z

9. Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016;338:114-129. doi:10.1016/j.neuroscience.2016.06.006

10. Candow DG, Chilibeck PD, Forbes SC. Creatine supplementation and aging musculoskeletal health. Endocrine. 2014;45(3):354-361. doi:10.1007/s12020-013-0070-4

11. Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52(11):687-697. doi:10.1136/bjsports-2018-099193