Navigating Pain with the Stoplight Guide: A Practical Approach from Boston’s Physical Therapy Experts

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Managing pain during recovery can be challenging, especially when trying to balance pushing through discomfort and avoiding further injury. At Sustain Physical Therapy in Boston, we utilize a unique and practical tool called the Stoplight Guide to help our clients understand and manage pain effectively. This system, which categorizes pain levels into green, yellow, and red lights, provides a clear framework for determining when it’s safe to continue an activity and when it’s time to stop or modify. In this blog, we’ll delve into how the Stoplight Guide works, its benefits, and how it can be applied to your physical therapy journey.

The Concept of the Stoplight Guide

The Stoplight Guide is a simple yet effective method used in our physical therapy practice to help clients gauge their pain levels during exercises and daily activities. Pain is subjective and can be influenced by various factors, including the nature of the injury, individual pain tolerance, and psychological factors. The Stoplight Guide breaks down pain levels into three categories:

  1. Green Light: Pain levels that remain the same or decrease during activity. This indicates it’s generally safe to continue the exercise.
  2. Yellow Light: Pain levels that slightly increase but remain manageable (typically up to 4/10). This indicates caution but not necessarily a need to stop.
  3. Red Light: Pain levels that significantly increase (5/10 or higher). This indicates the need to stop or modify the activity to prevent further harm.

Applying the Stoplight Guide in Physical Therapy

In our physical therapy sessions at Sustain Physical Therapy in Boston, we use the Stoplight Guide to tailor treatment plans and ensure our clients can safely progress through their recovery. Here’s how we apply it:

  1. Green Light (0-2/10 Pain): If a client starts an exercise with a pain level of 2/10 and it stays the same or decreases, we classify this as a green light. This means the exercise is beneficial and can be continued, helping to desensitize the body to pain and build strength without causing harm.
  2. Yellow Light (3-4/10 Pain): If pain increases to a 3 or 4/10, it falls into the yellow light range. This level of pain is often acceptable, especially for non-traumatic injuries. It indicates that the body is being challenged but is still capable of handling the stress. We may proceed with caution, adjusting the intensity or duration of the activity as needed.
  3. Red Light (5+/10 Pain): If pain escalates to 5/10 or higher, it is classified as a red light. This is a clear signal to stop or significantly modify the activity. Continuing at this pain level can exacerbate the injury and lead to additional symptoms. In this case, we reassess and adjust the treatment plan to avoid further aggravation.

Benefits of the Stoplight Guide

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The Stoplight Guide offers several benefits for both clients and therapists:

  1. Clarity: It provides a straightforward way for clients to communicate their pain levels and understand how to respond during activities.
  2. Empowerment: Clients feel more in control of their recovery, knowing when to push through discomfort and when to take a step back.
  3. Safety: By categorizing pain levels, we can ensure that clients do not overexert themselves and risk further injury.
  4. Progress Tracking: It helps track pain responses over time, allowing therapists to adjust treatment plans based on client feedback and progress.

Examples of Using the Stoplight Guide in Practice

Let’s explore some practical examples of how the Stoplight Guide can be applied to different scenarios in physical therapy:

  1. Running Physical Therapy: A runner recovering from tendinopathy might start with low-impact exercises. If their pain remains at a green light level, they can gradually increase intensity. If pain moves into the yellow light zone, they proceed with caution, perhaps focusing on form and technique. However, if the pain hits the red light zone, we immediately modify their activity to prevent further tendon damage.
  2. Shoulder Pain Management: For a client dealing with shoulder pain from rotator cuff tendinopathy, exercises like rotator cuff strengthening or dynamic stability drills are used. If the pain stays within the green light range, we continue progressing. In the yellow light zone, we might adjust the exercise load or technique. Red light pain prompts us to stop and re-evaluate the exercise, potentially shifting focus to lower-intensity activities or manual therapy.
  3. Post-Surgical Rehab: Clients recovering from surgery, such as ACL reconstruction, benefit significantly from the Stoplight Guide. Initial activities might include gentle range-of-motion exercises. Green light responses allow for progression to more demanding tasks. Yellow light feedback leads to cautious advancement, while red light signals necessitate halting and reassessing the rehabilitation plan.


Understanding and managing pain is crucial for effective physical therapy and injury rehab. The Stoplight Guide offers a practical framework for clients at Sustain Physical Therapy in Boston, helping them navigate their recovery journey with confidence. By recognizing when to push through discomfort and when to modify or stop activities, clients can achieve optimal outcomes and long-term relief.

For personalized guidance on managing your pain and enhancing your physical therapy experience, contact Sustain Physical Therapy in Boston. Let us help you achieve your recovery and performance goals with our innovative and holistic approach to physical wellness.

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Dr. Adam Babcock PT, DPT

Sustained Fitness and PT

"We Help Active Adults Quickly Recover From Pain Or Injury So They Can Stay Active, Get Back To What They Love To Do, and Do It For Decades"