How to Train With Pain & Stay Healthy

Pain. It’s part of the human experience and, unfortunately, can impact us during training.

Shoulder pain, back pain, elbow pain, and knee pain is common and affects almost everybody at some point in time. There are a lot of misconceptions about training while injured or in pain.

Flawed Perspective:

Knees hurt? Squat more hip-dominant.
Back hurts? Avoid any spinal movement.
Hips hurt? Don’t do anything involving abduction.

What if we told you that these statements are incorrect and can set you back even more? Pain doesn’t have to ruin you, debilitate you- or put you out of the gym. Instead, it can be a teacher and make you a better athlete.

Movement can be both the cause and the solution to pain; it should not be avoided.

(Disclaimer: First of all, always speak to a healthcare professional about your unique case, especially if you have a diagnosed injury. This article is not meant to diagnose or treat anyone. Take everything with a grain of salt).

Communicate with your coach

Immediately, when you feel something wrong, let your coach know.

Coaching should be a partnership built on trust and communication. After all, if your coach doesn’t know you’re in pain, how will they know how to help? A lack of awareness and insight could worsen your symptoms and strain the relationship.

Use the resources that are available to you. And simply vocalizing the issue with another human being can be cathartic- your coach is there to guide you through these times.

Keeping them updated with how your body is feeling, what you’re noticing, will allow for the best possible success.

2. Mindset shift: Pain Does Not Equal Injury

"Pain is not the same as injury. And hurt doesn't equal harm. We now understand that pain is a complex experience that is more related to the perception of threat and a need for protection than active tissue damage." - Austin Baraki, Barbell Medicine*. In other words, pain doesn't necessarily mean you are about to break. Pain may not be indicative of injury, harm, or danger. Let that take some stress off your shoulders: just because something feels off doesn’t necessarily mean your body is breaking down.

Often, especially in Western societies, we view pain with a great degree of fear. This can make the issue even worse. You feel something off in your body, you assume the worst, become afraid of it, and you start to avoid physical activities.

Remember, our bodies are strong, resilient, and capable.

When you push your limits, your body will likely fight back- eventually. It’s a natural response. Use these experiences as a tool to make you a better athlete, looking for areas to grow.

Need changes to your programming? Adjust your volumes/intensities? Have a weaker muscle group that needs more attention? How are your recovery habits outside of the gym?

Pain is multifactorial and likely isn’t caused by one singular circumstance, but it can provide an opportunity to improve your habits. In life, when we avoid & run away from discomfort, it never leads to growth. The same holds here. Going into avoid/fight-or-flight/restrict mode won’t help you.

3. The goal is to desensitize the body, not avoid movement

On that same note, avoiding movement, even movements that have caused discomfort, won't help you. Drawbacks of avoiding movement include:

It can further aggravate your symptoms
It doesn’t address the root cause of pain
You become de-conditioned and be at higher risk for injury later on
You’re often taking away an activity that's enjoyed

Resuming training to whatever degree possible, will allow you to continue making progress, feel better, and move forward. The goal is to expose the area to load/stress in a controlled way so that the body can adapt & become more resilient.

For example, if you are experiencing knee pain and forward knee movement while squatting hurts; training this pattern in modified ways can strengthen the area, de-sensitizing your body to squats. You may perform accessories like heel-elevated squats, or Knee Touchdowns, requiring forward knee travel; to gradually strengthen the knees. Progressively increasing that stress over time will allow you to handle more down the road.

When going through this process, you work through some pain temporarily. A tolerable level of discomfort in the beginning is expected- and the goal is over time, it becomes less and less.

With your training program, you want to include some exercises that strengthen the hurt area, so you can continue moving well in the long run. Avoidance is a short-term band-aid and doesn't address any root issues.

4. Modify Your Program to Overcome Pain

A major misconception is that while hurt, you need an entirely different program. The truth is, you should still be progressing on your previous goals and lifts. You just may need some additional considerations.

The first step is to determine a starting point: you want to find a type and dose of exercise that results in either improved or stable symptoms within 1-2 days post-training. If you feel yourself consistently getting worse after a certain volume/variation/load, variables should be manipulated & modified. Try and keep in as many typical movements as possible while making adjustments when necessary.

1. Reduced Load

The first variable to modify is load. Maybe you can’t squat 225 without severe discomfort, but do 45, 95, and/or 135 feel okay? If so, train lighter squats as you’re recovering. You can even increase the difficulty of the exercise while keeping the weight low-such as adding a tempo or increasing the rep range. This way, you can maintain your fitness/strength level without aggravating symptoms. Continue monitoring how you feel in the days that follow. From there, you can progressively add weight.

2. Reduced ROM

If the lighter weight is not enough to improve/stabilize symptoms, try reducing the range of motion of your main lifts. If, for example, you’re struggling with back pain, and even lighter deadlifts are still too irritating, pulling off blocks would be a potential variation. Elevate the bar 1-4 inches off the ground- this should mitigate some discomfort. Block pulls will still allow you to train the movement without excess stress from pulling off the floor.

3. Swap for a different variation

If the lower weight and reduced range of motion are still not enough, THEN you modify the movement to a similar pattern. Barbell squats to Goblet squats, or even Static lunges, step-ups, Bulgarian split squats, etc. Sub out barbell deadlifts for Romanian deadlifts, hamstring curls, hip thrusts, single-leg RDLs, etc. Still train the primary muscle groups, but just with a different variation.

On your rest days, monitor how you feel post-training.

On any given day, you can find a movement that will make you feel good. Maybe it’s not your typical variation- but we have many tools in the strength world. Whether it’s a different bar, load, set/rep scheme, range of motion, etc.- as long as you’re MOVING and feeling better overall, you’re taking steps in the right direction.

5. Autoregulate based on the day

Many people want to look for the “perfect plan” to get them out of pain, yet, that doesn’t exist.

The truth is, you have to listen to your body and respond accordingly.

Maybe one day your hip feels extra tight, and squats are highly uncomfortable. But the next day, you could be feeling much better & squats feel good for you.

This is where autoregulation comes in. Have a basic structure to your training, yes, try and stay as on-program as possible, yes, but respect changes in symptoms over time. Treat it like you would RPE- know that your program may differ depending on your level of discomfort. Some days may require extra modification and warm-up, other days less, and that’s part of the process.

6. Manage your Expectations

Remember, the goal is not always "pain-free" in just a couple of days. That can be unrealistic. Instead, aim for improvement over time, weeks, and months.

Symptoms will fluctuate, and the process is never linear. Your body may feel worse on a given day or week, which can be very discouraging, but if the trend over time is an improvement- that's a good sign. There will be ups and downs like anything else- which can provide frustration. External stress, life, etc., can also impact how you feel, not just your time in the gym. Continue regulating your symptoms while maintaining a realistic expectation for the best success.

7. Manipulate Variables Outside of the Gym

When you get hurt, the instant reaction is often to change your training. Sometimes, you also need to look elsewhere.

Lifting is a stressor on the body & stressors outside of the gym directly affect your performance.

Many athletes fail to prioritize their nutrition and recovery, impacting physical wellbeing.

You need adequate fuel in the tank to prepare your body for big lifts.

You require plenty of rest to repair yourself after a hard session.

Restricted calorie intake, inadequate protein, a low-carb diet, lack of micronutrients, dehydration, poor sleep, too high exercise frequency (such as high-intensity cardio, too many sessions per week, etc.) will all negatively affect you. Before adjusting anything with your training, ensure you’re getting adequate fuel & prioritize your recovery. I bet your body will feel better already.

8. SEEK PROFESSIONAL HELP AND ADVICE

There are just some instances in which you’ve used all of your current tools, you’ve given it time, and the problem is just getting worse. If after weeks and months of consistency, modifications, education, trial-and-error, etc., and symptoms have worsened or not improved, seek out help. If you feel hopeless and have no idea where to start, speak with a professional. Don't keep repeating the same steps, expecting a different result.

Look for a well-versed clinician or PT to guide you.

There’s nothing wrong with asking for help and gaining more insight into your situation. It can only help you. Always keep that in mind if your discomfort persists.

Pain can be a difficult and scary experience to navigate. Unfortunately, it’s something that many humans go through at some point in life. The key is having the right tools, shifting your mindset, utilizing resources, and forming solid habits. Discomfort and hurt don’t need to debilitate you, take you out of the gym, or put you on bed rest. Your body is strong, capable, and resilient. Instead of viewing things with doubt and catastrophe, approach your training with a curious, experimental mind, and you’ll become a better athlete as a result. On the road to feeling better & gaining knowledge at the same time!

*Taken from the article "Pain in Training: What Do?" (2019, Austin Baraki, Barbell Medicine) https://www.barbellmedicine.com/blog/pain-in-training-what-do/