How to train around pain: A Physical Therapist’s Secret

Updated: Aug 24


So, imagine you’re in the middle of a workout and you start to feel an ache or pain. It probably happens pretty often, right?

I’m guessing most of these little aches go away on their own... But what do you do when the pain doesn’t dissipate and persists for multiple reps or sets or even workouts? What do you do when it continues to inhibit you in multiple aspects of your life for days, or weeks, or months, or even years???


The pain perpetuates and is causes you to compensate to avoid the pain. That may be fine and well in the short-term. But long-term, these compensations will just lead to other issues and more pain. Or maybe you just avoid the exercises all together. Chances are the same exercise that is causing pain, is absolutely needed to help rid yourself of the pain, even though you hurt your body doing that same movement. Ironic huh?


For instance, if patients came to be saying to hurt their lower back doing deadlifts the other day. I think most people, even many healthcare professionals will say “Ok, don’t do that exercise for a while." And some will day, don't do those ever again (avoid those health professionals!)

This is such a lazy cop out of health care providers and as a member of that community I know we can do better.

Our goal shouldn’t be to just avoid movements that cause pain; the goal should be to fix whatever it is that is causing the pain so we can return to that same movement.


So back to the deadlifting back pain example, if you hurt your back during that movement, yes maybe you need some rest from higher intensity exercise in general including these exercises for a short time period. But prolonged rest or avoidance of that movement pattern will often be more detrimental to your function in the long run. We want to try to get back to deadlifting ASAP!

But how do we do that without pain? There's the catch...

What we have to do is alter one or more of the attributes of the exercise to progress back to previous level of performance prior to the injury.




I’m tired of hearing from my patients that their doctor or some other coach or therapist says to them:

“Don’t squat, it’s bad for your knees”

“Running isn’t worth it. It’ll hurt you more than help.”

“Never lift overhead now that you hurt your shoulder”


All this does is further lead to fear and avoidance by the patient and leads own a path of if you don’t use it, you lose it. Not to mention it cause a fear of movement, but that's another topic for another blog post.


This article is going to provide ideas on how to adjust or modify your workout routine to avoid common pains we see prevent people from completely avoiding movements and taking it out of their routine completely.


Four factors to alter

1. Weight/Resistance

2. Range

3. Tempo

4. Alternate Exercise


The primary goal is to make least number of changes possible staying as close to the movement as possible.

Let’s go through an example of pain with a certain exercise and how to alter or modify the movement to not only eventually return to your goal but reduce injury in the future.



Let's say you're having knee pain with a front squat




Weight

  • First attempt to perform your full front squat with less weight than you normally use. If you perform a full front squat and still have pain following a significant decrease in weight, then move on to the next step.

  • If you can do entire movement, then continue to perform at this weight and gradually increase over the next few weeks each time. The goal is to stay pain-free but also get back to your previous weight ASAP.


Range

  • For this option, stay heavy around your normal weight you use

  • Attempt the front squat, go as deep as you’re able to WITHOUT pain i.e. if you have pain when you’re at 80% of your ideal depth, then only go to 70% of your normal…Stay in pain-free range. You may have to increase reps to achieve adequate muscle fatigue since you decreased the range


Tempo

  • Go SLOWER!

  • There’s really no fancy explanation here. I often find when I cue a patient to go slower, they’re better able to control the movement and alter themselves out of pain. They become more in tune with their movement patterns, become more coordinated, and find ways to continue to train, but navigate around the pain.


Alternate Exercise

  • A front squat causes a lot of shearing across the anterior aspect of the knee joint

  • If front squatting is currently causing pain, then switch to back squats for the time being. The glutes and hamstrings become more engaged in this position. Therefore, we can decrease the force going the quads and knee joint until you regain strength and mobility necessary for returning to front squats while using these other alterations to rehabilitate from your injury.


  • But let’s say you still want to target the quads in attempt to return to front squat eventually. Then I would suggest a modified pistol squat in a small range in this case. This sort of combines a few factors to alter. The first being an alternate exercise, the second being weight or load decreased, and the third being less of a range doing a ‘modified’ pistol squat versus and full pistol squat which would likely elicit similar symptoms as a heavy loaded front squat.



Hopefully this blog opened your eyes to seeing that if you have pain, you don’t have to drop all your activity and strength training. In the same breath, you don’t have to keep pushing through pain. There are ways to continue to progress without making an injury worse and suffering chronically with your pain and dysfunction.


If you’re struggling with these concepts, then that’s where a performance physical therapist can help. Give us a call today and let’s talk about how we may be able to help you live pain-free again!



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