There is nothing more frustrating then experiencing pain. It can really put the breaks on your health and fitness goals and leave you confused with what you should and shouldn’t be doing. This is an extremely common experience that we get asked about on a daily basis.
This article is meant to be a brief practical guide but first it’s important to understand a couple of key points:
Pain is a complex experience that s related just a much to the perception of threat and a need for protection than active tissue damage. This pain experience can be influenced by a number of biological, psychological and social/environmental factors which is referred to as biopsychosocial factors. To understand more about pain and the latest science here is a previous article https://adaptivestrength.com.au/understanding-your-pain-the-key-to-helping-you-get-out-of-pain/
One approach we typically do not recommend for most routine aches and pains in the gym is absolute rest. While recovery is certainly an important component of training adaptation and rehabilitation, absolute rest is typically unnecessary and comes with costs as well.
But how should you go about training with pain?
The Key step: Finding the entry point
Our first and most important step is to find our “entry point” into the rehabilitation process. The usual approach for determining this is to find a type and dose of exercise that results in either improved symptoms or stable symptoms over the subsequent 24-48 hours after training. If you experience a marked increase in symptoms during or after training it is likely the dose of exercise is too high in terms of intensity, volume or both.
A general guide to do this is to simply decrease the external load (weight on the bar). We generally would prefer to “undershoot” when seeking out the entry point rather than continually over shoot. Another strategy is to reduce the external intensity by increasing the number of reps per set (12-15) and add a tempo component to the lift.
A common error we see is when someone has pain deadlifting at 150kg for 5 reps and reduces the load to 115kg and expresses frustration or hopelessness because they still have symptoms but remain reluctant to reduce the load to 60kg or even an empty 20kg barbell which may be the right entry point for you and your symptoms. We would generally prefer to under-shoot rather than continually overshoot as demonstrated in the example above.
Now if you have reduced the load, increased the reps and added tempo (slowing things down) but you still have persistent, intolerable symptoms across all ranges of motion the next step is to adjust the stimulus by either
- reduce or alter the range of motion based on what in tolerable
- change the exercise all together
For example someone who experiences back pain immediately off the floor when deadlifting may temporarily change to an elevated deadlift from blocks. An individual who experiences pain in the bottom of a squat may change to a box squat. The external load should still be reduced in this situation
If reducing the range of motion still causes symptoms then it is worth changing exercises temporarily. There are no “right ” or “wrong” exercises in this situation, but rather exercises that should target the affected area in a way that is tolerable to the individual. For example swapping squats for lunges, or deadlifts for glute bridges etc
In summary to find the right entry point you should follow these 3 key principles:
- Reduce the load to the point where symptoms are tolerable during and after exercise. Reducing load/intensity can also involve increasing reps at much lighter weight or slowing the exercise down by adding tempo
- Reduce or alter the range of motion of an exercise to where symptoms are tolerable during and after exercise
- Change the exercise all together temporarily to something that works the area that is tolerable to the individual
Once the entry point is found the next goal is to begin stringing together a series of small victories in order to build positive momentum. Overly aggressive jumps in loading dosage increase the risk of symptom exacerbations
A key point here is that being “pain free” is not typically a realistic short term goal; symptoms are always a part of the rehabilitation process and there will be ups and downs along the way.
An increase in symptoms may be related to a number of factors, including the dosage of stimulus (load, volume etc), but also due to outside biopsychosocial factors such as anxiety, sleep disruption, life stressors etc. This is an opportunity to reiterate that “hurt does not equal harm” that symptoms are an expected part of the process and that we have strategies to mitigate symptoms typically by modifying the dosage and type of loading
The most common errors made in this process involve overly aggressive increments of loading despite worsening symptoms. Typically full recovery may take several months for tendinopathy’s while aches and pains may resolve in a few days. Patience is definitely a key part of the process
If you are struggling with symptoms, are having difficulty finding an entry point into the process seek out assistance from a trusted clinician