Complete Guide To Working Out With Pain

So you’ve been training and working out for a little while and now you've started experiencing pain. It might joint pain, muscle pain, or chronic pain from an old injury. Either way, pain is an extremely common experience that I get asked about on a daily basis. The questions is essentially, "what happens now?"

I want to go over some practical strategies that you can use to continue to make progress with your exercise routine without making the pain worse. But before we can do that, we need to go over some basics on what exactly pain is and how it works in our bodies.

Part 1: Let's Explain Pain

For years, the medical community explained pain through a mechanical lens, and many professionals do. The body is commonly viewed like a machine; the more damage it has, the more pain you will have. Essentially, once your body is "worn out" you're screwed. In the pain science community, this viewpoint is referred to as "hurt" is equal to "harm". This is a logical conclusion that leads to the assumption that you should completely stop any painful activities.

The good news? This view has been shown to be inaccurate. We can do things that machines cannot... we can heal, adapt, and overcome. Pain is much more complex than injury=ouchie. Pain is much more related to our body's perception of threat and need for protection in the area.

Think of hunger. Hunger is a sensations that protects us from starvation. There are many causes of hunger. It could be factors like undereating, hormones, or smelling good food that makes you hungry. It could be more emotional factors like stress, anxiety, and cravings that make you hungry. It could even be social situations like being around other people eating that makes you hungry. There is no single "hunger generator". There are a large number of factors that contribute to your hunger besides the amount of calories you have left in the day.

Pain is the same way; there is no single "pain generator" that we can point to as the underlying cause for your pain. We can blame biological factors (pressure, stretch, hot, cold, inflammation, fatigue, sickness, etc)... We can also blame anxiety, stress, prior experiences, environment, etc. Pain is unpredictable. because something hurts a lot, does not mean that you have a lot of damage and vice versa. Just because you have a lot of damage does not mean that you have to have a lot of pain. Hurt DOES NOT equal harm.

When you look at your body mechanically, you can only rely on mechanical fixes. Things like surgery, manual therapy, and having perfect form are your only hopes. When you can look at things in a different way, you give yourself more options for beating your pain and living life the way you want to.

Part 2: Training With Pain

One approach I typically do NOT recommend for most aches and pains in the gym is rest for long periods. While recovery and rest is absolutely important, it does come with it's drawbacks. Specifically, it results in deconditioning, meaning that your body gets weaker the longer you rest. This creates a cycle that most are all too familiar with. You come back to the gym trying to do a lot of things you did before and then you end up reaggravating the symptoms and the pain persists. So in most cases, you need to stay active.

Step 1: Finding the entry point

Our first and most important step is to find the starting point. Begin by finding a set of exercises with the sets of reps that lead to the symptoms staying the same or improving over the following 24-48 hours. We can use the traffic light guide to make sense of this process.

Red Light: Pain gets worse during exercises and stays worse afterwards. Remove this exercise and/or reduce training load at the next session.

Yellow Light: Pain gets worse or stays the same during exercises and returns to normal after. Continue with exercises with caution. Exercise program may need to be modified in future sessions.

Green Light: Pain improved during exercise. Continue with the exercise program as designed.

When it comes to finding this starting point, there a lot of variables that we can choose from to find the perfect workout routine. We can use more or less weight, more or less effort, or more or less sets and reps. We can train more often, we can use different exercise variations, we can add tempo, and many other things.

Option #1: Reduce The Intensity

The most common way that I approach it is to decrease load or weight on the bar while keeping other variables the same (i.e. the same sets/reps, exercise, etc). If your symptoms only come on when you're lifting heavy loads, then you should respond really well to this type of approach. Back off the heavy loads for a week or two, then gradually work back up to heavy efforts. You most likely have put too much stress on your joints and connective tissue.

If you mentally struggle with the idea of lowering the weight, then you may need to increase your "internal" load. This refers to how hard an exercise feels. You can do this by lowering the weight, but increasing the number of reps, or by adding tempo (pauses or slow negatives).

Remember the goal is to find an "entry point". So we'd rather go too light or too easy at first then work our way up, as opposed to being stubborn and continuing to irritate the tissues. Once you found a routine that is challenging, but does not irritate your symptoms, you've found your starting point.

Option #2: Reduce The Range Of Motion

Now, if you have symptoms during a particular exercises regardless of weight, then you won't respond well to the above approach. In this case we need to either 1) adjust range of motion or 2) change the exercise completely.

For example, a person who feels knee pain or hip pain at the bottom of their squat can add in box squats with depth limited. If another person feels shoulder pain at the bottom of their bench press, they can add in floor press. Keep up with these new exercises as long as symptoms stay reduced, then gradually work in full range of motion with reduced weight.

Option #3: Change The Exercise

If your symptoms are still persistent after this approach, then a full change in exercise in warranted. This can be switching to front squats from back squats, or dumbbell bench instead of barbell bench. There's no right or wrong way to do this approach. Your goal is to find the exercise most similar to the painful exercise that you can do without symptoms.

As far as frequency, try to hold to the same amount of days per week that you were doing before. If your progress is slow, try to add in an extra day of rest between sessions.

Step 2: Progression

Once your starting point has been found, it's time to build. You need to build small wins at a time in order to be successful in the long term. If you start making aggressive jumps in weight or intensity, you raise the risk of your symptoms returning because your body isn't ready.

In the short-term, being completely pain-free is not a realistic goal. Ups and downs in symptoms is a normal part of the rehabilitation process. Your pain may be worse on an given day due to any number of factors that we talked about earlier (weight, volume, stress, anxiety, sickness, etc). Remind yourself that hurt does not equal harm. You can continue to progress slowly but surely using the strategies in this article.

When you're ready to start progressing the weight of your exercises, it's important to remain patient and conservative. If you're stuck at a yellow light in the first session (pain is neither improving nor worsening), don't change anything to see if your body begins to adjust. If you progress to a green light and your body is starting to feel better, you can begin my increasing in small increments (2.5-5lbs or 5-10% at a time). Remember that progress is never linear. Once you increase load, I recommend holding at that intensity for another session or two to give your body time to adapt.

The biggest mistake you can make is jumping up to your 100% because you felt good in one session. Your body needs time to adapt and get stronger. You should assess how you feel each time you increase the weight, increase reps, or change the exercise.

Step 3: When to get help

If the steps laid out above helped to get you back to pain-free fitness, then congrats, no further help is needed. But, I recognize that this process isn't easy. Even with my own training, it's difficult to navigate a new set of symptoms and stay patient through the recovery process.

If you are struggling with symptoms, having difficulty finding an “entry point” into the process, or tried to proceed through this process without success, you should seek help from a trusted clinician. This may involve someone local to you, or I would be happy to help.

If what you are doing now is not working, do not assume that repeating the same process again and again will provide a different result. Sometimes, big changes are required. Recovery from injury or old aches and pains may require you shift your perspective and go after the small wins.

Find the hardest thing you can do well and embrace the process.