Training Around Aches & Pains in the Gym
Pain is annoying. We have all experienced it, and we know that it is no fun to deal with. Unfortunately, pain is a part of the human experience. Regardless of whether you sit on the couch your whole life or you’re in the gym 5 days per week, there is a very high probability that you will experience some nagging aches and pains. This article will lay out a general 4-step approach, originally created by Dr. Austin Baraki of Barbell Medicine, medical doctor and strength coach who dedicates his time to educating people on the science of pain. I have used this approach on myself and with several of my clients with great success, and I think it is worth sharing here. What this approach does not entail is taking time off from the gym, because rest is not the same thing as rehab.
Step 1: Don’t Freak Out
This may sound silly, but it is probably the most critical step to understand. Often times when somebody tweaks a muscle or joint in the gym, they will automatically think the worst. A common example of this is somebody feeling a pain in their back while doing a squat or dead lift, then automatically thinking that they herniated a disc or broke their back. As an aside, herniated discs are very common and most people who have them are asymptomatic (1). This act of letting your brain jump to the worst-case scenario is known as catastrophizing, and it should be avoided at all costs. Catastrophizing has been shown to worsen the pain experience in multiple ways including increased pain severity, longer duration of pain, kinesiophobia (fear of movement), and much more (2).
It is important to realize that humans are resilient and adaptable, not fragile. There are very few things that can occur in the gym that will result in serious injuries. Most aches and pains will go away on their own within a matter of days or weeks. When you feel pain in your back, your hip, your shoulder, or your knee while exercising, the first step is ALWAYS remind yourself that pain is a part of life, and that it’s no big deal. Odds are it will be gone in no time.
Step 2: Address Work Load
It is not uncommon for there to be a threshold of volume or intensity (or both) over which pain occurs. For example, you may notice that you begin experiencing pain in your hip when you do squats with more than 135lbs, but you don’t have any pain when the load is lighter. You also might notice that you experience some pain in your shoulder when you do overhead presses for more than 30 reps per workout, but not when you only do 25 reps per workout. The solution here is pretty straightforward; stay under the pain threshold for a while and slowly work your way back up once the pain is gone. Using this example, you should do the majority of your squats with under 135lbs and the majority of your pressing workouts should be less than 30 total reps.
Step 3: Address Range of Motion
You might notice that there is a particular part of a movement that causes your pain to flare up, but you’re able to move through the rest of the range of motion with no pain. Again, the solution here is obvious; avoid the range of motion that is causing you problems until the pain is gone. An example of this from my own training is from a few months ago when I was experiencing some shoulder pain while doing bench presses. I noticed that as I was lowering the bar down, I’d start getting a little bit of pain in my right shoulder once the bar got to about 3 inches away from my chest and below. I was able to train my bench press around this issue by placing a rolled up exercise mat on my chest and only lowering the bar down to where it touched the mat instead of lowering it down all the way to my chest. After about a week and a half of benching like this, I started adding in regular bench presses with lighter weights in addition to the exercise mat presses. My shoulder felt completely fine and pain free after about 3 weeks!
Step 4: Change Exercises
Like I said above, there are no “bad” exercises, so it is important to rule out workload and range of motion as contributing factors before you completely remove an exercise from your program. That being said, there are so many exercises that accomplish similar goals, and unless you are somebody who competes in an exercise sport like powerlifting, weightlifting, crossfit, or strongman, there is nothing inherently special about any particular exercise. If you notice that you have pain in your knee while doing back squats but not while doing front squats, step-ups, or leg presses, then there is no reason for you to do back squats! Front squats, step-ups, and leg presses will train the same muscles in a similar fashion. Likewise, if you have pain when you do overhead presses with a barbell but find that you have no pain with dumbbell overhead presses or incline bench presses, there’s no reason to continue doing barbell overhead presses.
I hope these four steps will help you train around any aches or pains you may experience. Remember that rest is not rehab. Pain is a normal part of being a human, and it does not mean that you can’t train. Later articles will include how your trainer can help you with your aches and pains, and we will also talk about examples of how to implement this process for specific common aches and pains such as knee pain, back pain, and shoulder pain. For further reading on pain, I will link some references and resources below.
Schmidt, Christian. "Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations." Manuelletherapie21, no. 02 (2017): 54-55. doi:10.1055/s-0043-105930.
Quartana, Phillip J., Claudia M. Campbell, and Robert R. Edwards. "Pain Catastrophizing: A Critical Review." Expert Review of Neurotherapeutics9, no. 5 (2009): 745-58. doi:10.1586/ern.09.34.