"To train, or not to train? That is the question."
There is a lot of misconception when it comes to pain and training while you have it. Should you continue, or should you stop? – in this guide I will show you a few basic steps to take when you have pain when training.
This is what rehab could (or even should) look like...fun ;)
If you are an active person, there is a very high chance that you have experienced pain or injury. These injuries can be really frustrating. Set-backs that can result in the loss of your precious gains. The question is, do I have to stop and do nothing until the pain is gone? The answer is, it depends, but most of the time, NO. In actual fact, stopping completely could be more detrimental to your recovery.
When it comes to exercise treatments, there is not much evidence to support that "physio-type" exercises are any more beneficial than regular movements. This is good news.
Disclaimer alert: I AM NOT SAYING THERE IS NO PLACE FOR PHYSIO-TYPE EXERCISES, I just did mine this morning.
What I am saying, is that there is a good chance you can keep doing what you enjoy, without causing more harm.
What you should know about pain
Pain is a very interesting mechanism that your body has. It is a protective mechanism, call it an alarm, that let's you know there is potentially something wrong. However, it has been shown that it can be triggered by things other than tissue damage.
Pain IS NOT = Tissue damage
To keep this article simple, we will not dive too deep into pain as this is a whole blog of its own. What you should take away from this is that if you are experiencing pain, it does not mean you are broken. Instead, focus your attention to the controllable factors.
Definitions
Before I get into the steps of dealing with your pain while training, I want to clarify a few things.
Injury: For the sake of the article, when we refer to injury, we will be talking mostly about non-traumatic injuries. Traumatic injuries such as broken bones or complete tissue tears cannot be treated the same and do of course require medical interventions.
Intensity: When we refer to intensity, we will be referring to factors such as volume, load and frequency of the exercise or movement.
Program variables/Intensity:
Frequency: How often you train (weekly)
Volume = Sets x Reps (weekly)
Load: % of 1RM or RPE/10 (rating of perceived exertion), basically how heavy
Disclaimer: Note this article does not replace medical advice, you should always seek professional guidance before following this guide.
Overview
#1: Tweak your technique
#2: Tweak your program
#3: Reduce Intensity
#4: Substitute
#5: Re-integrate
#1: Tweak your technique
In my 15+ years of coaching, I would estimate that more than 60% of cases were resolved by changing technique or intensity, but not stopping.
Some subtle, small changes to your technique could make all the difference.
In the case of hip or knee (and sometimes back) pain, this could be as small as changing your foot stance in a squat: going slightly wider with your stance, turning your toes out a little or even slightly staggering your stance ie. one foot slightly more forward. This could change how your body perceives the movement, and result in less or no pain.
In the case of shoulder pain, changing your hand-grip width: wider, narrower, overhand or underhand grip, or even staggered stance in push ups for example.
These are just some small changes you could make to try change the sensitised activation pattern, but still completing the same task which will in the end yield similar, if not the same, results.
Don't forget, it is still important to get any other conditions ruled out by a professional before taking this advice.
#2: Tweak the program
If tweaking your technique didn't help, perhaps you need a greater spread.
Many programs require that people accomplish the bulk of their volume for a particular element or muscle group, on one day per week. If this is the case with your program, try this: Take half of the sets, and split them over 2 days
Example:
You need to do 6 sets of 5 reps on Bench press
Take 3 sets of 5 and do that on Monday, then take the other 3 sets and do them on Wednesday or Thursday.
Therefore your weekly total volume is the same, and no need to reduce the load.
#3: Reduce Intensity
Okay, you have tried tweaking the technique and program, but still theres persisting pain and discomfort. This might just mean that your body just isn't ready for the intensity you are working at.
This is where we look at the programming variables such as frequency, volume and load. We would change these variables until we get a tolerable intensity.
Side note: Tolerable would be 4/10 level of pain or less. If it goes over this, it would not be tolerable.
If you are working on Hypertrophy (muscle growth) or muscle endurance, your volume will probably be pretty high to yield this kind of result. When you have high volume work, you want to make sure you allow between 48-72 hours between sessions of the same group. This is highly dependent on the individual. so your frequency should be around 2-3 times a week for that element or muscle group. If you are experiencing pain, you may want to reduce the volume to a tolerable amount (which you should monitor and test for as you train).
If you are on a strength program, you will probably be lifting significantly heavy weights. You would want to reduce the load (could be anywhere between 5-60%) to achieve a tolerable level of pain or discomfort. Some strength programs require you to perform the movements more frequently due to the lower rep schemes, however, reducing the frequency by a day or two could also help your body recover and adjust to the overload.
#4: Substitute
Wait, we are not yet ready to stop moving. Next step would be to find a suitable alternative, one that will work the same muscle groups, but may be a completely different movement.
For example, you have back pain when doing squats, because when you squat, you hinge forward at the hips and place a good but often intense stress on the back. But you don't want to lose leg gains (because it is such hard work to gain).
A good substitute is lunges or split squats. In a lunge, your body remains more upright, but the legs still goes through very similar ranges under tension.
A shoulder example: With shoulder pain doing overhead press, but reducing the technique or intensity didn't help, you could change the upward push to a forward push and do push ups, dumbbell press or bench press. You will still work the front shoulder, chest, triceps like you would in the overhead press, and it will have all the space in the joint in this plane of motion.
#5: Re-integrate
Coming back once you have significantly reduced pain can be challenging, because you obviously want to jump straight back to what you were previously capable of in terms of intensity, but it may not be the best strategy for re-introducing a once painful movement.
Here are some things to pay attention to:
Do not go too heavy to start (keep RPE low - 4/10 or 30-50% 1RM)
Keep volume low "3 sets of 5" kind of low
Each week, add small incremental load or volume (2.5kg or 1-3 reps) until RPE of 8/10 can be achieved tolerably.
Once you have reached this point, you have successfully rehabbed your injury while still maintaining good health!
Thank you for reading, if you have any questions about this post, or if you would like to know more on a particular topic, you can DM us on socials @biokinetic_lab or email us at jordybiokinetics@gmail.com
I would love to hear your feedback :)
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