Training with pain
Read time 4 min
Check out the first part of the blog here.
Two persons can train the exact same way, but only one gets injured. Sometimes it can be a matter of luck but I believe it’s worth taking a closer look. Maybe the injured person wasn’t eating or sleeping enough, or maybe they had a lot of stress going on. Could these lifestyle factors affect the person’s injury risk and pain experience?
At least a study by Mann et al suggests that collegiate football players had a higher injury risk during periods of high academic stress (1).
But right now we wanna focus on how to manage your pain if you want to keep training at the gym.
I’ll start by saying that if you have pain, it’s best to consult a healthcare professional if you’re unsure about the situation.
Can I train with pain?
Should you avoid pain when training? You can, but it doesn’t seem to be any better than training with some pain. A meta-analysis found that rehabilitation protocols using painful exercises offer a significant effect over training without pain (2). I believe enabling you to do meaningful things is more important than avoiding pain altogether.
EDIT: As a caveat, there are some conditions where training with pain is not advised. For example, stress fractures are one of these conditions.
Back pain in training
So your back hurts in deadlifts. What now?
Based on what we now know about pain, movement variability, and training, we want to find an entry point for you to start training. We want to spice things up a little. Some options could include reducing the weight on the bar, range of motion (ROM), tempo, or something else. Once we find the entry point, we’ll progress from there by planning a route to your goal.
There are many ways we can approach your problem. It’s a process and it’s going to take time. There are good days and bad days when you feel like it’s not moving forward. In those moments it’s very helpful to have a coach to help you navigate through it.
Below are some example exercises for someone with back pain in deadlifts. These are individual but I’d start with something like this:
Monday: Single-leg deadlifts
Wednesday: Block deadlifts (reduced ROM)
Friday: Tempo deadlifts (slower velocity)
We will monitor your pain response daily to make sure we are not aggravating the issue more. I believe a lot of you have been in a situation where it’s hard to take a step back and not push against the pain.
Graded exposure
Graded activity is a concept used in rehabilitation. The point is to progress training regardless of pain to achieve goals and increased activity. A very close concept is called graded exposure where the person’s feared activities are confronted step by step. These approaches have been utilized in chronic low back pain. (3, 4)
Although the effects in a systematic review and another meta-analysis have been small, I value these approaches because they enable you to keep training and still make progress. (3, 4)
So how can we know how much is okay? Enter the traffic lights.
TRAFFIC LIGHT MODEL
The traffic light model is widely used for figuring out how much pain is okay (5). It’s a subjective scale with 0 being no pain and 10 being the worst pain you can imagine.
Green light is when your pain is 0-2, you can probably push a little bit more depending on the problem you are facing.
Yellow light around 3-6 is still okay, but you probably don’t want to keep hitting your head against the wall if the light never turns off.
Red light is 7-10. If you find your pain hitting it, it’s best to take a step back, let things calm down, and build it back up.
I have been in a situation where I’ve tried to figure this stuff out on my own. It has led to frustration and losing interest in training. Don’t be like me and miss months or years from your hobby. Let me guide you to find confidence and fun in training.
Sign up for a free coaching consultation below.
References
1. Mann JB, Bryant KR, Johnstone B, Ivey PA, Sayers SP. Effect of Physical and Academic Stress on Illness and Injury in Division 1 College Football Players. The Journal of Strength & Conditioning Research. 2016 Jan;30(1):20–5.
2. Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017 Dec;51(23):1679–87.
3. Graded Activity and Graded Exposure for Persistent Nonspecific Low Back Pain: A Systematic Review | Physical Therapy | Oxford Academic [Internet]. [cited 2022 Apr 28]. Available from: https://academic.oup.com/ptj/article/90/6/860/2737764?login=false
4. López-de-Uralde-Villanueva I, Muñoz-García D, Gil-Martínez A, Pardo-Montero J, Muñoz-Plata R, Angulo-Díaz-Parreño S, et al. A Systematic Review and Meta-Analysis on the Effectiveness of Graded Activity and Graded Exposure for Chronic Nonspecific Low Back Pain. Pain Medicine. 2016 Jan 1;17(1):172–88.
5. World of Hurt: A Guide to Classifying Pain [Internet]. Thomas Land Publishers Store. [cited 2022 Apr 26]. Available from: http://store.thomasland.com/musculoskelpain2015.aspx