TEACHING CLIENTS TO ADJUST WHEN FEELING PAIN
Episode 40 came about after my experience at the Prehab 101 Seminar with Dr. Jacob Harden in Victoria B.C. Canada in September. If you’re in the fitness space and don’t follow him, I highly suggest you find him on the gram @dr.jacob.harden. And if you need CEU’s for the NSCA or other organizations, his Prehab 101 course is approved – which is amazing.
Today’s episode addresses something has likely happened to everyone listening. If you lift weights, you have definitely had this happen on some level.
You’re working out and you experience pain.
You’re following your program as planned and you feel in a pinch in your shoulder or twinge in your back. So, what do you do? Go home? Move on to the next exercise? Modify? Push through the pain?
That, my friend, is what I am teaching you today.
This is not a gold standard, biblical approach or one size fits all system. But, it is what I do with my clients and is in line with what I have learned from professionals whom I hold in high regard.
So, here I am, sharing it with you.
I work with my clients on a pain scale from 1-10.
It doesn’t start at 0 because 0 is no pain.
Now, 1 is barely any pain. Below 5 is tolerable.
10 is the worst pain you can imagine – think child birth without meds.
So, if a client’s pain is below a 5 (meaning it is tolerable), I am totally fine with them working through the lift.
If the pain exceeds a 5, they have some regressive options.
Option 1 is to reduce the load.
Client reduces the load. Then one of two things happens.
Either client’s pain decreases or it doesn’t.
Based on that, they either complete sets at that weight, where pain is 5 or below (tolerable pain) or, if the pain didn’t go away, I’ll sometimes have them decrease again until we find a tolerable load.
BUT, we must also keep in mind that there is a goal of the movement we were doing, right? So if the goal was to work at an intensity of 85% effort on RDLs, heavily loading the hamstrings, but the client can only tolerate a load at 50% effort…then we enter waters where I alter tempo and maybe even exercise selection, which we’ll get into as well.
Soooo. We altered load by decreasing it.
Pain is tolerable, finish workout as planned, make record of weight and pain.
Lowered weight and pain didn’t change, now we use option 2.
And option 2 is decreasing the range of motion.
Can we do RDLs from a shorter range of motion with tolerable pain?
Yes? Great, work at that range of motion with a tolerable load. Record pain level and load.
No? The pain stays the same, above a 5?
Then we change exercise selection. That’s on the client if they have a comprehensive understanding of WHAT the given exercise was meant to do. I personally work with a lot of other professionals in the field so they may be able to make this adjustment themselves.
Now, I ask 4 other determining questions of a client who has pain
I don’t have this is a flow chart yet for clients, but plan to make one so they have a helpful visual.
I am a fan of empowering the client. And I also lean more toward pain as a sense, or a perception. It does not mean stop all movement.
If we can educate clients around their pain and help them feel safe, they are more likely to continue training and enjoy it.
That is not to say we are negligent and ignore pain. Not at all. But let’s not let it run our workouts or limit us in areas it doesn’t need to.
You are not your injury. Right? I hope we’re all on the same page there. While strength training is a stress and yes, can cause injury, it is ALSO how you or your clients are going to rehab, 100%. You will use some amount of load to rehab the injury or irritation. That’s a fact (even if surgery is needed, you’ll do strength training as post op, right?). In most cases anyway.
That’s my point here.
Kind of a tangent. I’ve had A LOT of injuries from torn ligaments to disc bulges to an undiagnosed shoulder I am currently working with. I’ve had good experiences with chiros and PTs and terrible ones. The great ones involved the professional educating and empowering me as the patient. I am not a doctor, physical therapist or chiro, okay? I’m just a strength coach who believes that load and capacity are highly valuable tools in rehab and prevention of re-injury. When programmed properly, they build resilient, anti-fragile humans. And that’s what I’m here for.
So that’s what I want to expand on those options and steps for clients when they feel pain during a session.
Pain above or below a 5?
Above, decrease load.
Below, continue but monitor.
Decrease load, pain above or below a 5?
Above, decrease ROM.
Below, continue but monitor.
Decrease ROM, above or below a 5?
Above, move on, contact me, I’ll make adjustments.
Below, continue, but monitor pain.
With all of that, answer questions:
Pain between sets?
The next day?
And at what level?
If you or your client have decreased load, and range of motion and pain is still above a 5, then we switch up the exercise.
What do we base this off of?
Simple. Well, there are actually two things we need to pay attention to here.
What muscles were we loading? In what plane? For what intensity?
For the RDL scenario, that’s a Sagittal plane, largely eccentric hamstring exercise. In this case, at a high intensity of 85% effort.
Great. Perhaps reverse hypers don’t cause pain? Perhaps a glute ham focused back extension doesn’t cause pain. Both can give you the same training stimulus.
If you want to completely destroy the hamstrings with no hinge, eccentric curls or Nordic curls this will 150% do the trick. You just don’t get the same degree of lengthening the hamstrings.
Why do we need to know this?
In my scenario it’s the lower back. That data gives us direction as to what area we need to assess and take a deeper look at.
This is where I assess 1:1 clients. Are the extension sensitive? Flexion sensitive? Is their core strength lacking? There a number of things to consider and look at here.
But I advise against just working around pain without sending your human to a doc or assessing within your scope.
Recently I had an old 1:1 client who started Built By Annie to re-enter into training after some time off. Now, she’s a health care practitioner, has orthopedic surgeons in the fam. She’s a smart cookie and knows her body well.
She was having some back and adductor pain. I had her try a few things and sent her some assessments. Her pain was not getting any better as she’d been experiencing this for 6 months.S he got MRI results back and has a herniation in her L5-S1 with some muscular atrophy of my paraspinal muscles in the area. Hi. That’s beyond me, right?
I cancelled her subscription and sent her to Dr. Sean over at the Active Life RX directly.
She is not her injury. She may not even need surgery. Which would be amazing. But that is not my call.
I tell that story just make clear that we are not playing doc as trainers. While there’s a lot of overlap between chiro, physical therapy, and strength coaches, it’s important we know where the borders of our lane lie.
That’s it fam. If you’re a trainer or a trainee, hopefully you have some solid parameters to go off of when you feel pain in the gym. Again, hi, Annie Miller, CSCS here. Not a doc. This podcast does not constitute medical advice on any level, mmmmmmk?
With that, I hope you found value here today. I actually went over this topic in depth with my BBA and 1:1 clients in a monthly coaching because like I said, I want people to be informed and empowered around their pain (without neglecting it completely).
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I'm an adventurous introvert from Vancouver, Washington who lives on sleep + "me time." I'm a lover of lifting weights, dinosaurs, real talk and traveling with my husband. I am here to help you move better, lift more, bust the myths of the fitness industry, and inspire you to love the process.
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