Should i train through pain?

If you want the short answer

Most of the time = you can still train, just change something. If you want the long answer, read on.

To get things started, first we have to define what pain is. The International Association for the Study of Pain currently describes pain as ;

“ An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

From this definition, we can see that damage can either be occurring causing pain (however damage is not always equal pain), or we can feel pain as an interpretation of a stimulus (potential tissue damage). Whilst pain is an extremely complex multi-factorial phenomenon, it is important to recognize that there are different types of pain which require different management strategies. Without going into details , we should not train through pain if red flags are occurring. A red flag can give us an indication that a sinister medical event is occurring, and needs further investigation.

If you are experiencing any of the below symptoms or anything else significant, you should consult the emergency room and not finish your session ;

• Significant chest pain (with / without arm, face or back referral)

• Extreme dizziness or facial signs and symptoms such as difficulty speaking or swallowing

• Loss of bowel or bladder function

• Increasing weakness into both legs or arms

• Significant fractures, muscle ruptures, bleeding or bruising

• Significant abdominal pain

• Significant pain in general (9/10+)

On the other end of the spectrum, the definition also stated that pain can result of potential tissue damage, which may be your body communicating to you that something needs to change. This means that we can manage training around pain to maintain or even build fitness, however we may just need to manipulate our training variables.

An important consideration is that whilst we are training hard and pushing adaptation thresholds, we are bound to experience some sort of niggle as we train closer to our tissue tolerance, therefore the body may perceive this as a threat (niggle). If we are not pushing adaptation thresholds, the training likely isn’t hard enough for us to actually improve.

As as we increase in our training age and therefore have to train harder, managing niggles becomes more and more important for long term progress. If you stopped training every time you had a niggle, how much improvement do you think you’d make in the next 10 years?

Personally if i stopped training every time i had a niggle i’d be the same size and strength as i first was when i bought my shed gym at 16 years old, but that’s just me.

Physically, the main reason to train around pain rather than eliminating it, is to prevent deconditioning. Anything is better than nothing in terms of maintaining fitness, however you’d be surprised how quickly you decondition after a few weeks of doing nothing. The next reason is to maintain a psychological outlet, and continue to be adherent to meaningful tasks, which can aid the recovery process if all other variables are taken care of.

That all being said, here are some ways we can change our program to ensure we are training around pain ;

Training variables

Training variables the building blocks of our training program. These are things such as exercise selection, frequency, intensity, volume (load, sets, reps), tempo, rest periods, recovery etc. When we are in pain, we need to ask ourselves what is the purpose of the particular movement that is causing pain., so that we can modify our training accordingly.

Examples - Shoulder pain with overhead motions in a bodybuilder, or Shoulder pain in a bench press in a power lifter.

Whilst the bodybuilder gets assessed on his physique on stage - no particular movement is necessary in the short term, just the amount of muscle he has. The power lifter gets assessed on that specific movement, so that movement most likely needs to be apart of the rehab plan in the short term if a competition is near.

Whilst it is obviously going to be beneficial to get a diagnosis and a management plan specific to you, here are some ways you can manipulate training variables to train around pain

1. Exercise selection

   Can we modify the aggravating exercise to train a similar pattern to what the painful task is? Here we look to modify things like grip width or hand position, range of motion, planes of motion, equipment / strength curve used, grip components etc. The main goal is to determine whether or not we can keep a similar pattern in to what the currently painful motion is.
   
   E.G
   
   Powerlifter - Instead of bench pressing to the chest, we can implement a pause just above the chest or to a block in a non painful range, which is still targeting movement specificity
   
   Bodybuilder - Can we manipulate the grip used to allow pain free pressing overhead, or manipulate the angle of incline to a lesser degree, making the exercise comfortable?
   
   
   

2. Frequency
   
   This is how often we train a movement or pattern. Can we temporarily reduce the frequency of the pattern to allow things to calm down? This may be - going from training the movement 3 times per week, to 2 times per week, allowing greater amounts of recovery.
   
   
   

3. Intensity / Volume
   
   Intensity can either be absolute (percentage of 1RM on the bar), vs relative (RPE), and volume is the total amount of work completed. Whilst intensity is going to be imperative depending on the time of year for competitive athletes, we may need to priorities volume at non painful intensities and build resilience in higher rep ranges (Lower absolute intensity and higher relative intensity) when higher loads become painful. Another strategy to keep training heavier may be to do fewer heavier sets, and accumulate volume at lower absolute intensities to maintain conditioning.
   
   
   

4. Tempo

   
   This refers to the speed of the movement. Utilizing tempo work can be useful with individuals who experience pain above a certain 1RM percentage. When moving slower, we inherently have to use less load as the motion becomes more difficult. This may be a great tool to work on movement efficiency for the lifter and the person will generally find the most efficient path for them when the motion is slowed down.
   
   
   

5. Loading the opposite direction to what is currently painful
   
   If all else fails, we can completely avoid certain ranges for a period of time while things calm down or load the opposing direction if applicable. We can then re introduce the previously aggravating movement at a lower volume, whilst building up gradually.

Whilst the above list is not exhaustive, it may give you a starting point into some things you can modify in order to train around pain. Another important factor to consider is recovery, which i plan on covering in a later blog post. For the last time, pain is extremely complicated, and if it is bothering you, seek out an allied health professional who understands your sport.