Pain During Training: Now What?

We have all been there. In the middle of a training session, performing a movement you have done countless times before and suddenly you feel a sharp “pulling” sensation, a painful “snap”, or maybe an intense ache. Immediately the alarms go off and you wonder, “What was that? Am I injured? Do I keep going?... Now what?”.

This blog will give a brief overview on what the presence of pain may actually mean and provide an easy guide to follow in order to decide to continue training without modification, stop activity all together, or change training parameters to make movements more comfortable.

Explaining Pain

Historically, the terms pain and nociception were interchangeable in the context of tissue injury. Nociception is defined by the processing of painful/noxious stimuli by the nervous system in the presence of injury or damage to tissue. However, it is now known that the experience of pain is much more complex and much harder to define. The experience of pain is personal and subjective to the individual. What may be painful for some may be considered an irritant or not painful at all to others. Although pain may be difficult to define, what can be stated is that pain does not always equate to tissue damage. The experience of pain is subjective to an individual’s learned behaviors and past experiences, also known as biopsychosocial factors. (For a deeper, nerdier dive into pain science, visit Dr. Brooks’ blog “Why Am I Still in Pain?” here.)

 For the purpose of this blog, pain will be defined as a “somatic experience that reflects a person’s apprehension of threat to their bodily or existential integrity”. (Cohen et al. 2018) Meaning that the experience of pain can be the body recognizing and reacting to a potential threat to the system, and can be present in the absence of injury or damage to the body.  

Is the Pain Tolerable?

The first question to ask yourself when you experience aches and pains during training is – is it tolerable? The answer to this will differ from person to person. However, using the following numeric pain rating scale will help offer some guidance.

For the scale, a “0” is considered no pain at all and a “10” is the worst pain imaginable. Although tolerable pain is subjective to each person, in order to provide a clearer construct to follow, we will define tolerable symptoms (regardless if they are sharp, achy, throbby, etc.) to be 4/10 or less in severity. Another, more simple question to determine if the pain is tolerable is do you feel comfortable pushing through it? If the answer is “yes”, then the symptoms are tolerable. If the answer is “no”, then symptoms are considered to be a bit too intense to continue without modification.

Is the Pain Long Lasting?

Once the severity of the pain being experienced is determined, ask yourself the following questions:

• Is the pain relieved by rest?”

• Is the pain relieved by continuing exercise/movement?

• Is the pain worsening as you continue?

If the symptoms are decreasing in intensity with rest or continued movement, then you can continue on with training without modification. If the symptoms are not decreasing, but also not worsening, you may also continue without changing your workout plan.

If the pain is worsening with continuing the same movement, then try some modifications. The good news is complete rest or shutting it down is often not the answer when pain pops up in the gym.

How to Modify

If you find that symptoms are not improving with the same exercise/movement in which the pain occurred, or you don’t feel comfortable proceeding, try modifying the following exercise parameters:

• Change intensity
  
  Typically, this will mean decrease the amount of weight or load you are using. If you are not performing a weighted exercise, decrease the effort in which you are performing it.
  

• Change volume
  
  Switch up the amount of sets and repetitions you perform. If symptoms are increasing with a higher rep scheme, decrease the amount you are doing and see how that alters pain intensity.
  

• Apply constraints to the movement
  
  If performing the exercise throughout the full range is not tolerable, try limiting the movement to a more comfortable range of motion. (Example: box squats vs full depth back squat)

Credit: Physio Network

Conclusion

Onset of pain during training can be frustrating and at first, very concerning. However, it does not mean tissue damage or injury has occurred to the body. Aches and pains will pop up with activity, and that is 100% normal. The human body is highly adaptable and excellent at healing. More often than not, minor aches and pain will resolve on their own. However, if you begin experiencing discomfort with training that does not resolve with the above modifications or is beginning to limit your ability to participate in the activities you love, head to the “Schedule Now” button to get in contact with one of our Doctors of Physical Therapy for a free phone consultation.  

Dr. Paulina Tselikis,

Co-Owner, PT, DPT, ATC, USAW-1

The PATH Rehab & Performance

References:

Cohen M, Quintner J, van Rysewyk S. Reconsidering the International Association for the Study of Pain definition of pain. Pain Rep. 2018;3(2):e634. Published 2018 Mar 5. doi:10.1097/PR9.0000000000000634