My Thoughts on Training People in Pain

“Should Personal Trainers and Strength Coaches Train People in Pain?”

Obviously, this was a loaded question and one that I was hoping would generate some quality discussion.

I think we definitely achieved that! 🙂

But now I want to tell you a bit about my thoughts on this topic, and how I’m hoping it can make you a better trainer or coach along the way.

Let me begin by telling you a few clients who I absolutely won’t work with, under any circumstances:

  • Anyone in neck pain. This is always a referral out.
  • Anyone with radicular/shooting back pain. Again, refer out.
  • Anyone who has just incurred what I deem to be a serious acute injury to a joint, ligament, muscle, etc.

And along those same lines, there are certain things I will never do to someone, based on my current skill-set:

  • Joint mobilizations, and
  • Hands-on soft-tissue work.

Now that we’ve got that out of the way, let’s dig a bit deeper.

It’s my opinion that almost every single client we train has had pain at one point in time in his or her lives.

It could be an old sports-related knee injury.

Maybe it’s a lower back tweak they suffered when putting up the Christmas tree last year.

Hell, it could be a strained shoulder that they endured while playing toss with their kids!

What I’m getting at here is this: It’s rare that we get a full-deck when it comes to our clients. Almost everyone has had some pain in his or her life, and most will have some pain the second they walk in your day to start “getting into shape.”

So what is the dividing line?

How do we distinguish who we will train, and who we should refer out?

This is perhaps the most important thing I will say here, so be sure to read this carefully:

1 – If you are in doubt, refer out.

2 – If you aren’t 100% comfortable training this person, refer out.

3 – And if you think you’re super-duper smart, you probably are – but refer again #1. When in doubt, refer out.

As trainers and coaches, our #1 goal should be to do no harm.  And if you’re training someone that is beyond your skill-level, you can’t promise him or her that that will be the case.

However, if someone has knee pain from time-to-time that’s the result of an ACL injury they had 10-15 years ago, I don’t feel a referral is necessary. Some people may disagree with me here, but chances are they aren’t going to go back and go through physical therapy again.

What they really need is some intelligent training – they need a quality program that adheres to the joint-by-joint principles, coupled with some coaching that will ensure they are doing things correctly and not placing excessive stress on the knee.

The same thing goes for lower back pain.  Now again, if someone shows up on my doorstep with shooting pain down to their heel, they’re getting referred out – no questions asked. I’ll often ask this on the phone before they ever come in, just to save everyone time.

Here’s a scenario: Someone comes to you with horrible low back pain. You refer out, and physical therapy cleans it up.

Now they’re back to see you for fat loss, sports performance training, or even post-rehab, if you want to call it that.

Can you design a program that keeps them pain-free?

Do you understand enough about the back to create a “back-friendly” training program?

Do you understand the positions that are most likely to be provocative? Or put them back into pain?

Can you administer the exercises in a fashion that keeps them healthy going forward?

I feel like it’s our job as trainers and coaches to have an understanding of what things cause pain or dysfunction, and how to avoid those in their training programs.

You may never treat their pain head-on, but at the very least, you should be able to keep them out of pain going forward.

So if you ask me, should we train people in pain?

My answer would be “it depends.”  How’s that for a cop-out?

And who you work with may be different at different points in your career. We all need to know our own personal limits, but I know I’m willing to take on more serious issues now than I would have in the past.

I’ve seen more things and have a better idea of who I can help and who I can’t. Experience will do that for you.

But remember, there is never any reason to be ashamed of referring out. I would much rather refer someone out and look somewhat intelligent, than to try and fix someone up that is beyond my skill-level and look like an idiot!

Before we wrap this up, though, I want to mention something that I feel is even more important.

We get so caught up in the idea of pain – but why aren’t we talking more about prevention?

Addressing the little issues before they become BIG issues?

One of the things we pride ourselves on at IFAST is not only getting people out of pain, but making sure our healthy clients never get into pain in the first place!

Again, it comes down to the basics – understanding the anatomy, taking them through an initial assessment, developing a program based on their needs and goals, and of course, high-quality coaching.

The more you know and understand, the greater the success you’ll have.

And this is why I feel like my Bulletproof Knees and Back Seminar DVD’s will be so valuable to you.  Beyond being able to help more people, you’ll be able to keep the clients you already have moving and feeling better than ever before.

It’s not necessarily a “goal” for them, but it’s always a goal for me.

The longer I can keep someone moving well and feeling great, the longer they’re going to enjoy training with me at my gym.

Tonight at midnight, the Bulletproof Knees and Back Seminar DVD’s will go on sale.

Are you serious about taking your skills to the next level?

I sincerely hope so.

All the best

Mike

7 Comments

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  1. There are so may trainers who doesn´t see their lack of knowledge and having huge ego trying to fix something that they don´t know how and just continuing with the fatloss or performance training before they are ready. As naparapath and trainer I often get new client. which has been training with personal trainer before and have got broken down and got more pain.

    If you have the knowledge and skills to help the client, YES continue the work. If not refer them to someone who do know.

    Thanks for bringing these thoughts out. Good one Mike!

  2. I was expecting this answer, since I said it myself.

    I like your logic here, and I agree wholeheartedly. Especially about the instant referrals. This just stresses the need to have good network of professionals that you can refer to.

  3. Hello Mike.
    I don’t really like to leave comments ( as I write tons of articles every day for my websites…) but as I was in pain and my story is in your topic I thought I might leave it here 🙂

    Well almost all year of 2010 was a pain in the a** for me ( regarding low back pain ). When I walked or stood on the chair I didin’t felt any pain in my back, but a little side bending or forward bending and boom, the pain was there ( not unbearable but it was annoying and I wanted to make it stop ).

    So I started buying allot of books, dvd’s and started researching. As a side note , my leg training was mostly around leg press,leg extension, leg curls as I didin’t really wanted to learn the squat and deadlift without the help of a trainer.

    Anyways, I said what the…. , after reading some forums and saw that allot of people reported better backs after doing either deadlifts and/or RDL’s, I purchased about 2 books and 3 dvd’s on olimpic lifts ( of course I know very well who are capable ).

    So after reading the dvd’s and the books, I started with the deadlifts. Low weight at the beginning ( 84 lbs at first ) and good form. I noticed that my hamstring flexibility was poor so I also started to do flexibility work ( also after reading some books ) and got my flexibility just right.

    At the beginning, when I was deadlifting, through the motion, the back felt good and low back pumped, but as soon as I finished deadlifting, I had a little discomfort. ( I forgot to notice that every night when I went to bed, in the first 1-2 minutes my lower back hurt a little even before starting doing deadlifts ).

    So basically I trained through pain and now fast-forward 4 months ahead, I deadlift 340 lbs ( 3 reps with good form ) and atm still going up in reps and lbs.

    My lower back is like a brick, my legs are monsters ( and the bed pain is gone, now I don’t fear that when I go to bed, I will have some pain ).

    I don’t really know what kind of problem I had but now it’s fixed ( I guess I’m a little lucky 😉 ).

    So I think it depends, if you don’t afford / have time to go to a chiropractor or someone who can check you, you can start training with low weights and if the pain when you train is greater than it is when you are “idle” then stop and go to a medic.

    I was lucky to be able to deadlift with my bad back because when I did that motion, my back didin’t hurt so I was able to train it and get it stronger.

    Like you, I agree that it depends and your body is the best instrument to tell you if you can train or not.

    Have a nice day

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