Are there things you would love to do but pain stops you? Do you feel like people don’t quite believe you or think you’re exaggerating when you try to explain how you feel?  Would you like to be able do more with your family and friends? Has your pain contributed to you becoming less active and getting out of shape?  How much would you love to get back into doing some form of exercise but you’re afraid it will make things worse.

Should you exercise?

If you’re suffering from pain, exercise is the most beneficial thing you can do. The evidence that demonstrates this is overwhelming, however I do understand that that’s a very easy thing to say and when you’re really suffering, where do you start?

Is hitting the gym the answer?

A quick look into the fitness industry and it won’t take long for you to see that it’s awash with high intensity, no pain no gain style training, so I can fully understand that it can be more than a little daunting stepping into a gym. I completely get why you’d be hesitant to get started even with the help of a personal trainer. There is nothing more precious to you than your health and you’re trusting another person with it. You’d probably be surprised at the number of people I’ve had to help rehab that the fitness industry has broken with its intensity driven attitude towards training.

What do we now know about pain?

Our understanding of pain and how to manage it has had a recent and monumental shift towards the bio-psychosocial model. This means that whilst the state of your tissues (muscle, tendon, ligament, bone etc) in the body is still important, consideration must also be given to psychological factors and the social aspects too. This is where the fitness industry falls down a little when it comes to helping with pain. Fitness is aimed solely at changing your physique. You’re either trying to build muscle and burn fat and you’re wrong to want anything else. These two strategies have even been modified to try to cure pain. You may have heard of losing weight to cure knee pain or strengthening your core to get rid of back pain? In almost all cases “core strengthening” to get rid of back pain is bullshit. I’m not saying there isn’t a benefit to training and getting stronger, but pain is more complex and this simplistic biomechanical solution usually falls short and leads people to give up on exercise because it doesn’t work.

So what do we do then?

Exercise works! I train people in pain on a daily basis and I’ve helped a lot of people out of pain using it. I believe we need to alter the focus away from physical adaptation and altering your physique. More muscle and less fat should be a welcome side effect rather than a goal. Gym training typically involves following a program of exercises to create stress on certain muscles to promote a physical adaptation. If you want bigger glutes you perform squats to place the glutes under tension, stressing them and forcing them to grow. When you’re in pain, how well do you think you’re going to squat? Your ability to move will be compromised by pain. Pain will cause you to move  differently and that’s just a straight up fact. So the focus shouldn’t be on the performance of skills but rather on the development of them. Learning to move again, learning to use your body to its current capacity

How do we develop movement skill?

Interestingly, how fitness professionals are educated to teach exercise isn’t a good model for developing movement skills. Cueing you to move “correctly” only highlights the fact that things are not right, potentially creating a negative experience for the trainee. Pain will cause you to move differently but that doesn’t mean you can’t move effectively. You need to be placed in an environment where you can own your movement, to own your technique, be given the freedom to explore your movement and to establish where you are strong, and acknowledge where you are weak. You need variety of physical environments to develop your skills, you need to start with a low intensity to allow space to make risk free mistakes. You need space to fail without catastrophic consequences.

The technical part

For the sake of argument lets come back to the squat, and I’m using it as a means of helping you get in and out of a deep chair because even if you’re in pain, life requires you to sit down and stand up again. You show me your squat and it doesn’t look anything like the textbook says or like how anyone else is doing it in the gym. That’s ok, you’re owning your movement, if your back rounds then that’s fine. If your knees cave in, that’s also fine. If you drop your head and look at the ground then that is all ok. This is a great starting point as you’re doing what I would ask of from a squat. Hips go down and then back up again, everything else is superfluous. I will then change the environment and continue to get you to squat in whatever way feels best to you. I might ask you to hold a light weight in different positions, I might change the height or position of one of your feet, I might ask you to reach for targets, touch cones, close your eyes, change things in so many different ways that you’ll begin to see there is no optimal squat as each environment requires a different movement and you will be more than a little surprised at how capable you actually are. As you improve the challenges will become harder and more advanced and not only will your ability to squat go up but your ability to choose the most efficient pattern for many scenarios that will be more applicable to real life.

Putting it all together

Training like this you will still stress the tissue and it will adapt and grow stronger, your body will change like it does when you do any exercise improving the bio aspect. You will become more confident in how you move improving the psychological aspect and you will no longer fear the social situations where the pain used to beat you. In a nutshell this is how I train people out of pain using the bio-psychosocial model and it really works.