Should We Train Clients In Pain?

As a person who trains both athletes and general fitness clients, I’ve had more than my fair share of folks come in with some sort of nagging pain.  So, the question comes, “As strength coaches and personal trainers, do we train people in pain?”  My answer is yes…sort of.

As a fitness professional, it is not in my scope of practice to diagnose or treat pain.  I simply don’t have the tools or the skill set required to do so.  For example, if a client comes in with shoulder pain.  There are a myriad of things that could be wrong with them.  It could be an AC separation, torn labrum, torn rotator cuff, or even bone cancer.  All of which would require a different treatment.

If I have a client who comes in with any sort of persistent pain, I always have them go see their physician (In Indiana, physical therapy requires doctor referral).

This being said, it doesn’t mean the client can’t train around the pain.  Here are some examples of things we can still do for our clients who are experiencing some sort of pain:

For Back Pain:

  • We can still do all upper body movements.
  • We will usually cut out all bilateral lower body activity and stick to just unilateral.
  • They can still do core exercises, however they may need to be regressed a bit.

Shoulder Pain:

  • We can still do most pulling exercises.
  • We will eliminate all pressing exercises except pushups.  They can usually do those pain-free.

Hip Pain:

  • We can usually do most hip dominant exercises.  We will typically throw out all knee dominant until we hear back from the physician.
  • Upper body doesn’t usually present a problem.

Knee Pain:

  • We usually switch to just hip dominant lower body exercise and take away knee dominant. 
  • Upper body really doesn’t have an effect.

As you can see, even though a client is in pain, there’s still a lot we can do.  The important part is to have an open line of communication with client and understand that it is not our job to diagnose them.  This is why it’s important for the fitness professional to develop a good network of physicians, therapists, and chiropractors to refer out to.