How To Train Around Pain Or Injuries

The purpose of this blog is to show you the 10 best exercise modifications for training around pain or injuries.

Looking for rehab or performance programs? Check out our store here!

Rehab is Training in the Presence of Injury

Before showing the exercise modifications, I’d like to share two quotes that will serve as the underlying theme of this blog.

The first quote is by the French writer and philosopher, Voltaire – “The art of medicine consists of amusing the patient while nature cures the disease.” 

Although the context of this blog is slightly different, the message remains the same – Most new, non-traumatic instances of musculoskeletal pain will self-resolve when given enough time and the appropriate environment to do so. 

The second quote is by a world-renowned physio and researcher, Phil Glasgow – “Rehab is training in the presence of injury.”

Rehab is often thought of as someone doing something to you – massage, cupping, needling, etc. While you might consider these helpful adjuncts, the foundation for successful rehab is actually built upon learning what you can do for yourself (oftentimes with the guidance of a clinician or coach).

Rehab and training should be represented along the same continuum. If your training looks significantly different from your rehab or your rehab looks significantly different from your training, you may want to re-evaluate your approach to one or both.

Therefore, the purpose of these exercise modifications are not to provide cheap gimmicks, quick fixes, or “corrective” exercises. Instead, they are intended to help you find an appropriate entry point to training, while reducing the risk of pain progressing into something more debilitating or long-lasting.

1. Load

Although the exercise modifications are not listed in any order of importance, the first, easiest, and probably most well-known change you can make to an exercise involves reducing the load. 

With an exercise that requires external load, like a barbell bench press, you simply decrease the weight on the bar. However, there are various ways you might implement this modification. 

For example, if bench pressing 185 pounds for 3 sets of 8 is causing you shoulder pain, you can try bench pressing 165 pounds for 3 sets of 8 instead. The obvious issue with this approach is that you aren’t training as hard.

Therefore, another option would be to reduce the weight, while also increasing the number of repetitions to maintain your same level of effort. In this example, you might bench press 165 pounds for 3 sets of 12. When dealing with a nagging injury or pain, some people find that they better tolerate higher rep ranges with relatively lighter loads as opposed to lower rep ranges with relatively higher loads.

The upside to this approach is that it’s now been well-documented that gaining muscle can occur with almost any rep range, assuming your effort is sufficient. So, unless you have very specific, rep-related strength goals in the short-term, decreasing the load while maintaining a comparable level of effort is a viable option for many. 

For exercises that use your bodyweight as the load, such as push-ups, pull-ups, and air squats, this looks a little different.

For push-ups, you can elevate your hands or perform them on your knees.

For pull-ups, you can use a band to offload some of your body weight.

For air squats, you can use your hands for assistance to reduce the demand on your legs.

2. Effort

The second modification is one I just mentioned – effort. Although it may be ideal to maintain your same level of effort when experiencing pain or an injury, it’s not always realistic. There’s good news, though!

It was previously believed that you had to take every set to failure in order to maximize muscle growth. Fortunately, research has revealed that you can take every set to failure to grow muscle, but you can also leave 1 rep in reserve, 2 reps in reserve, 3 reps in reserve, or even 4 reps in reserve, presuming that other aspects of your programming are adjusted accordingly.

And I’m referring to making progress right now. I might argue that gaining muscle or strength shouldn’t be your priority if you’re experiencing an injury that’s negatively impacting your training. Instead, you may try to maintain your gains, which requires significantly less effort, while focusing on trying to overcome your current setback.

Additionally, you could apply this thought process to different exercises that train similar muscle groups. For example, if you went from bench pressing 185 pounds for 3 sets of 8 to bench pressing 165 pounds for 3 sets of 8 due to shoulder pain, you could, in some cases, attempt to make up for that reduced effort and intensity by taking other pain-free chest exercises closer to failure, such as push-ups or cable flies.

3. Range of Motion

The third modification is range of motion. A general rule of thumb is that people experience the most symptoms near the hardest portion of an exercise, which often coincides with the end range position of at least one joint. I’ll give four examples.

If you’re experiencing shoulder pain during the bench press, I would expect symptoms to occur when the bar is touching your chest. Not only are your pecs, deltoids, and triceps working extremely hard here, but your shoulder is at or near its end range of motion. To restrict the range of motion at the bottom portion of the exercise, you could place a block or some other object on your chest.

A push-up is most challenging when your chest is closest to the floor. Similar to the bench press, you can place a block or object between your chest and the floor to reduce the range of motion.

To reduce the range of motion of a squat, you could squat to a box or bench.

A deadlift is slightly different from the three previous examples because you’re starting at the hardest part of the exercise. You’d want to raise the bar from the floor by placing the weights on blocks, boxes, or plates.

I’m a big fan of incorporating objects because they can be used for objective markers of progress. For example, if you started deadlifting from 45 pound plates, you could slowly progress by moving incrementally closer to the floor using smaller plates.

4. Speed

The fourth modification is related to the speed at which you perform an exercise. Have you ever tried implementing a specific tempo?

If each repetition of your bench press normally takes 1-2 seconds, you could lengthen each repetition to 6 or 7 seconds by lowering the bar over the count of 3 seconds, pausing for 1 second at the bottom, and raising the bar back up over another 3 seconds. 

A slow tempo can help with your technique, control, and allow you to be more aware of how your shoulder is feeling during each repetition in this scenario. If keeping track of the tempo and repetitions simultaneously is challenging, I highly recommend downloading a free metronome app on your phone. 

If you want to eliminate the speed component of the exercise entirely, you can do isometrics. For the bench press, you can either lower a loaded barbell toward your chest and hold it there for a specified time, or push an empty barbell into the safety bars if they’re available to you.

Whether you’re implementing a tempo or isometrics, you’ll likely have to reduce the load or difficulty of the exercise. 

5. Frequency

The fifth modification is the frequency of your exercises. Let’s stick with the shoulder pain example.

Let’s say that your shoulder pain only arises at the end of your chest day, which you perform one time per week. On that chest day, you do 4 sets of bench press, 4 sets of incline dumbbell presses, 4 sets of dips, and 4 sets of cable flies. Altogether, you’re doing 16 sets of work for your chest on a single day.

Can you split that up over the course of the week instead?

If you did an upper/lower split, you might do 8 sets of chest and 8 sets of back on Monday, and then repeat another 8 sets of chest and 8 sets of back on Thursday.

If you did a full body split, you might do 4 sets of chest, 4 days per week. You’re still accomplishing the same number of total sets for the week, but you’re asking your shoulder to do less total work in a single day.

There is no best training frequency for strength or hypertrophy, so you can experiment to see which type of program works best for you.

6. Volume

The sixth modification has to do with manipulating the volume, or total number of sets, of your training. This is intimately related to exercise frequency as we saw in the last example because if you change one, you often change the other as well. So, you could change the total number of sets that you perform in a single session, or change the total number of sets that you perform per week.

Many people are concerned about losing their gains if they decrease their total volume, but I think about it in 1 of 4 ways:

1. If you evaluate and reflect on your current program, it’s possible the total number of sets you’re doing is unnecessarily high, not actually beneficial to your gains, and may have even contributed to your injury.
2. Gaining is always much harder than maintaining, so you might be able to reduce your volume for a short period of time to rehab your injury while maintaining your strength and muscle mass. 
3. Regaining strength and muscle seems to be much easier for most people than the initial phase of gaining that strength and muscle. If you’ve been trying to push through an injury for 12 months because you don’t want to lose your gains, maybe it’s time to sacrifice a few months of loss so you can actually move forward. You should easily regain any lost strength or muscle in the long run.
4.  If you reduce the total volume of your chest training, you might be able to use that extra time and energy to bring up other lagging body parts, such as your legs or back.

7. Rest Times

The seventh modification has to do with rest times, usually in the form of increasing them. I understand that some people prefer getting in and out of the gym quickly, but try slowing things down, at least on the movements that are most aggravating. If you’re not completely exhausted or out of breath, hopefully you can be a little more intentional with what you’re doing, how you’re doing it, how it makes you feel, and how you might respond by using some of these other modifications.

8. Exercise Variation or Technique

Number 8 involves modifying the exercise variation or technique. I’m going to use the word “variation” very loosely here, and you’ll see why in the next recommendation, so don’t get too mad at me.

Starting with the bench press, if you have shoulder pain, you might use a narrow grip or even switch to a flat dumbbell press. I told you not to get too mad at me – it’s still a flat, weighted press.

For the deadlift, if you have low back pain, you might swap out a conventional deadlift for a sumo deadlift or a Romanian deadlift.

If you have low back pain with a barbell back squat, you might try elevating your heels to stay more upright or temporarily change to a goblet squat. 

If you experience symptoms with skullcrushers, you might try doing them one arm at a time or switching to triceps pressdowns.

There are an infinite number of possibilities, but the idea is that you’re reducing the demand on your injured body part or changing something about an exercise that allows you to execute it with less pain.

9. Exercise Selection

You made it to modification number 9 – exercise selection! For this one, you need to understand the purpose of your exercise choices.

What is the purpose of a squat? You could argue that it’s to get better at squatting. But you could also say that it’s to train your knee extensors, or quads, and hip extensors, or glutes and adductors. If you’re unable to perform a back squat, front squat, goblet squat, air squat, or any other squatting variation, what’s a good alternative?

How about a split squat, step up, or lunge? They may look different, but they’re training similar joint movements and muscle actions.

What if you can’t perform conventional deadlifts, sumo deadlifts, or Romanian deadlifts?

Well, you might ask yourself how you can get a similar training stimulus to your back extensors, hip extensors, and hamstrings using other exercises. Maybe you use some combination of extensions on the roman chair, hip thrusts, and leg curls.

Once again, there are infinite possibilities here, but the more informed you are about your training routine, the better the decisions you can make. 

Four Key Points

Before moving on to number 10, I want you to understand four things:

1. You should probably be using a combination of these exercise modifications, whether that’s 3 or 7 of them.
2. You should be thinking about these modifications as being “more or less” as opposed to being “all or nothing.”
3. I’ve provided a framework, but the challenge is often about finding what works best for you. That’s why I said to think about these exercise modifications as “more or less.” You’re experimenting with finding the right amount of each modification to create the optimal program for you.
4. While not the basis of this blog, there will be times when you need to address specific deficits in strength or range of motion during the rehab process, which, in reality, just means you have a comprehensive and well-rounded training program.

10. Doing Nothing (Or Changing Your Perspective)

What’s the last modification? It might come as a surprise, but it’s actually doing nothing, or at least changing your perspective.

Despite popular belief, pain is not always avoidable. For example, what if you have low back pain at rest or with any form of exercise? If the entry point to training is pain-free exercise, where do you start?

Or if you try to wait until you’re pain-free to do any form of exercise, is it possible that you end up doing less and less until you’re not exercising at all?

It’s not uncommon for the fear of pain, or the fear of what that pain means, to be a barrier to starting exercise, but it’s not realistic to expect the rehab process to always be completely pain-free. Rather than finding a pain-free baseline, sometimes it’s necessary to find a tolerable baseline (whatever tolerable means to you) and slowly work toward your goals from there.

Sleep, Stress, Nutrition, & General Physical Activity

I bang this drum in just about every blog I write, and it’s for a reason. If you’re trying to reduce your risk of injury or recover from an injury, I can’t emphasize enough the importance of trying to prioritize your general health. If you’re looking for the best massage gun to buy yet you’re only sleeping 5 hours per night, you’re stepping over hundred dollar bills to pick up pennies. 

When it comes to sleep, stress, nutrition, and general physical activity, you don’t have to be perfect. No one is; perfect doesn’t exist. But if you’re skipping out on sleep and general physical activity to binge watch Netflix each night, that’s something you may consider changing.

Summary

In summary, most new, non-traumatic instances of musculoskeletal pain will self-resolve when given enough time and the appropriate environment to do so. Rather than looking for quick fixes or gimmicky gadgets, you’re better off learning what you can do for yourself. If you’re experiencing pain or an injury, consider modifying these variables as they relate to your training:

Also, don’t forget that prioritizing your overall health is another important strategy for recovering from an injury. Are you taking advantage of opportunities to improve your sleep, stress, nutrition, and general physical activity?