Injury & Rehab
Seeing a professional: who does what and what to expect
People delay seeking help partly because they do not know who to see, and partly because a previous experience involved being told to stop lifting.
Two things stop lifters from getting problems assessed. Uncertainty about who to see, and a well-founded worry that the advice will be to stop training.
Both are addressable.
Who does what
Physiotherapist. The most likely first port of call for a musculoskeletal problem. Assesses movement, strength and pain, provides a working diagnosis, and — most importantly — builds a rehabilitation programme. In many places you can self-refer.
Look for one who works with lifters or athletes. The difference in approach is substantial: a physiotherapist familiar with strength training will modify your programme rather than replacing it with unloaded exercises.
Sports and exercise medicine doctor. A physician specialising in musculoskeletal and exercise-related problems. Can order imaging, prescribe, and refer onward. The right choice for complex, persistent, or unclear problems.
General practitioner. The route to referrals in many health systems, and the right first stop for anything systemic, for medication questions, and for red flag symptoms.
Orthopaedic surgeon. For problems that may need surgical management. Worth noting that a large proportion of musculoskeletal problems are managed better without surgery, and that a surgical opinion is one input rather than a verdict.
Registered dietitian. For nutrition, particularly with a medical condition, an eating disorder history, or a weight-class sport. The title is protected in many jurisdictions; "nutritionist" often is not.
Strength coach. For technique and programming. Not a clinician and should not be diagnosing anything, and a good one will refer you when something is outside their scope.
What a good assessment involves
A thorough history — what happened, when, what makes it better and worse, what you have tried, what you do in training, and what your goals are. The history is where most of the diagnostic information comes from.
A physical examination — movement, strength, specific tests.
An explanation you understand, in language that does not frighten you.
A plan with a timeline and specific things you will do, plus criteria for progressing.
Discussion of what you can continue doing, which for a lifter should be most things.
Warning signs in a consultation
Being told to stop all training with no modification offered.
An explanation framed around structural damage and fragility — "bone on bone", "your spine is unstable", "you should never squat again" — without discussion of the poor correlation between imaging and symptoms.
A treatment plan consisting entirely of passive interventions with no progressive loading.
Imaging ordered immediately for a straightforward problem with no red flags.
An open-ended course of appointments with no discharge criteria.
Any claim to fix things by realigning something.
You are entitled to a second opinion, and getting one is normal rather than rude.
How to be a useful patient
Bring your training log. What you have been doing, how it changed recently, and what specifically provokes the symptoms. This is genuinely the most useful information you can supply and almost nobody brings it.
Be specific about pain: where, what kind, when it started, what makes it worse, whether it is improving or worsening, and whether anything unusual preceded it.
State your goals explicitly. "I want to squat two hundred kilos in nine months" gives a clinician something to work toward. "I want it to stop hurting" gives them much less.
Ask what you can do rather than what you cannot.
Then actually do the programme. The most common reason rehabilitation fails is non-adherence, and rehabilitation exercises are dull and easy to skip. Treat them as training — log them, progress them, and do them consistently.
Questions worth asking
What do you think is going on, and how confident are you?
What can I keep doing in the meantime?
What is the expected timeline, and what should improvement look like at two weeks and at six?
What would make you change the diagnosis?
When should I come back, and when should I be worried?
When to go sooner rather than later
Any red flag symptom — numbness, weakness, loss of bladder or bowel function, unexplained weight loss, fever, night pain, significant trauma.
Anything getting worse over weeks despite modification.
Anything that has not improved over six to eight weeks of sensible self-management.
Anything you are worried enough about that it is affecting your training decisions or your sleep.
Early assessment is nearly always cheaper than late assessment, and the six-month version of a problem is much harder to shift than the six-week version.
