Injury & Rehab
Training around pain without making it worse
The two common responses to pain — stop everything, or push through — are both usually wrong. There is a middle path and it is better supported than either.
Something hurts. The two instincts are complete rest until it goes away, or ignoring it and continuing as planned. Both are common and both usually produce worse outcomes than the middle option, which is modifying load while continuing to train.
This is general information, not clinical advice for your specific problem. Persistent, severe or worsening pain, and anything with red flag features, needs assessment by a clinician.
Pain is not a reliable damage meter
This is the single most useful concept in modern pain management and it is counterintuitive.
Pain is an output of the nervous system, produced in response to a judgement about threat. Tissue damage is one input to that judgement. So are sleep, stress, fear, previous experience, expectations and beliefs about what the pain means.
Which is why imaging findings correlate poorly with symptoms. Large numbers of people without any back pain have disc bulges on scans. Large numbers with severe pain have unremarkable imaging. The tissue state and the pain experience are related but not the same thing.
The practical consequence: hurting does not automatically mean you are damaging something, and the fear that it does tends to make pain worse and recovery slower.
The traffic light approach
A widely used framework in tendon and musculoskeletal rehabilitation, and a reasonable general heuristic.
Green: pain up to around two or three out of ten during the activity, settling within twenty-four hours, and not worse the next morning. This is generally acceptable to train through, and loading in this zone is often what drives recovery.
Amber: pain in the four to five range, or lingering into the next day. Reduce load, modify the movement, and monitor.
Red: pain above five, sharp, worsening across sessions, or accompanied by swelling, loss of movement, weakness or numbness. Stop that movement and get assessed.
The twenty-four-hour response is the key marker. Something that hurts a bit during and is fine the next day is usually tolerable. Something that is worse the following morning is a signal that the dose was too high.
Modify rather than stop
Complete rest deconditions tissue, reduces capacity, and frequently leaves you returning to the same load with less tolerance than you had before. Tendons in particular respond poorly to rest and well to appropriate loading.
The modifications available, roughly in order of how much you should try before abandoning a movement:
Reduce load. The same movement lighter is often completely painless.
Reduce range. If the bottom of a squat hurts, squat to a box above that point and load it there.
Change the variation. Front squat instead of back squat, trap bar instead of conventional deadlift, dumbbell instead of barbell pressing, neutral grip instead of pronated. Small changes in joint angle and load distribution frequently remove symptoms entirely.
Change tempo. Slower, controlled repetitions are often better tolerated than fast ones, particularly for tendon problems.
Reduce frequency or volume for that pattern while maintaining everything else.
Only when none of these produce a tolerable version do you remove the movement, and even then you keep training everything else. A shoulder problem does not prevent squatting.
Keep training the rest of the body
This matters more than people realise, for two reasons. Maintaining overall training keeps fitness, habit and mood intact, and all three affect recovery. And there is reasonable evidence for cross-education — training the uninjured limb produces some strength retention in the injured one — which makes unilateral work worthwhile when one side is out.
Load is the treatment, not the enemy
For the majority of musculoskeletal problems in lifters — tendinopathy, muscle strains past the acute phase, non-specific back pain — progressive loading is the intervention with the best evidence. Passive treatments feel good and generally do not change outcomes much on their own.
That means the rehabilitation programme looks like a training programme: specific exercises, progressive load, tracked over weeks. It requires patience, because tendon adaptation in particular is slow, measured in months.
When to get assessed
Sudden severe pain with a pop or tearing sensation. Significant swelling or bruising. Inability to bear weight or move a joint. Numbness, tingling, or weakness. Pain that wakes you at night consistently. Pain that is getting worse across weeks despite modification. Anything systemic — fever, unexplained weight loss, night sweats.
And, honestly, anything that has not improved in six weeks of sensible self-management. A good clinician who works with lifters will modify your training rather than telling you to stop, and that conversation is worth having early rather than after six months of hoping.
