How to Train a Client in Pain

Personal trainers increasingly work with clients who are in pain but have medical experts telling them it's fine to train — and often, training genuinely helps. This is a quick look at how to approach programming for a client in pain.

First, understand what pain is

Before anything else, it helps to understand what pain is, and what it isn't. I'd resist the idea that the emotion lives "in the brain" and instead call it an experience of the whole body, interpreted by the brain. Roughly, it happens like this:

• Stimulant / trigger — acting on the body, triggered by the brain, or both.
• Physical reaction — a change in the muscle, physiology and physical state.
• Brain interpretation — a feeling built from environment, history, prediction, guesswork and mood.

If that feeling continues, it starts to magnify, and it can cause lasting changes in how the client experiences pain.

Know the type of pain

Not all pain is the same. The main types:

• Acute — specific reason, under 12 weeks
• Chronic — over 12 weeks, non-specific
• Referred — away from origin, or from organs
• Myofascial — specific spots or areas
• Muscular — sprain, strain, overuse
• Neuropathic — neuron dysfunction
• Phantom — pain in body parts you no longer have

As trainers, we mostly deal with referred, muscular and chronic pain. It's also worth knowing how clients describe their pain, because the words carry information:

• Sharp — musculoskeletal trauma
• Burning / tingling — neural
• Stretching — muscular feedback
• Deep aching — muscular feedback
• Stabbing — vertebral
• Deep, boring or grinding — bone or joints

In our Injury and Pain courses we go much deeper into this, and into how the language clients use — and the language we give them back — changes their experience.

Programme around the goal, not the pain

Here I'm assuming you've already established the client's movement goal, beyond simply "not feeling pain". If you haven't, do that first. Pain is a hurdle on the way to the primary goal, not the goal itself. Keep it in its place and the whole programme changes shape.

Good programming improves the client's experience of the various triggers for their pain. You want a system where the client remembers each exercise as something fun and something they do well. To get feelings to settle that way, we build the programme using a story structure — it's the best way I've found to help a client hold on to the experience positively.

Use games

For each component of the programme, I'd use a game. Games provide distraction and give the client targets outside the body, away from the pressure of form. Using games and unusual training tools is something Ollie does especially well.

In Games for Pain — a short course on building games for clients who are suffering — we break games into four categories. Their rules let us set the right intensity to get results, and we make the movement required to complete each task one that's pain-free, or as close as we can get, while still challenging the client into positions and activities they fear. Done right, the game does the coaching for you: the client chases the target and forgets to guard the movement.