How to deal with pain during training

You’ve been training consistently for several months.  You’ve been adding weight to your squat but recently you’ve started to experience left knee pain during your squat. This can be worrisome. You might start thinking you are causing damage. Though this may be true that ,in some cases, pain is an indication of damage in many cases that is not the case.  

Pain is a warning system. It indicates that there is a potential for damage.  Back in the day we looked at athletic/fitness injuries/pain as a result of only biomechanical origins.  Your pain was based solely on the stresses placed on it.  Over the last ten to twenty years the understanding of pain has expanded. There is a “new” model of explaining pain called the biopsychosocial model.  This model indicates that pain is a multi-factorial process that is based on biological (bio-), psychological and environmental (psychosocial) factors.  

Biological factors consist of:

  1. Nociception 
  2. Inflammation
  3. Fatigue
  4. Training load
  5. Sleep
  6. Illness

Psychological factors consists of

  1. Fear/anxiety
  2. Depression
  3. Stress
  4. Mood state
  5. Expectations
  6. Past experiences 

Social factors consists of:

  1. Knowledge of other people’s experiences
  2. Reactions from others
  3. The environment
  4. Culture

If the stresses placed on the knee during a squat is significant enough and your psychosocial factors consider the stress a threat you will experience pain. 

So if you are experiencing knee pain (or pain anywhere else) in the gym what should you do?  

Don’t Rest 

Resting your knee completely until you are pain free is not recommended. Rest ultimately leads to loss of strength, muscle mass and takes you further away from your goals. If you are experiencing tendinopathies you may see no improvement once you return to activity. Also, if you’ve stopped training because you are experiencing lower back pain, rest may result in worse outcomes in the long run. It’s important to stay active.

Modify training variables

What you need to do is modify the stresses you place on your knee.  Make modifications to your workout that don’t aggravate your knee.  

How can you modify your workout to reduce the overall load on the tissue?

  1. Reduce the weight to reduce the intensity
  2. Reduce the repetitions to reduce overall volume
  3. Reduce the sets to reduce overall volume
  4. Reduce rating of perceived exertion to reduce overall load
  5. Increase the number of repetitions and slow the movement down (3 seconds up: 3 seconds down) this will force you to reduce the weight you can use.
  6. Reduce the range of motion you move the joints through.  For example some people experience knee pain at the bottom of a squat so switching to box squats may help. 
  7. You may need to  drop the exercise and try a different movement.  

Use a traffic light analogy to gauge your activity’s effect on your knees.  If you rate your pain 1 to 4 out of 10 this is a green light situation.  You should be able to perform the activity without further aggravation.  If your pain is between 5 and 7 then this is a yellow light situation.  In this case you might want to pay attention.  There is the possibility that an aggravation can occur. If you are 8 to 10 out 10 then this is a red light situation and you should stop or not perform the exercise, for now. 

Once you discover what modifications will not aggravate your knee then you can begin to slowly expose the area to greater stimulus.  What we are looking for is positive workout experiences that don’t aggravate your knees. Remember you don’t have to be pain free during this process. It’s alright to have some discomfort that doesn’t escalate during training or 24 to 48 hours after training.

Load the area and then monitor.  If there is no aggravation perform this workout a couple more times.  Again, if there is no aggravation, increase the weight.  Remember just like strength training, improvements are not linear.  There may be some days where you might have to take a step back and work at a lower load and then slowly progress forward again.  There is no benefit in being overly aggressive by continuing to increase weight even though you continue to aggravate your knee.   This only lengthens your recovery.  Lastly, understand that for some it may take several months depending on the problem you are experiencing.

Still struggling?

You may also ask yourself

  1. Are you recovering from your workouts adequately?
  2. Are you eating well enough?
  3. Are you sleeping well enough?
  4. Are there other stresses in your life?
  5. Are your fears justified?
  6. Is your training program appropriate for you?
  7. Is there enough variety in your exercise selection?

There may be other factors at play.  Seek out a chiropractor, athletic therapist or physiotherapist who can help you pinpoint training errors in your workouts or discover biomedical reasons for your pain.

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