Training Clients with Chronic Pain

Trainers need to take a different approach to best serve clients with chronic pain.

"My new personal training client was in an accident two years ago, and has had chronic back pain ever since. She has been to numerous specialists who say different things, and she has tried all kinds of painkillers. Her medical clearance form says she may perform 'symptom-limited exercise.' I wasn't sure exactly how much I should or should not push her, so I spoke with her physical therapist. Apparently, if my client lets pain be her guide, she will end up weak, bedridden and in more pain than ever. Instead, she has to start slowly, build gradually, and just accept the fact that some pain will be present. Usually I tell clients to 'stop if it hurts,' but this is not something I should say to her. I wonder what I should say instead. Any ideas?"

Most of the time, pain is a helpful response that motivates people to correct or escape from a situation causing damage to their bodies. For example, if someone sits in the same slumped position for too long, the neck and shoulders start to ache, so he or she will get up, stretch and change position.

Pain that occurs with injury provides a similar motivation: People limit movement while the injury heals. Many illnesses, such as the flu, make people ache all over, which encourages them to stay in bed and give their bodies the rest needed to cope with the illness.

But sometimes pain remains long after an injury has supposedly healed. Sometimes pain develops with chronic conditions, such as arthritis and fibromyalgia. People with chronic pain often avoid physical activity, since it hurts. But avoidance leads to weakness, which in turn leads to a further decline in functional capacity and, ironically, more pain. Weight gain and depression often accompany chronic pain.

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