A Clarification on Training Through Injuries

by John Petrizzo, DPT, SSC | September 28, 2021

Those of you who have followed Rip’s Q&A forum for any length of time have seen hundreds of questions related to various types of injuries. Fortunately, most of the injuries that are incurred while barbell training are relatively minor and as such, Rip’s advice is typically to “train through it.”

This is generally very good advice, as we know the deleterious effects of being sedentary usually far outweigh the prospect of having to train with a bit of pain. However, training through pain does not necessarily mean continuing to do the same things in the gym without modification. The purpose of this article is to provide the reader with a few simple strategies they can use in their training the next time they are dealing with an ache or a pain.

When managing a training related injury, the first thing you have to determine is whether or not the injury is serious enough to require a modification to your program. A good general rule of thumb is that your pain should not worsen with exercise. Ideally, it would improve as you progress through your warm-up sets, but at the very least, if it is stable, then you should be able to proceed with your planned session provided the pain is tolerable to you. However, if your pain worsens during your warm-ups, then a change is necessary.

Once you have determined that a modification to your training is necessary, the next thing you have to figure out is whether there is a load that you can use that is tolerable and does not exacerbate your symptoms. If so, great. Start at that weight and gradually work your way back up to your previous poundage. This process can take as little as a session or two for minor injuries, or several months in the case of more significant load reductions. If you cannot find a tolerable load to use for a given exercise, then further change will be necessary.

If you cannot find a manageable load to use when working through the full range of motion of a given exercise, the next thing to consider is whether you can move through a part of the exercise’s range of motion without worsening pain. If so, start the process of warming-up and gradually titrating up your training load through whatever range of motion you can manage without increasing your symptoms.

Examples of exercises that can be used successfully with this type of strategy would be high box or pin squats, pin presses, and rack or block pulls. From there, you can gradually increase load and progress the range of motion as your symptoms allow. A strategy that I have successfully used with this type of progression is to alternate sessions between increasing the training load and increasing the range of motion. Essentially, each session the stress is provided either by increasing the weight on the bar or the range of motion, not both simultaneously. In doing so, you are only providing one novel stress at each session and will better be able assess your response to the stimulus.

In my experience, load and range of motion modifications will often help lifters train through most of the minor injuries they experience in the gym. However, if further program modification is still necessary to alleviate painful symptoms while training, another strategy that can be employed is modifying repetition speed. In particular, slowing down the eccentric portion of your lift and incorporating a brief pause at the turnaround point on exercises like the squat and bench press that utilize the stretch reflex can be particularly helpful for muscle belly and tendon injuries. The reason for this is that the underlying cause of most acute muscle and tendon injuries is rapid, eccentric overload and our muscles produce more force eccentrically at higher velocities of lengthening. Therefore, slowing down your eccentric on a given lift will decrease eccentric muscle force production which can in turn help alleviate painful symptoms.

Additionally, utilizing tempo work like this will also force you to take weight off of the bar, so it is interrelated to my first suggestion. Another potential benefit of this type of work is that it gives the lifter more time during each repetition to focus on their technique and execution, so it is a good opportunity to work on correcting any form issues that have crept up over time.

Finally, and perhaps most importantly, if you are having pain that is severe, persistent at rest, unrelated to activity, and hard to pinpoint, get yourself checked out by a medical professional ASAP. This type of pain is not typical of the kind of musculoskeletal pain we expect to see occur as an occasional consequence of hard training, and could be the sign of something more serious going on that should not simply be ignored.

Utilizing the previously mentioned strategies can go a long way to helping you train through and around minor injuries in the gym, and help you avoid the oftentimes unsolicited advice of friends, family, or an uninformed doctor, nurse, or physical therapist simply telling you to stop lifting and to take up yoga or Pilates instead. If you feel that your injury requires the attention of a knowledgeable practitioner, check out the Starting Strength Coach Directory or Starting Strength Online Coaching as we have a growing number of qualified coaches who are also healthcare professionals with extensive experience in helping lifters manage their injuries.