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How To Train People In Chronic Pain 2.0

During the four years since I wrote this article, I occasionally lament the original got no readership. I truly think many Personal Trainers could benefit from the ideas contained within as could those we train who are suffering from of the many conditions which result in near constant pain. Here is attempt number two! CK 2021

Many coaches struggle to train people in chronic pain. I want to help change that.

This article talks about how you can design strength training sessions for those in chronic pain in a way which fosters autonomy by involving the client in the decision-making process from the start.




  1. 1.

(of an illness) persisting for a long time or constantly recurring.

"chronic bronchitis"

synonyms:persistent, long-standing, long-term, constantly recurring

Above is a list of potential conditions (or categories of conditions) causing persistent or chronic pain. It is in no way exclusive and people suffering with a huge variety of illnesses may be in varying degrees of constant pain.

As a coach not in constant pain, and indeed who has never been in constant pain for more than a few days it is impossible to put myself in the shoes of someone with a condition causing long-term pain.

As it's impossible to comprehend what they are going through it's my job to listen to my clients to establish a way for my clients in constant pain to regulate their own training.

The article below lays out my system for helping those in chronic pain to decide on their own gym work based on how they are doing when they arrive at the gym

Training People With Chronic Pain

Here is the infographic I think of when planning someone's session who is in chronic pain:

An example session for someone in a high amount of pain but with high energy levels would be:

- Dumbbell goblet squats to a box (up to 3x8 reps)

- Laying leg curl machine (up to 4x10 reps)

- Deadbugs (up to 3x20 reps)

The most important thing for both you and your clients to remember is training people in chronic pain takes lots of practice.

You will get things wrong and occasionally aggravate their symptoms. Sometimes they will. This has to be understood by both sides and must be cleared by medical professionals before proceeding.

Pain isn't visible

You may have clients who are in so much pain that they feel dizzy or sick when standing some days and then other days they will be completely fine during the session but you might not look any different.

It is not as simple as going by how they look and sound or even by what they say because people in chronic pain may try to mask their pain via conscious or unconscious coping strategies. This emphasises how important it is for the coach/client relationship to be strong and built on layers of understanding, trial and error and an environment facilitating discussion and growth.

Be sure to ask about their pain levels, and be sure to look out for subtle signs their pain is worse than they say or an exercise is making them uncomfortable. If you feel this is the case, talk to your client and adjust their program accordingly.

Many in chronic pain think that training is impossible or that they shouldn't train if any pain is present.

As a trainer you can help them change their mind.

Relationship With Pain

Each person suffering from chronic pain has a different relationship with it so it's important you treat them all as individuals.

I try to use relatively neutral terms like low, medium, and high while drawing the graphic up because it is so hard to pin down exactly what pain means to a particular person.

You have to work with your chronic pain clients over months and years to establish what exercises can be done on the low pain days, the high pain days, and the medium pain days to create a battle plan to allow someone to train on the days they are functional enough to do so.

In other words, you give them options.

Options, options, options

You giving options to a population who may feel as if they don't have any options and that is huge.

Pain has a huge impact on someone's energy levels which is why I decided to add another tier to my graphic as pain levels and energy levels don't necessarily correlate.

This gives you another series of options to facilitate more appropriate training for your clients.

We always want our chronic pain clients to feel like they can make progress and demonstrate mastery. Maybe the high pain exercise list for a particular client has simple movements to be done at home because they are in too much pain to leave the house.

Maybe the low pain day exercises are a series of strongman-style exercises.

Each case is individual and you must build up the

categories steadily and be prepared to switch them up particularly if they have an unpredictable condition.

Putting It All Together

Below is a screenshot of a programme I assigned to one of my chronic pain suffering clients.

She was able to choose between the programmes and was able to take ownership of her pain and decide what she was capable of that day.

This is big.

Imagine feeling as if exercise was something beyond your reach and suddenly it's within your grasp now you have options!

This is amazing and you get to provide that to clients!

You lucky thing you.

If you are a trainer try to appreciate even getting to the gym might be a herculean feat for someone in chronic pain so don't expect miracles every session.

Change plans when you need to and appreciate the efforts of your clients who could well be giving everything to see you.

Not many will go to the trouble of appreciating their efforts so make sure you are the person to do so.

Training Around Chronic Pain Yourself

I would strongly recommend you work through my graphic when it comes to your own planning of sessions but the very best way around it is to hire a coach to help you plan around your pain.

A coach will help you make the low pain day lists, the high pain day lists and the medium pain day lists.

They'll give you options and show you how to do exercises correctly.

They should help you to feel confident and safe in the gym environment even when that might seem like a silly idea at this point. A coach can show you it isn't.

What If You Don't Want A Coach But Want To Strength Train?

I'd recommend watching as many exercise tutorials as possible, working alongside your doctor and start by doing one strength training exercise each time you go to the gym for 1-2 sets of 6-10 reps.

Gauge how you find it and when you are confident with the movement you can add a second exercise.

You should repeat this process for weeks, months and years until you have a full repertoire of exercises to choose from depending on how much pain you are in.

From these exercises you can create lists of exercises to do on low pain days, medium pain days and high pain days.

When energy levels are low but you still want to do something perform less sets and reps and use less weight. On medium days do a little more and on high energy days you might want to push yourself a little more if it's appropriate.

There are people out there like you and people out there who want to help and support you and I am proud to be one of those people.

Thank you so much for your time.

By Chris Kershaw

The Heavy Metal Strength Coach

Chris is a Personal Trainer, Strength Coach, Writer and man of small stature and a massive metalhead with more than a decade in the industry. He trains everyone from beginners to high level athletes but beginners are his favourite.

You can reach me through the email address

My Instagram is @theheavymetalstrengthcoach.

Thank you for reading!

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