A client once told me, “Chronic pain is not for wimps.”
It certainly isn’t. So what do you do when a client comes in for a consultation and tells you they have pain in their head, shoulders, knees, and toes (though their words are usually less than sing-song)?
Clients with chronic pain, whether it’s in a single area or is widespread, can be an intimidating challenge to tackle.
How do you get clients out of pain without causing them more pain? If you’ve ever had a client come to you with a laundry list of aches and pains, you know the struggle. Trying to find exercises that cause enough discomfort to work, but not enough to spike pain.
As trainers helping clients with chronic pain, we want to improve mobility and support regular movement. We can do this by a combination of low-impact activity, stretching, and strengthening, along with a lot of communication.
It’s not our job to provide treatment but rather to offer support and work alongside healthcare providers to help our clients maximize strength and mobility while helping them manage pain.
Let’s jump right in so you can start helping your clients manage their pain today.
Low-Impact Exercises That Support Pain Management
Rather than giving you an arbitrary list of exercises that may (or may not) work for your client, let’s talk about how to reduce stress and strain while getting your clients moving.
This starts with low-impact activity. It may seem like a given, but low-impact exercises are typically better suited to individuals with chronic pain. High-impact, plyometric activities place greater force on joints and muscles, which can increase pain and inflammation. Low-impact activities do just the opposite. They reduce joint stress while maintaining effectiveness.
Does low-impact always equal low-intensity?
Absolutely not. Low-impact exercise, when done right, can be done with relative ease. It can also make your muscles burn more than a HIIT session. For clients who can walk comfortably, try a brisk walk to improve blood flow. For those who feel better in the water, water aerobics can improve strength, coordination, and endurance while reducing the joint load.
Couple low-impact activity with controlled, intentional movement. Think of flowing movements instead of robotic ones. Create fluid movement patterns that allow clients to work within a comfortable range of motion, without locking or bottoming out at the end points of an exercise.
Tai chi is a great teacher of this. Teach your clients to create a mind-muscle connection that allows them to move within a pain-free zone.
Once they’ve established that connection, help them bring it into the stretching and strengthening parts of their workouts.
Stretching Exercises to Reduce Chronic Pain and Improve Mobility
Do you want to give good advice to someone with chronic pain? Don’t tell them to just stretch more.
When muscles or joints are sore, people automatically assume that stretching is the answer. Often it is, but when it comes to stretching with chronic pain, there’s a fine line between pain relief and pain increase.
Stretching often encourages individuals to push to their joints’ end ranges of motion. While this can certainly increase flexibility, it can sometimes cause pained joints to flare up.
When it comes to stretching with clients experiencing chronic pain, a good warm-up is paramount. When someone experiences chronic pain, they favor the painful area, causing it or nearby areas to become tight and tense. These tight muscles, along with conditions like arthritis and other similar conditions, may require a longer warm-up time before stretching.
Once muscles are warm, begin with gentle stretches and dynamic mobility work before jumping into deep stretches.
Get the lower body moving with dynamic stretches such as:
- Marching for the quads and hip flexors
- Side steps for the hips and glutes
- Step-ups and step-downs for quads, hamstrings, hips, glutes, and calves
- Open and close the gates for hip mobility
The above exercises should be done pain-free before continuing additional reps. These exercises target tight muscles while increasing blood flow and improving mobility.
Move into postural work to mobilize the upper body and reduce strain and tightness through:
- Wall angels
- Wall cobra
- Shoulder pendulums
- Scapular retractions
Before creating a program or trying an exercise, ensure that your client does not have any existing injuries that could be complicated by exercise.
When stretching, we often focus on the limbs and forget our torso, which connects them all. Improve your clients’ spinal mobility by doing:
- Sitting or standing spinal twists
- Spinal flexion
- Spinal extension
These exercises should be done gently and within a comfortable range of motion, especially by those susceptible to spinal injury and those with low back pain.
Strengthening Exercises to Build Muscle and Support Stability
Strength is a way out of pain for many people, or at least to a reduction in pain. Strengthening muscles surrounding sensitive, painful, or arthritic joints is especially beneficial. When these muscles are strong, it provides support and stability to the joint, which can help relieve painful joints.
Start with exercises that strengthen and engage the core. These provide spinal support and encourage core engagement during other exercises. Core engagement has been shown to aid in injury prevention and should include “muscle activation, neuromuscular control, static stabilization, and dynamic stability.”
This advice is directed at core work, but can be applied across all muscle groups.
A simple progression of this may look like:
- Muscle activation – Gentle abdominal drawing-in maneuver coupled with diaphragmatic breathing
- Neuromuscular control – A single-leg stand to focus on the mind-muscle connection
- Static stabilization – An inclined plank or wall sit
- Dynamic stability – A bird dog or dead bug
For clients with chronic pain, muscle activation helps them focus on engaging the correct muscles, which may be tight or unused due to pain.
Once they feel comfortable engaging the appropriate muscles, work on creating the mind-muscle connection. This can help clients make the differentiation between the pain of their condition and the natural work that comes from exercise.
Static stabilization exercises can help clients engage muscles without bending or overusing inflamed joints. Once they’re ready, introduce dynamic exercises to increase strength and mobility.
As appropriate, offer controlled resistance through resistance bands, body weight, or suspension trainers. These offer gentle progressions and may be more appropriate for those who find machines or free weights to be uncomfortable or painful.
Breathing Techniques and Nervous System Regulation
Never underestimate the power of breath. A technique far undertaught and underutilized in pain management is breath control.
Breathing influences pain signals, nervous system regulation, and stress response.
Longer inhalations can bring added oxygen and energy to the body to help it warm.
Breath retention at the top or bottom end of the breath can help increase focus (Be aware that breath retention should not be practiced by those with unregulated high blood pressure or certain other health conditions).
Longer exhalations can help calm and cool the body.
You can teach your clients to practice controlled breathing as a solo exercise and in combination with other movements.
Deep breathing helps provide oxygen to the muscles and can help them release tension that can add to their pain.
Start by helping your clients become aware of their breath. Once they are more aware of their breath and how it feels, they can begin to control it using diaphragmatic breathing or other deep breathing techniques.
Other useful breath patterns include box breathing and 4-7-8 breathing.
Each of these methods of breath control has different use cases, but they can all be used to help a client focus, reset, and control pain.
Safe Programming Strategies for Clients Managing Chronic Pain
It can seem overwhelming at first to create an exercise program that reduces pain while increasing strength, mobility, and well-being for someone who is already in pain.
Use the following five recommendations to create safe exercise programs for clients managing chronic pain:
- Control both progression and intensity in each individual session. A client’s pain levels change day to day and may vary widely within a single day. Have options for progressions, regressions, and modifications available in all sessions. Provide options for various intensities as well.
Be mindful of the effects that exercise has on your clients. If they are having a good day, they may be able to push harder. However, pushing too hard on good days can trigger increased pain in the following days. Help your clients notice the aftereffects of their exercise so that sessions can challenge them without having adverse effects later on. - Reduce the stress on your client’s joints by avoiding high-impact workouts and heavy weights. This is especially true for those who have joint-related pain. For cardio sessions, seek out machines or activities that support your client’s aerobic activity and endurance without putting undue stress on their joints.
- Help your clients maintain proper body positions throughout each exercise. Look for signs of fatigue and a loss of form, ending the exercise before they lose proper form. This will decrease their risk of injury.
- Monitor your clients’ pain response and adjust your programming based on their feedback. Find out about the pain levels before starting exercise. Check in frequently throughout their workout to ensure that exercises are done with only mild discomfort. Reevaluate post-session and reach out again a day or two to follow up.
- Don’t be afraid to coordinate with a healthcare provider when needed. As trainers, we tend to get in the mindset that we are responsible for our clients’ entire well-being, when we are really only a small part of it. Obtaining consent and then connecting with a client’s doctor or physical therapist can help you see how to best help your client while working within your scope of practice.
Professional Responsibility and Real-World Risk
The last thing any of us wants is for a client to get injured during a session or as a result of one of our training programs. Chronic pain introduces another variable to this equation.
During your first visit with a client who experiences chronic pain, learn about their pain and how they interpret it. If you can, help them differentiate between the discomfort of exercise and the pain of their condition(s).
Many people, especially those who are just beginning to exercise or coming back after time away, may not immediately be able to tell the difference. Try starting with exercises that cause little to no discomfort.
It may not seem beneficial to start with exercises that don’t cause any perceived effort or discomfort, but it’s actually quite the opposite. If your client associates exercise with pain, which is common if they’ve done physical therapy or have overexerted themselves, they may shy away from movement. By helping them find movement that doesn’t hurt or is at least tolerable, it can decrease exercise anxiety and improve adherence.
There will always be a risk of increased pain during or after sessions, but that risk increases when your exercise program resembles clinical treatment. Remember that it’s not your job to diagnose, prescribe, or treat as a medical professional would. Likewise, pushing a client’s end ranges of abilities, similar to a physical therapist, is also often out of our scope of practice.
Instead of treating their pain, address and support it by selecting exercises, variations, and supervision that help your clients manage chronic pain, improve their ability to perform daily activities, and prevent future injuries.
Why Liability Insurance Matters When Working With Chronic Pain Clients
Chronic pain exercises for clients support movement and daily function. They also require structured programming and professional awareness. Chronic pain varies from session to session, increasing unpredictability for you and your clients. What feels okay one day may not be feasible the next. This can make it difficult to keep exercise programs the exact same each time, making flexibility on your part necessary.
Claims often involve common training activities like stretches or strengthening exercises and can occur even if you’re doing all you can to work within your client’s abilities.
When working with clients experiencing chronic pain, having an insurance policy designed for personal trainers is part of responsible practice. Look for a policy that supports coverage for instruction and supervision. Choose coverage that protects you whether you’re training clients at a gym, their homes, or online. A comprehensive insurance policy includes professional liability and general liability to protect you and your business if a client experiences an injury or more pain under your care.
When guiding chronic pain exercises for clients, responsibility extends beyond programming. Insurance policy coverage supports trainers when outcomes are unpredictable.
Get covered with an insurance policy designed for fitness professionals through Insure Fitness Group.
