I have been training people with chronic pain syndromes for many years now and it has been an incredibly rewarding, frustrating, enlightening, guilt-ridden gratifying period of my career.
As a Personal Trainer I believe you should be able to train people in chronic pain (assuming both you and your client is cleared for training.)
This article talks about how and also goes into what to do if you are yourself suffering with chronic pain.
(of an illness) persisting for a long time or constantly recurring.
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.
It can be very hard to put yourself in the shoes of someone in chronic pain unless you are in it yourself.
People in chronic pain can come across as "soft, lazy and hard work" but often nothing is further from the truth.
Unfortunately, people in chronic pain often feel like a burden and can read people like a book and can see when others get impatient or start thinking that they are putting it on or somehow choosing to be in pain all the time.
Sometimes this person being impatient can be a trainer. Sometimes this trainer can put someone off training for life by treating them with a lack of empathy.
If you are a trainer reading this article then it is my aim to show you how not to be that guy.
Training People With Chronic Pain
Here is the infographic I think of when planning someone's session who is in chronic pain:
The most important thing for both you and your client to remember is that training people in chronic pain takes lots of patience.
You will get things wrong and occasionally aggravate their symptoms. This has to be understood by both sides and must all be cleared by medical professionals before proceeding.
You may have clients who are in so much pain that they feel dizzy or sick when simply standing some days and then other days they will be completely fine during the session.
It is not as simple as going by how they look and sound because people in chronic pain will mostly try to mask it and put their best foot forward, often resulting in them running out of energy very quickly due to the effort of the pretense.
The problem with pain is that it isn't always visible. It's very easy to assume how someone is just by talking to them. Be sure to ask about their pain levels in a subtle way and then plan your sessions or programmes accordingly.
The key to training people with chronic pain syndromes in giving them options as it is incredibly easy for them to be overwhelmed especially on the days that pain is highest.
Many in chronic pain think that training is impossible or that they shouldn't train if any pain is present so never train at all.
You as a trainer can help them change that.
The above graphic gives both you and your client a guide to work through.
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 tried 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 in order to create a battle plan to allow someone to train on the days that 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 also has a huge impact on someone's energy levels which is why I decided to add another tier to my graphic to deal with the fact that while someone might be suffering from low pain levels but also incredibly low energy levels for whatever reason and vice versa.
This gives you and your client another series of options to be able to deal with the day-to-day struggle with pain and recovery.
We always want our chronic pain clients to feel like they can do something. 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 strongwoman style exercises.
Each case is individual and you must build up the categories steadily and be prepared to switch them up at any time particularly if they have a quite unpredictable condition to meet the needs of the client.
Putting It All Together
Below is a screenshot of a programme I assigned to one of my chronic pain suffering clients.
I've worked with her for many years and know her very well. I mess up sometimes and she ends up in more pain but gives me amazing feedback so over the years we've been able to come up with exercises to do on the different days.
We'll change this up every few weeks and see how it progresses!
She is able to choose between the programmes and is able to take ownership of her pain and decide what she is capable of that day.
This is big.
Imagine feeling as if exercise was something beyond your reach and 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 that even getting to the gym might be a herculean feat for someone in chronic pain so don't expect miracles every session.
Adapt as you go. Change plans when you need to and most importantly appreciate the efforts of your clients who could well be giving absolutely everything in order to see you.
Not many will go to the trouble of appreciating their efforts so make sure you are the person to do so.
Not only will this go along way to getting a client for life but it will make that person's day and take some of the edge off the ridiculous amount of pain they are in all the time and bring a smile on the darkest of days.
Training Around Chronic Pain Yourself
I would strongly recommend you work through my graphic on training 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 also 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.
Do this on days where you are in little pain and see how you feel on days where pain is a little higher and see how you respond.
Gauge how you find it and when you are confident with the movement you can add a second exercise and see how you find it.
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.
Just know that you have options and you can train around the pain in most cases.
Also know that you are not alone.
There are people out there like you and also people out there (and lots of them) 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
Chris is a Personal Trainer, Strength Coach, Writer and man of small stature and reader of The Discworld Series with a decade in the industry. He trains everyone from beginners to high level athletes. His favourite clients are people getting into the gym for the first time because they can make the biggest changes in their life.
You can reach me through the email address Chris@kershawstrength.com
My Instagram is Chris_Kershaw_Strength.
Thank you for reading!