Pain Science and Fitness Training –How We use Language and Coaching to Help Personal Training Clients Move Past Pain and into Fitness

At Catalyst, we have a unique expertise in working with clients who have had injuries or are currently in the process of rehabbing injuries, both in our Personal Training and our Semi-Private Training programs. Why are we so successful in this arena?

One element is of course technical expertise and experience—our coaches are knowledgeable in the anatomy, physiology and biomechanics of movement, and can coach and teach exercises uncommonly well. We’re smart about programming, exercise selection, and load management.

But beyond that, we’re also extremely deliberate in what we say (and don’t say!) to clients, and how we coach clients who have had injuries. This article will go over some of the non-technical methods we use, and hopefully provide some food for thought for personal trainers and fitness coaches, and for previously injured persons looking to regain fitness.

One caveat: We never, ever, ever, offer fitness solutions to medical problems. This is one of the biggest problems in the fitness industry today— “Oh your back hurts? Let me show you some core exercises” for example. Pain is a medical issue and needs the qualified care of a medical professional.  As we’ll discuss further, fitness can be tremendously valuable in helping clients move past injury, but if someone is in pain, fitness in no way replaces medical treatment from a doctor, chiropractor, physical therapist, or other medical professional.

With that in mind, here are some things we strive for in our fitness department:

  1. We build trust in order to remove doubt—Doubt and second-guessing are a natural response after injury. If you’ve been hurt, you’ll naturally try to avoid activities that could cause pain again. However, being constantly unsure of what to do is not helpful either. Sometimes, I meet clients who have jumped around from program to program, abandoning each without giving them time to work. Ultimately, we need the client to mentally “buy in” and commit to the process. This involves trust.

    We build trust in a few ways. First, we LISTEN to our clients before we devise a plan. Practitioners who want to jump into action before fully understanding the client are doing their client a disservice. On top of that, the feeling of being understood is critical to the client’s success.

    Next, we devise a plan, and COLLABORATE with the client. We don’t have some clipboard with all the answers that the client never sees. We typically write 4 to 6 week exercise programs, and give the entire program to the client, so that they can understand the process and be a part of it.

    In addition to collaborating with the client, we also collaborate with the client’s medical professionals. We’ll talk to their physical therapist, chiropractor, acupuncturist, or doctor, whether that professional practices at Catalyst or elsewhere is irrelevant. The entire care team, both medical and fitness, should be aligned in their plan of action. Few things are more harmful a client’s mindset than to have a physical therapist telling them one thing, while the personal trainer does the opposite. Yet too often, these professionals fail to communicate with each other.

    By doing these things, we’re able to get people to commit to our progress and see results. Our members frequently tell us “I can’t believe how liberating it is to not have to second-guess myself. You guys handle the programming and coaching, and I just need to put in the work to see results”

  2. The “nocebo” effect - We are careful in the way we discuss pain, and are careful not to dwell on injury. Most people know about the concept of placebo – an inert stimulus causes a BENEFICIAL response, typically because the patient believes the stimulus to be effective rather than inert. The “nocebo effect” is the opposite –an inert stimulus causes a HARMFUL physiological effect.

    For example, if I’m working with a client who successfully rehabbed a shoulder impingement in physical therapy, and we’re performing a landmine press (exercise involving the shoulder), and I ask “Does that hurt your shoulder?” there is a real danger that the client may experience pain as a result of being asked to search his body for pain. The subconscious mind does very poorly with negatives. The act of asking someone to search their body for the “absence of pain” can often produce pain. A better question might be “How do you feel when you do that exercise”—I’m giving him the chance to express concerns, if there are any, without creating a subconscious negative bias (Nocebo effect).

    It’s a fine line—we need to be aware of what’s going on with our clients, and if they’re having trouble it’s important we address it, but at the same time it’s critical that we not use language that could suggest a problem or cause the client to start doubting.

Pain can be psychological just as much as it can be physiological and using language which encourages our clients to dwell on injury, expect injury, or identify with injury, can frequently exacerbate symptoms or elongate recovery time. We want to conceptualize pain as a temporary occurrence caused by a fixable problem, not a permanent alteration to one’s body.

  1. We ask our clients to document their progress—one of the most frustrating parts of rehabilitating an injury can be feeling like you’re stuck spinning your wheels. However, clients often fail to recognize their progress when their only lens is subjective—small gains go unnoticed, especially when one’s fitness level is still below what it was prior to the injury. As a result, clients can feel like their pain issue is permanent, and this belief can be self-fulfilling.

    The easiest way to solve this is by having our clients document their progress. If someone says to me “I don’t feel like I’m getting better” I can point them right to their program sheet and say “Well 4 weeks ago when you started you were only able to do a kettlebell deadlift with 10kg and had a lot of difficulty with form, and today you did one with 14kg and kept your spine in a perfect position” for example. This is small progress, to be sure, but progress nonetheless. These tangible examples of progress “soften” the mind and help convince the brain that the injury is not a permanent problem.

    By the way – you may have noticed that we have our clients document their own progress, rather than having our coaches fill out a form or journal on behalf of the client. This is intentional – the process of documenting one’s results reinforces the work that was done and helps the client identify and own their results. Moreover, when we see documentation in our own handwriting, it’s more believable and personal.

  2. Our community provides peer examples that you can move past pain—So often, people getting over an injury can feel like they’re on an island. One of the most harmful beliefs to progress is the belief that “my problems are special.” While it’s true that each case and each client is unique, having the belief that your problems are exotic and unusual makes the possibility of a solution remote to your mind.

    One of the best ways to eliminate this negative belief is to see examples of people just like you who have had success rehabilitating injury. Every single day at Catalyst, I see clients who haven’t just learned to live with injury – they’ve gotten past it and are thriving. We have semi-private training members who came to us missing sensation down an entire leg due to back injury, that now squats hundreds of pounds, swings kettlebells, and carries her daughter around the grocery store. Another one of our members came to us in debilitating chronic pain, unable to exercise for months and months—this year he’s gained 20lbs of muscle and just sent me a video of himself doing a 90lb Turkish get-up.

    When you see others having such success, it tells your unconscious brain “you can do that too” and challenges you to find ways to be successful, rather than hold the belief that your injuries are insurmountable. Do not underestimate the power of community.

  3. When a client says “this hurts,” we don’t just drop everything and stop (wait, what???)—This point is very nuanced, but extremely important. As discussed above, we never use fitness solutions for medical problems, and would never ever try to fix someone’s pain with exercise. But “pain” is a very broad term and sensation, or awareness does not always equal pain.

    Sometimes, we must give clients permission to experience new feelings and sensations (this fits in closely with “building trust” above). For example, a few weeks ago I was working with a personal training client who had come to us after having a hip surgery. He had a lot of strength training experience before his injury but has been (rightfully) apprehensive about performing squat movements.

    We decided that Zercher squats would be a good fit for him—the anterior load of the barbell forces abdominal engagement, and the torso angle is relatively forgiving on the closing angle of hip flexion compared to other squat variations.

    After performing his first set, he said that his hip felt “weird.” I probed a little further with some questions, and what we discovered was that his hip stabilizers were weak and tight from lack of use. Along with that, the surgery had altered the architecture of his hip, so he lacked motor control of that hip, and his brain was still figuring out what to make of this new joint. We continued the workout, and he’s making great progress. The point is this: If I had simply panicked as soon as he mentioned his hip and shut down that exercise, I would have denied the client a rich opportunity to get stronger and start regaining function.


Another way that this concept comes up is when someone is using bad form on an exercise and experiencing pain as a result. In this case, it’s totally appropriate to try modifying the exercise. For example, my client is performing a goblet squat and mentions that her knee hurts, but I notice that her knee is collapsing inward as she descends. I might cue or use a quick drill to teach her to properly keep her knee aligned over the middle of the foot as she descends. If this is all it takes to remove pain, than we’ve accomplished quite a lot—we’ve taught the client how to use better movement patterns to keep herself out of pain. It’s a fine line however—if she’s continuing to experience pain, I may need to modify or abandon the exercise and get back in touch with a medical professional.

Pain is a nuanced, multi-factorial experience that can be different for each individual. Medical intervention is necessary to get someone out of pain, but fitness can play a crucial role in helping people to regain their function and their lifestyle, and to help prevent further injury. A great coach won’t just use technical expertise to help their clients, they’ll also use language and coaching to address the psychological obstacles that prevent people from making progress.



    




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