How to Build Muscle Even With Chronic Pain or Injuries

Train Around Chronic Pain & Still Build Muscle

Written by Marco Walker-Ng on January 1, 2017

I will be the first to tell you that chronic pain can really take away from exercise. It’s a huge reason a lot of people do not enjoy activities as much as they could.

Over the years training clients and conversing with fellow gym folk, I’ve noticed a trend in fitness and in sports where a lot of people just push past chronic pain to reach their goals. They’ve accepted it as their norm. While I do respect someone’s ability to get the job done regardless of their pain, I still believe that you can modify your training program to reach your goal and decrease pain.

I do not claim to be a pain specialist whatsoever, and I still refer people to see a physiotherapist if it is a serious injury. However, it’s rare to meet a client who doesn’t have at least one thing bugging them. You learn to tweak things, work around injuries, or even fix them. It’s amazing what well progressed exercise can do.

Not everything requires a doctor visit, pain killers or bed rest. In fact, I believe staying active in a healthy way while recovering from an injury is one of the best ways to recover more quickly.

In this article, I’m going to go over my process of working around chronic joint pain with my clients.

Assessments

When I am assessing clients, I’m looking at how naturally they move. What are their sticking points, how have their muscles developed, how well do they transfer their weight from foot to foot? Usually, you can tell if something hurts because they avoid certain ranges or grimace while doing certain things.

I ask them to tell me, but sometimes it’s hard for people to admit their limitations.

Don’t be shy.

“What makes you vulnerable makes you beautiful.” – Dr Brene Brown.

“But still, let’s make sure you’re a little less vulnerable next week.” – Marco

Find out what hurts and what things make it hurt. This will be your progress marker when trying the strategies below.

Since I’m in the business of bulking people up, not fixing injuries, my first goal is to find ways for them to build muscle in a pain-free way. I will now go over the step-by-step process I use to do that.

The Method

My method is nothing new. Since I’m looking for fast relief, I’m thinking what can I do right now that can allow this person to get the job done. We’ll go over some longer-term solutions at the end of this post, but let’s start with the stuff that can have an immediate effect.

We’ll use the example of coaching someone with knee pain through a squat.

Reginald is doing his first set of bodyweight squats for his assessment. He is leaning too far forward and is only going about halfway down. He tells me his knee hurts too much to go any lower. At this point, I look for the limiting factor, and maybe in this case I notice that his hips are tilted forward and his calves are stiff. I now suspect he is having trouble getting lower in his squat because his tilted hips are causing unwanted tension in certain areas, like his calves. This is making his squat feel awkward and painful.

Intervention 1—The 90/90 Hip Lift

This is an exercise that uses the hamstring muscles to restore a more favourable ‘mobile’ position to his hips. This exercise is used to balance out the tension so that it’s not all in just one spot.

Re-Test. Reginald will then do another set of bodyweight squats and see how it feels. Most times he’ll squat a little lower and it will look a bit smoother.

Intervention 2—Modify His Lifts

This intervention involves either modifying his lifts or teaching him how to do the lift with more favourable biomechanics. The first cue I might try is to relax more and “melt” into the squat. The next thing I’ll do is give him a weight to hold out in front while he squats (a goblet squat), helping him stay more upright.

Re-Test. After this, we probably have a significant improvement in Reggie’s bodyweight squat, both in terms of range of motion and technique. It might not be perfect, but it’s more perfect. It’s important to understand everyone is starting from a different spot. Not everyone will have an athletic squat right away.

Build Some Muscle

During his workout I will have him do a goblet squat variation to whatever depth is comfortable, focusing on breathing naturally through his sets. I will pair his squats with a reaching exercise, like a push-up. I’ll add an extra reach at the end of the push-up to further get his center of gravity back. During his rest time, I will sometimes have him do a 90/90 hip if it worked well before.

Then we’ll fill in the rest of his workout with lifts designed to build muscle and strengthen his body overall. After all, having forward-tilted hips and an awkward squat doesn’t mean that Reggie can’t curl his heart out.

How does this apply to chronic pain?

Speaking from a strength and conditioning coach’s perspective, if you have too much tension in the wrong places, over time something is going to wear down. The breakdown tends to be in trouble spots, like the knees, back, elbows, and shoulders. So this approach is designed to balance out tension and create the feeling of a bit more joint space. The movement should start to feel easier and more natural, instead of like it’s grinding up your joints.

You might have to drop the weight a bit to experiment with this. Not a problem, I’ll mention a few ways of tweaking your program to account for this. And you can lift a little more weight in simpler exercises to make up for the lighter weight you’re using with the technical ones. Sometimes, you may only need to do a few warm up sets until it’s feeling a lot smoother then it holds as you up the weight.

Other Factors

Sometimes you have great mobility and fluid movement but your joints ache anyway. In that case, it could be that you’re simply training outside of your recovery abilities. It could be that you fatigue too quickly. Get a look at how much volume you’re doing, and if you’re balancing out the proper amount of rest necessary.

One strategy to reduce the wear and tear you’re putting on your body while still building a maximal amount of muscle might be to switch to higher rep ranges.

Dr. Brad Schoenfeld recently conducted a study where he had one group of participants start up a strength training program, the other start up a bodybuilding program. They each lifted with the same volume, and the programs even produced the same amount of muscle growth, but the guys who took a bodybuilding approach wound up with far fewer injuries, fewer aches and pains, and less general weariness (study).

In the Bony to Beastly Program, we take this into consideration by using a strategic blend of rep ranges, but even our fairly conservative blend of strength training and bodybuilding might be too much for some.

Application To Your Training

Let’s review a couple concepts that can affect joint pain:

  • Posture
  • Coordination
  • Fatigue and Training Load

Now let’s apply it to a guy who is doing 5×5-style training who is dealing with knee and elbow pain on his pulling movements.

His Program:

  1. 5×5 Back Squat
  2. 5×5 Barbell Row
  3. 5×5 Bench Press

His Improved Program:

  1. 5×12 Goblet Squat + 5×5 relaxed breaths of 90/90 Hip Lift
  2. 5×12 Neutral Grip Lat Pulldowns
  3. 5×5 Bench Press
  4. 2×12 Dumbbell Biceps Curls, Triceps Extensions and Shoulder Raises

Explanation:

We’ve made the squat more knee-friendly by switching to a different variation and increasing the rep range. He will still build just as much muscle, too. We’ll work our way back up to the full back squat eventually, but while there’s still chronic pain, there’s no need to rush the process.

The 90/90 hip lift repositions the pelvis and ribs in-between sets so that each set is done with better form, more range of motion, and more balanced muscle activation. This ingrains a better movement pattern and starts to fix the problem in the longer term. Since the 90/90 hip lift also has an impact on shoulder positioning, he’ll be working towards better elbow movement as well.

We’ve switched the barbell row for the lat pulldown to allow for less weight pulling on the elbow joint while he’s regaining strength. Switching to a neutral grip also reduces strain on his elbow joints.

To make things even better, cueing “smoothness” helps to take away unnecessary tension from the exercise. Since he is working with lighter weights that before, he’s more likely to breathe through the lifts instead of holding his breath and trying to force things.

The third exercise, the bench press, was left alone because it wasn’t causing any issues.

Then because the client is after muscle growth, we’ve added in some extra exercises that are easy to recover from, won’t stress the areas he’s struggling with and will make sure that he’s fully stimulating the areas he’s trying to grow.

Real Life Example

Context: Charles’ first session, complains of a stiff aching back often.

We begin the warm up with a 90/90 hip lift followed by some toe touches. During this time, I’m not cueing him, I’m just letting the hip lift shut off his back. As he feels his back loosen up more, we begin doing more mobility drills periodically interrupted by more 90/90 hip lifts. Since we were doing goblet squats that day, he won’t leave the warm up until his squat feels free. That way when we start the workout he’s not worrying about a tight back, he’s enjoying the release that comes with physical exertion. After the workout his back felt much looser. His homework is to do his hip lift daily and try to be a bit more active as he still gets a stiff back when he sits for long periods of time.

Conclusion

  • Before overhauling the program, try adding in the 90/90 hip lift to your warm up and work your way up to your weight with some smoother, more natural lifting. Think less, and work within your ROM that is comfortable even if your technique is not perfect.
  • If you still have pain, consider modifying the rep scheme, going for higher reps and lighter weight. Or just spend a bit more time with the 90/90 Hip lift and regressed versions of the exercise.
  • Take an inventory of your training volume and your recovery and see if they match up.

I’ve had clients whose pain actually got worse from giving them too many cues since it made them too stiff. I’ve since learned to work more with what people already have instead of trying to make them perfect on day one.

By adding repositioning exercises and aiming for natural movement, you may not have perfect technique on day one, but you’ll get your workout done, build muscle, have fun… and then before you know it, your technique might actually look pretty dang sweet too.

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So, what'd you think? 9 responses below.

Adil

Greetings.
Nice article Marco, it came out for the rescue just in time when I was feeling like giving up. There was a need for someone to give tips for building muscle without chronic pain.

I have Upper and Lower Cross Syndrome with its Anterior Pelvic Tilt component being more of a problem.
I especially have a tight left psoas muscle that won’t get lax for long term despite the fact that I have been doing exercises to fix it for about a year:

– BRETZEL and bretzel 2.0

– REVERSE CRUNCHES

– Doing GOBLET SQUATS regularly (3 times a week, nowadays with a 20 kg dumbbell , trying my best to maintain neutral spine and stimulating abs while standing up from each squat (contracting glutes at the end of the rep) .

– occasionally doing FRONT PLANKS while maintaining neutral spine, contracting glutes and abs

At times it feels like it has been fixed: on such wonderful days I wake up full of energy and my abs are on, I stand tall and feel flexible and strong. It’s a joy getting up and downstairs.
But then as the day passes or the next day I wake up with a stiff left lumbar side, abs weak and mood off.
It’s at times depressing to look at my side view in the mirror, 10kgs of muscle gained in a year but seeing the same pot belly and hyperlordosis appearing when I stop flexing. The same ugly look like it was a year back.
On certain workouts when I’m goblet squatting I feel my abs working more than on other days when it’s a struggle to make them work . I think it’s because of APT as well.

APT is very common among people. I see it very often. It strikes out because of its ugliness. And it’s a very tricky and hardy problem to isolate, grasp and fix and it takes a lot of effort in doing stretch exercises to fix it.
Fixing the pot belly was the google search I had made a year back that made me discover bonytobeastly.com.
You guys did a great job in writing about it in FAQs but it would be even awesomer if you wrote a detailed article about it too.

I hope Shane the ectobeast is reading this too. That obsessive and clever nerd …

Regards
Adil

Marco

Hey Adil! Thank you so much for taking the time to reply. Here are my thoughts on some things you can try. Reply back to let me know how it’s going.

1. Start doing the 90/90 hip lift daily and possibly within your workouts – since usually it makes the exercise you are doing easier and more natural to do.
2. For the next two weeks ignore all the cues you’ve taught yourself to do and forget what your exercise should look like – your only markers of success will be if the exercise feels good and if it is pain free.
3. You can continue doing the exercises you were previously doing, but try to relax through them more. And if you are doing the Bretzel, stay away from end range.

I know this is a tall order, but I would like you to give this a shot and we’ll tinker from there!

All the best,

Marco

Krsiak Daniel

Hi Marco,

thank you for this article.

Long time I struggle with the lower back issue and pelvis position. I always did physio rehab and not working out OR simply just working out. Only once I did some combination of both at the same time and it helped so much.

I will have to read this once more for sure and ask you on forum for some more details 🙂

Adil

No Marco, thank YOU for replying and helping me out.
So you basically are telling me to take it easy and not get ‘too cerebral’ while working out. Despite becoming too conscious about my posture and following these cues even while standing, walking or climbing I haven’t seen much improvement.

I’ll be obedient and let you know how it turns out after a couple of weeks.

Jane

I have a pain around my shoulder for a really long time, and I think it was injured by lifting in wrong form. I’ve been sitting around but it still doesn’t heal. What’s the best way to fix the problem? Should I go see an athletic trainer?

Please respond!

Marco

What do you mean by sitting around? Have you been completely inactive? I would definitely recommend seeing an athletic trainer or someone of similar profession to get a more specific look at it.

Something you can do right away to improve the situation is just doing any activity that does not cause any pain. Even something like brisk walking or hiking can be good for healing injuries.

The 90/90 hip lift exercise, done consistently over time is also great for improving the body’s alignment.

These are very general recommendations, as working to improve alignment and doing exercise that feels good can be useful in making you feel better. And progressive movement is good for injuries. However, I would still go see someone to get a closer look.

Jane

Thank you. I am still a student in high school and by sitting around I mean not doing any exercise that causes the shoulder pain. (I still do soccer,track, etc)

I asked my athletic trainer about it a few months ago and she said I should rest and see if it gets better. But when I try to do any upper body workout with light weights the pain comes back. Maybe it’s just something(growth pain?) I need to work pass fix.

Anyways, thank again! I am skinny person and I really want to be more athletic&muscular before graduation.

Marco

Haha, when you said sitting around I pictured literally you just sitting around doing nothing.
I would try to see a professional about it if you can.
In my experience as a personal trainer, if it’s always causing you pain, even during lightweight exercises, it could be either a technical issue, a fatigue issue, or an alignment issue.

Based on what you’ve described, pain lasting a while and not getting better even with rest, it sounds more like your body is just not moving the shoulder properly.

Was it a big injury that hurt it? Or did it just start hurting.
Let me know if you have more questions! Especially about muscle building… that’s our specialty :).

Name

I went through my brain again. The pain started around May 2016. It started when I was doing barbell chest press, but I ignored it for like 2 weeks. Then the pain got really strong so I stopped. I am pretty sure that I had a bad chest press posture, plus I was pushing myself too hard.

Ahh! Wish I checked in with my doctor last year. Now I have tons of works to do.(high school sucks) I will check out you guys soon, and thanks for the tips.

GAINZZ!

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