Pain Science: The Role of the Non-Medical Trainer

Start with the definition of pain from the IASP (International Association for the Study of Pain):

"An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."

The line I find most interesting is this: activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain — which is always a psychological state, even though pain most often has a proximate physical cause.

Knowing pain is an experience draws a clear line in the sand between trainer and medical professional. It's refreshing. The years of predicting injury and blaming the foot and posture for everything are gone. What's left is the impact I actually have on a client — which makes language, delivery and the emotions I provoke more important than anything else.

Trainer, not diagnostician

It's sensible, and within our scope, to rely on physiotherapists and doctors to diagnose and guide a client medically. Most medical professionals I've met lean toward a biomedical model — controlling pain through pharmaceuticals and, sometimes, surgery. That leaves the trainer to help the client understand the reasoning and research behind those decisions, while still enjoying their workouts.

Managing a client's experience depends on how the trainer is perceived away from training, and on how respected the client feels by you.

Where words go wrong

This is why a post I saw recently stuck with me. A personal trainer, well regarded as a pain specialist, had written:

"Muscle tightness is not a diagnosis of back pain."

The problem is that pain is a symptom. It's the feeling of pain that leads to exploring a more specific diagnosis. The statement risks telling a client who complains of tightness causing pain that they're wrong — when actually they're right — and that can make them feel their trainer doesn't respect their opinion.

If a client says they have pain because of a perceived tightness in their back, then tightness is at least a component of that pain. And tightness is usually a feeling, not a measure of tissue length — so the sense of tightness could be a precursor to the client perceiving danger and pain. Tightness is uncomfortable to many, but a positive sign to others; stability, strength and power get read from the same sensations.

To dismiss the feeling can leave a client feeling paranoid or unheard. Changing the perception of the emotion that produces the feeling of tightness might be the single best thing a trainer can do.

For balance: I agree that measuring a range of motion, declaring it too short without supporting research, then claiming that leads to pain and injury, is out of order. The industry does need to address the misrepresentation of movement and posture as predictors of pain. But solving one overreach with another just drags the trainer back into the role of alternative therapist.

Deliver movement, design experience

I think our side of the industry exists to deliver movement — choosing the right exercises, intensity, delivery and rest to provoke the right results, with a focus on safety and experience. The side effects of doing that well include the client feeling better, moving better, hurting less, performing better, lowering disease risk, and gaining the less tangible things: self-efficacy, self-worth, belonging.

Managing a client through a range of feelings should be the most significant focus we teach. Those feelings stem from emotions we induce through our stimulus — exercise choice, order, intensity, rest and delivery. Structuring them deliberately is what I call the exercise design experience.

Designing experience is more than stringing exercises together. Framed as a story, a designed experience educates clients and lets them meet everyday life with more positivity. Done well, it helps a client handle both current and future pain. Sometimes the improvement comes simply from enjoying workouts and feeling higher self-esteem.

Build a story, and pain, injury and a lack of ability become a small part of the whole. Lowering the significance of the perceived problem — getting the client to notice what they're good at — moves them from focusing on the challenge to placing it in the bigger picture, which reduces its overall impact. Pain becomes an obstacle to the bigger goal, and it gets treated like one.

In summary

• Learn biomechanics so you can design movements accurately — know every bone, joint and muscle, and how you predict it will move.
• Understand how to develop motor skills, perfect performance, load and recover appropriately, and how injuries change movement.
• Use great research from great sources, and balance it — don't just cherry-pick papers that confirm your bias. Challenge your position every chance you get.
• Discuss it with like-minded trainers and keep growing together.
• Make sure your business and social media reflect all of this, so the message stays clear.

I wrote this as an opinion piece built on years of research and mistakes. Don't take it as a call to authority — take it as a challenge. Research both sides of every argument, question my views and your own. And if you can't yet do the things above, take a course and get good at being the best trainer you can be.