Pain and gain:

Pushing your clients to the limit safely and responsibly - Part 1

How, asks PT and performance coach Susy Natal, do we balance our duty of care to clients with our responsibility to help them achieve their goals?


KEY POINTS
  • Pain is one of the body’s signals, and in training it can mean many different things
  • It is your responsibility as the trainer to keep your client safe – you also need to observe and collect information when there is pain present to decide how to manage the situation
  • Stay calm but be detailed with your line of questioning: the intensity, quality and localisation of the pain can all help ascertain what is going on internally for the client
  • If you are unsure about what has happened, refer on to a physiotherapist or allied health professional
  • Provide some guidelines to your clients to help them decide when pain has progressed beyond what is normal for training and is indicating that they should pull back.

Pain – vital, yet so often interfering with the progress of our clients.

Pain is one of the most primal signals that our body sends to alert us that something is happening, and its discomfort prompts us to take the action necessary to make it stop. In most scenarios this is adaptive, as the pain is signalling the presence of harm and the risk of further injury. In training, although this can also be the case, it is often not, which can make it challenging to push clients that are either highly risk averse or have a very low tolerance of pain.


No pain…

Then there are the clients at the other end of the spectrum who subscribe to the old-school saying of ‘no pain, no gain’ – a mantra that can get people into trouble if taken too literally, as not all pain is sending the same signal and so cannot be addressed with the same approach. As personal trainers we have a duty of care to ensure the safety of our clients, but we are also being hired to facilitate results, so this is a grey area that requires constant attention when dealing with the clients that have a tendency to push beyond what is sustainable and safe.


Identifying the pain

If your client reports that they are experiencing pain, your immediate priority should be to obtain as much information as possible about it. If the client mentions it while in the middle of an exercise, you should make them pause and explain – if it is safe for them to do so. If it is not safe, or if they cannot easily describe it in a sentence or so, make the client stop performing the exercise first and then begin a line of questioning. If they appear to be in distress or significant amounts of pain, you should make them stop exercising immediately and, where possible, assist them in terminating to ensure that they do not cause further injury.


Keep calm (but don’t necessarily carry on)

When you question your client, it is important to keep yourself together. In the event that a client has a potentially serious injury, your calm manner will assist them and prevent them from becoming further distressed. In the more common but less immediately serious scenarios, it can be helpful to remain composed because some clients may become hesitant to tell you that they are experiencing pain if they suspect that they will be met with an extreme reaction. Many people do not like to have attention drawn to themselves in the gym, so you need to be sensitive to this if you want your clients to trust you to be able to handle these situations well and therefore feel that they can be open with you.


Reluctant pain admissions

There are also clients that may hesitate to tell you that they are experiencing pain if they suspect that you will overreact by disallowing certain movements or otherwise being overly protective and holding them back from reaching their goals. As a trainer your focus should be entirely on your client, so ensure that you monitor not only the execution of each movement but also their reaction to the execution: if their facial expression or physical reaction to an element of an exercise suggests that they are in discomfort, ask them about it, while reassuring them that it doesn’t necessarily mean stopping exercising. Because of its diverse nature, the occurrence of pain does not automatically signify the cessation of the training session or that a movement needs to be removed from the client’s exercise program. In training, the pain experienced by clients can range from the beneficial type that’s getting results, right through to serious danger, so you need to ensure that you gather the relevant information before making any decisions about how to manage the situation.


Pain vs burn: knowing the difference

Make sure that your client knows how to tell the difference between the normal muscular burn and ache that occurs whenever an exercise becomes difficult and other types of pain. This may sound obvious, but to a complete beginner it may be new territory as they might never have experienced the sensation of ‘good’ pain.

It is also important that you pay attention to the client’s history of self-report. If they have a tendency to complain at the slightest onset of discomfort, then a minor complaint would be taken on in a very different way than if you were being told the same thing by a client who generally does not make any comments about the efforts of exercise.


Location and sensation

There are several important pieces of information that can help you figure out what may be going on for the client.

First, you need to find out where they are experiencing the pain, and whether it is localised within the one spot or whether it is radiating anywhere else in the body.

Second, the intensity of the pain should be assessed, and this is where ranking scales can come in handy. For example, if a 10 means they are about to pass out from pain and 1 is pain that they can only just detect, ask them to rate the level of pain experienced at the time.

Third, be clear – especially with exercise newbies – with what you are asking regarding the quality of the pain. Avoid terms such as ‘sharp’ or ‘dull’, as these can be mistaken with intensity in some cases; instead you could ask if it feels like a stabbing or a burning sensation.

Fourth, find out whether the pain is constant, pulsating, or only experienced through certain movements or positions. This, together with the behaviour of your client, can help you understand what they are experiencing and therefore help piece together what may be going on internally. A calm comment about something not feeling quite right is less serious than if your client becomes unable to touch or put weight on a certain body part, which in turn is less serious than if your client looks pale or presents with other signs or symptoms of very high levels of pain. Observe, collect information and remember that you are not always going to have all of the answers.


Know when to refer

There will be scenarios in which you are simply unable to figure out what is going on and will need the assistance of an allied health professional to resolve the situation. As personal trainers we are required by law to remain within our scope of practice and there are serious consequences for failing to do so. Your client’s safety is paramount and unless you are absolutely certain that the situation is resolved through a change that falls within your scope of practice, such as a form correction to stop a joint from hurting, and there is no underlying injury or issue that requires further assistance, then it is your responsibility to refer the client to somebody who is able to assist further, such as a physiotherapist.


Simple pain rules for clients

For all clients, but in particular those who like to push very hard, those who have a high pain tolerance and those who may be uncertain how hard they are supposed to push, it can be helpful to provide a few guidelines about what is considered safe to work through and what to avoid in their own training.

There will always be exceptions, and accidents do happen, but in order to keep clients training as safely as possible, especially during their own training when you are not with them, it helps to have some rules. Generally, movement that causes a 'stabbing' pain or pain that is clearly not muscular should be branded as off limits. Pain above a 5 on the scale mentioned above should also be discouraged for general population clients, as above a certain threshold they may struggle to pay attention to their form, which can lead to more serious injury. When you set these guidelines, remind clients to let you know if they ever do experience these undesirable types of pain, so that you can investigate together what might have occurred when they experienced it, check whether it was a one-off occurrence or whether there are ongoing symptoms, and figure out how to resolve it.

Your goal as a trainer should always be to assist your clients to work hard and smart, to enjoy their training sessions while always remaining safe. Having a solid system to manage situations when pain is experienced, both in your presence and your absence, will help you achieve this.


Susy Natal is a Sydney-based performance coach, widely published wellness writer, convention presenter and personal trainer. With a background in psychology, her integrated approach to training helps clients achieve strength of body and mind. With a major focus on strength training for females and on mindset coaching, Susy works with clients ranging from beginners through to athletes. Visit susynatal.com and follow her on Instagram HERE.