Live LOUD Life PodcastLafayette Colorado

Episode 59

Should You Exercise If You Have Pain?

Physical exercise has many benefits, but sometimes you experience pain as a result. Should you then stop training? Is it possible to prevent pain in the first place? In Episode 59 of the Live Loud Life podcast, Dr. Antonio answers these questions and more to help you exercise with confidence.


Episode Highlights

  • Understanding what pain means
  • Pain and the perception of pain
  • Different ways in which chronic pain presents
  • Should you rest and heal or keep training?
  • Pain can be a guide rail
  • What you should know about training in the presence of pain
  • Why you should audit mobility and strength capabilities
  • How Live Loud Chiropractic and Coaching can help

About Dr. Antonio Gurule DC



  • Father
  • Doctor of Chiropractic
  • Owner of Live LOUD
  • Personal Trainer & Health Coach

Our Mission

What’s up, guys! Welcome back to another episode of the Live Loud Life podcast. My name is Antonio, your host of the Live Loud Life podcast. My wife and I own Live Loud Chiropractic and Coaching here in Lafayette, Colorado. We are a family-based practice, we love working with the littlest of littles, all the way up into our generational health of grandparents and adults. Our big mission is we believe that families deserve more from their health care providers. We are trying to fill the gaps from the information that they’re maybe not getting from their OB, their PCP (primary care physician), but also the gaps from maybe their personal trainers or their coaches.


While we’re not saying we’re a jack of all trades, we really find that it’s important to connect all those dots and to help be that coach or liaison, if you will, to help our patients and our members really set themselves up and their families up for the best health possible. That’s really what our mission and our goals are. We love guiding you through the adventurous life you’re meant for and if we can do that in any possible way, shape or form, please do not hesitate to reach out and ask.


Overview of Today’s Topic

Today we’re going to be talking about pain. This is a topic that we’ve brought up in a number of different ways. I recently saw a post about this which coincides with the questions that we commonly get, so we just wanted to recirculate back around to this and have a discussion about it to see if it can help you with maybe some of the pain that you’re having. This is specifically towards pain when you are training.


Headline wise, clickbait wise, you see “do this so that you never have pain training ever again” or “if you have pain when training, do this and it’ll stop it.” And I’m not going to lie, I’ve been guilty. It’s what you’re trying to do. You’re trying to get someone engaged and curious about certain things because they obviously have pain. I just hope that I can have a better discussion around it rather than simply saying, “Hey, if you do this one small thing, it’ll eliminate pain.” Because we know that pain is much more complicated than just, “Oh, it hurts when I do this and thus if I just do this exercise or this stress, then it’s magically going to disappear.” That is not how it works. It’s obviously a lot more complicated, as we just stated.


But questions that we get are:


Hey, I’m having pain when I’m doing this exercise, what can I do so that I can continue doing this exercise? So obviously there’s a certain amount of discomfort or pain that’s making something not enjoyable for someone, that would normally be enjoyable.


Or vice versa: I’m having pain when I’m doing this exercise, is it going to get worse? That’s a loaded question that we oftentimes will get.


And/or: Hey, I’m doing this type of exercise, is there anything I should be worried about or mindful of so that I don’t get hurt?


There’s a lot of different ways in which training with pain comes into play. Based on the last question too, a lot of times people have a fear associated with a movement that they don’t even have pain for but they’re worried about it. Maybe because previously they’ve had pain or someone else that they know has had pain or gotten injured when doing it and so they’re going in with his hesitancy. Which is good, they’re being smart about it. Hey, what do I need to be mindful of or prepared about in case something does come up? We’re going to kind of just lay out in general how this conversation goes, and the background of this conversation always starts with a relatively simplistic breakdown of what pain actually is.


What Is Pain?

Pain is the perception of a stimulus within our body. For instance, let’s just use a pinprick or a thumbtack. If you hit that on your finger, your body’s going to feel that sharp point and that mechanical stimulation–mechanical meaning just like pressure, if you will but there’s obviously very pinpoint pressure. Your body will feel that and it’ll send a signal to your brain, and it’ll say pain and then you’ll get that reflex jerk. Depending on the type of pain, you might just do a short circuit where it goes through your spinal cord and comes back, so you have this jerk response of pulling away. The same thing happens when you touch something very hot, it’s just because it’s faster–we want to immediately move ourselves from that potentially harmful situation.


Now let’s say there’s something else that’s a little bit more slow burning, if you will. You’re running and your knee starts to hurt. Obviously, it’s not like a pinprick where you’re going to feel that pain immediately, but yet it starts to grow and fester and your body’s continuously processing like “hey, my knee is not feeling good, it’s starting to hurt, I’m running further and it’s starting to hurt more and more.” So you’re starting to process what the mechanical impact or stimulation upon your knee is actually occurring.


Perception of Pain Is Real Pain

That in a sense is how our body perceives pain, but again the perception of pain is what’s important. This is where things get complicated, right? Pain usually always starts when there’s some sort of a stimulant, meaning something elicits it. The pain can then linger. The reason why we say usually is, let’s take for instance phantom limb pain. Phantom limb pain, there’s obviously not a limb there but yet someone could still be having pain there. There’s a lot of research that goes on to like why that is and how to deal with it, but we also did see the initial insult was there’s a reason why the limb had to be removed. Or if it was abruptly removed like let’s say in an accident, muscles, bone, and nerves were all damaged in the process of that, so there was still an initial insult to the tissue. Insult meaning injury, if you will. And then we have the lingering pain afterwards because of that.


What’s really important to understand is that it’s the processing of that, so the brain plays a huge role into this. One thing that I definitely want to make clear is that pain is real. Pain is real and this is where it gets harder. Because of this whole pain science movement, a lot of times people have been pushing for pain is in your head and we can manipulate it and that’s an easier way to manage it. While it’s a perception of pain, yes, that’s our brain processing in our head, it is still real and it’s very real to the person.


Acute Pain vs Chronic Pain

This dives down a lot more into like when we start talking about chronic pain and different things like this. In the instance of training with and without pain, while chronic pain is definitely a scenario that we do deal with…. And I actually really enjoy dealing with chronic pain patients because there’s a certain element of confidence that we try to instill and push to help deal with that chronic pain. And so when we’re talking about training, that’s an important lesson, that’s usually where we start talking about is this acute or chronic? We have the conversation about how pain is perceived and what’s going on, but going through our normal diagnostic questionnaire:

  • Is this new?
  • Has it been going on for a while?
  • How long has it been going on?
  • Have you had recurrent injuries here before?
  • How many injuries have you had?
  • Have you had surgery, so on and so forth?

We really get an idea of what the tissue, what the body has gone through, to determine is this something where the tissue is actually damaged or is this something in which the tissue was previously damaged but yet our body is holding on to this lingering perception of pain? Because of a lack of confidence, because of a lack of preparation (meaning we didn’t rehab properly) or because of a lack of a strength (which kind of coincides with that rehab process). Those are all fundamental to understanding where the person is and what to do.


Identifying the Root Cause–Some Practical Examples

Let’s play out some hypothetical situations here. We’ll say someone comes into the office: My shoulder is hurting, it recently started within the last week or two and I’m getting a pinch whenever I do overhead lifting. Has this ever happened before? No. This is the first time, never happened before, I’m not sure what’s going on. Did I tear a rotator cuff? Very common question. What’s going on? Depending on the intensity of the pain, we will run through a range of motion, orthopedic tests, criteria, so on and so forth. But the question they have is, can I still train with this shoulder? The answer is yes, you can.


Now, is there going to be some quick and dirty things that eliminate the pain so that you can go back to doing the exact same thing that was causing you pain? There probably are a few little tricks that could help, but understanding the reason why is important in the first place. And the example we always use outside of trauma (meaning you physically hurt it with an accident or an incident.) In this case like for a shoulder, let’s say you were mountain biking and you fell two weeks ago and now lifting with your shoulder is hurting. Okay, we want to look at that fall. But if there wasn’t an accident, there wasn’t some sort of insult, then the likelihood of there being tissue damage goes down. Not eliminated, but goes down.


But there’s a reason why the shoulder started hurting with the lifting that you’ve been doing so then we go through and ask more questions:

  • Has your training volume gone up?
  • Have you increased weights?
  • Have you tried new movements?

So on and so forth, to kind of indicate to us maybe there’s something that we’re doing that caused that shift and that change. Which is, again, more likely the cause. And so this gives us a really good idea. Okay, now that we know how and why and what was happening previously, we can make a very good plan of attack so that you can keep training. So that we’re not losing, we’re not going backwards, if you will. We’ll allow you to train around the pain, multiple roads to Rome. We just have to understand, what are the things that are causing the pain? What are the movements that are causing pain and really making things worse? If we can’t modify, change those and work on technique, then we might have to eliminate them and do something else that replicates what you’re wanting to do but allows you to not keep picking at the painful tissue.


Two Ways of Dealing with Pain

This is important because I think people in this situation, they have very black and white viewpoints. Part of it is they just don’t know the modification process or how to kind of adapt. Which is completely fine and that’s what we’re here for, that’s what personal trainers and coaches are here for as well. But they either assume “it hurts and I just need to stop doing everything so that I don’t make it worse.” And that’ll help, but they didn’t deal with the issue on how it crept up in the first place. Or they have the “no pain, no gain” mentality and they think it’s just push through, push through, push through until it eventually just goes away. Can it work on both ways? Yes. One hundred percent, it can work on both ways. But is there a way to get us to where you want to be faster? I think so. And it’s just that whole method we laid out of understanding everything that kind of caused it in the first place right.


That is an acute onset type of thing, where we’re talking about something gradually coming up over the last two to three weeks. Usually these individuals are like, you know what, I can’t put a date on it. There was never a certain instance. I just know over the last few weeks it hasn’t been good and it’s not getting better because I’m still doing the thing, so on and so forth. That’s a very, very common situation. Plan wise, super easy. Just stop doing it, which is again what most medical providers will say. If you had the same conversation with the PCP or your primary care, they’ll just say stop lifting with your shoulders, let it heal. “Let it heal and it’ll get better.” Now, letting it heal puts us under the assumption that something was damaged or wrong in the first place, which is again very unlikely unless there was significant trauma.


That’s not to say that the tissue cannot be bruised or irritated. We use this concept of bruising very commonly because I can hit my leg on the corner of a desk or a table and have a bruise which would be micro trauma, if you will, but there’s no significant trauma to it. But yet I could be walking around with a limp for a little bit or it could be a little bit tight and sore (where I stretch and it hurts) and if I just let it rest, yes, it’ll be fine. But oftentimes, if you continue to move, it helps work through that bruising and helps keep the muscle from kind of binding up and spasming. And that’s really what I think is going on as opposed to this damage that needs time to rest and heal.


I think there’s a way for us to keep moving, which again, helps so many people just mentally. But not only that. Physically, where they feel so limited by having to constantly “heal” any little aches and pain that they feel, with the assumption that it’s always something that was damaged. I find that to be critical because if we always just say rest-heal, rest-heal, rest-heal, the first sign of pain or discomfort, we assume something is damaged, whether I tore a muscle or a ligament or something like that. Where it’s less likely that is the cause and there’s still more that we can do, and that’s super important. Specific example, though. Gradual onset over the last few weeks, could be last few months, depending on kind of what your load accumulation is, if you will.


Let’s use another example and we’ll just use the same thing–shoulder. My shoulders, I have been having this shoulder pain, it’s been going on for years. I hurt it a couple of years ago and I rehabbed it, I got it stronger, but it’s just never really been the same since. And once it kind of hit the status quo, it was basically like I’ve done everything I can do with it and I’ve given up on it. But yet, when you look at the things that aggravate it, the patterning of all the things that make it worse or hurt are almost the exact same. And this is very common for most injuries, just based on a mechanical loading pattern.


Pain Caused by Flexion Intolerance

For like lower back pain, the majority of people, at least that I see, are flexion intolerant. Meaning, when they bend forward is when it doesn’t feel as good and then they let it heal. A couple of weeks later, it’s good and then they do the same thing–back and forth, back and forth. How many times can you damage or injure it and then just let it heal back and forth? It seems a little weird, right? The shoulder is very similar. And we’re talking about a very specific population. We’re talking about training, we’re talking about lifting and training, not just an everyday person who’s not doing anything.


With shoulders, very commonly, we see pushing from a horizontal and a vertical perspective as being most aggravating for the front of the shoulder or the top of the shoulder. Yes, are there times when you’re pulling that can hurt? But I find that it’s probably more biased, that most of us are doing more pushing than we are pulling. And just the way that we’re loading the pushing as well is causing more load and aggravation to certain areas, such as the rotator cuff, bicep tendon, so on and so forth. Or training this “impingement” type of scenario where we’re constantly impinging it due to mobility restrictions. So injury previously caused some tightness, had some compensation patterns if you want to use that word. I like using just more altered movement patterns to achieve the task. It’s the same thing but it is what it is.


But what we see is now that we’ve rehabbed it, we’ve stretched, we’ve strengthened, we’ve done everything but yet we saw a pain, we never relearned or addressed how it happened in the first place. We commonly see this with pushing types of movements, whether that’s bench press, dumbbell press or even just your basic pushup. We see bicipital irritation and you can sustain a substantial flare up of tendonitis on this. And then you can rehab it, let it calm down, but you’re still doing the movement the same way. So oftentimes, we’re looking at this from a technique perspective of just understanding how mechanical load will stress you in areas, and what to do and how that can be the difference of training with and without pain.


It’s a trial and error. You have to understand that when you make cue and an adjustment, doesn’t improve it. Now, these are sometimes the tricks that we see, that if you have pain with the pushup, do this to eliminate it. Yeah, that can make a drastic difference and we see it time and time in our clinic care when someone’s having bicipital or front of the shoulder pain when they’re doing like pushups and we just cue how to tension better, how to draw back and support using the back. Oftentimes the pain immediately goes away, not because the bicep tendon is not still irritated or inflamed, but you’re not loading it heavier or putting more load to it, allowing it to actually calm down. That’s what you have to look at as far as being able to train in the presence of pain.


Pain Is Sometimes a Guide Rail

This is what I think is really important and this is off a case we had last week. This exact same situation. After we worked on the shoulder and addressed what we thought was to be the primary culprit of how she was basically dumping into the front of the shoulders because she’s hyper mobile in doing pushups. Can I still train even though it’s aggravated? Because her previous physical therapist was thinking it was a pec issue and an upper trap issue and told her to just let it calm down because they were really inflamed. Those weren’t the issue. The issue was the bicep tendon and the way she was doing pushups. I said yes, you need to train, I want you to train because the little bit of pain that you do have gives you a good rail guard of understanding how you’re loading. Whereas if you didn’t have any pain, it’s a lot more likely for you to just kind of fall into the same patterns.


So pain can actually be a very good guiding rail about how you’re moving and what ways we could potentially be moving more effectively and efficiently. Obviously, this is different than the no pain, no gain. If you’re training and your pain rails, your guide rails, you keep brushing up against them, you’re going to flare things up and make it worse. I’m not saying that you train in pain and you constantly are just bouncing around finding the edges until things get more flared up. You’re using it as a guide to make the appropriate adjustments so that you can continue training without significant pain. Because there is an element to training without pain but it’s not “no pain, no gain.”


It’s not uncommon and it is very common to have a little bit of aches and pains, to have a little bit of signaling. Pain is essentially your body’s way of signaling when things don’t feel right. It could just be tightness, it could be irritated tissue, it could be weakness. Weakness in the sense of like, hey, whatever you’re doing, your body might not be fully prepared to handle that load. And the muscles, tendons and everything are being maybe overloaded or overstretched. That’s going to send you a signal to say, hey, this is too much. Or slow down or de-load, if you will. These are all good signs to have if you have the understanding of what they might mean and how it is affecting the training that you’re doing.


Verbal Analog Scale of Pain

When it comes to rehab, getting back into training or doing something in the presence of pain or having pain, whether that’s newly acute or chronic, we use kind of like a green light system. And this is not something I created, multiple different providers talk about a similar system. But most people who are going to be training in the presence of pain, we’re looking at a pain scale of really no more than a 5. Like a 5 is fairly substantial. For those of you don’t know, I’m going to run down what’s called the verbal analog scale, it’s basically when someone asks you like rate your pain out of a 10. Sometimes they have like a smiley face, frown face, cry face, so on and so forth.


To give you a little bit better perspective of functionally what this means, if you have a 1, 2 or 3, you are kind of like I feel something but something is not right. If you have a 4, 5 or 6, it starts affecting your day. Example would be your lower back hurts, you’re having difficulty putting on your socks, your pants, your shoes, so on and so forth. If you have a shoulder, reaching up to the cabinets is kind of sore or reaching behind your car seat to reach for something can be sore. That’d be an idea of like a rough range of a 4 or 5 or 6.


A 7 or 8, you’re in tears. You come in and you say, yeah, it’s like a 7 or an 8 and you’re not like visibly uncomfortable, where you’re almost in tears. Just the smallest bits of movement or so are really kind of flaring you up and making you kind of like sweat or anxious or kind of tighten up–that’s a 7 or 8. And if you say a 9 or a 10, like you’re rolling around in pain. We’re going to call an ambulance, we’re going to get you to the hospital because we need to manage your pain with some medication or something like that. Like it’s that intense. That’s what we’re talking about. When someone comes in, they’re having a conversation with me and they say it’s a 9 out of 10, I know that’s not true. Whether you have a higher pain tolerance or not, when you’re in that much pain, you can visibly see it on the person’s face.


Training in the Presence of Pain

When we’re talking about training in the presence of pain, if you got a 4 or a 5, as we said, it’s already affecting your day. That’s going to make it a lot harder to train. Now, when we say train, there’s certain ways in which we can do it that are going to be helpful for the pain that you have. I’m not saying you just do whatever you were doing just lighter or slower (although that might be the case.) You might have to completely eliminate some things but we still want you training and moving and that’s the whole point.


If you’re at like a 1, 2 or 3, that’s a green light. You can still train. If the movements are starting to aggravate that pain, meaning that pain is starting to grow when you do it and/or if it’s worse after the day after, then you overcooked it and we know we need to modify and change things more. If you’re a 4, 5 or 6, that’s a yellow light, right? It’s like proceed with caution. Still okay but you’re going to be going a lot slower, you’re going to be going a lot lighter and we might be completely changing the movements that you’re doing to be more supportive with the pain that you’re feeling and where you’re at. Anything more than that, that’s a red light. Like if you’re in that much pain, yeah, training is probably not the best option for you.


But notice we did not say that at any point of feeling pain, it’s a no. So many times, we hear don’t train with pain. Don’t do anything if you’re having pain because you’re going to then create compensation patterns or you’re going to change how this is happening and this, and you’re going to create all these issues. And then it just turns into this cascading event of, well, a year ago you decided to train with pain and now you have this compensation pattern. No, it’s not. That’s way too complicated, way too involved. The movement process of training is what can actually be so therapeutic and beneficial for the majority of injuries or pain conditions that we’re talking about.


This is all predicated on the understanding that most of what we’re talking about are not significant injuries. You can have a full-blown rotator cuff tear and not a lot of pain. And so when we’re getting into these more complicated cases, that’s where you just need someone working one on one with you to really help you design in detail a plan. To just take this information and say, “Oh my pain is not that bad. Even though I know I have this, I got a free go to do whatever I want.” That’s not the case.


Now, it couldn’t be the case where it was a previous thing that has healed and everything’s good now, but it’s always good working with a sports chiropractor, a sports PT or a personal trainer who understands these things to help you design that best plan and course of action for you. But this is what I find to be critical when we’re having a conversation around pain because most people will come in to see us in pain and they want to keep moving. Let’s take for example the last situation where I want to avoid having pain when I work out or train. We have to define, what do you mean avoid pain? Because there’s certain amount of pain elicited based on micro trauma loading that you might feel–soreness, certain things like that. But yeah, we don’t want to necessarily just feel pain when we’re training.


Train According to Your Mobility and Strength Abilities

If that is the case, then it’s really going through a checklist or an audit process of ensuring that you have the proper mobility and strength and previous loading experience for you to be able to do the things that you want to do or that you’re getting into. Example, I had a new patient come in a couple of weeks ago. He’s a father, two young kids between the pandemic and everything else and COVID. Has been out of working out and training for two and a half, three years. Actually, three to four years because his kids were born. He did have his oldest before that and that’s when things kind of slowed down. And he wanted to get into CrossFit. Love it, man, great! Found a local gym nearby, we know the coaches there, we used to go to the gym ourselves, I find them to be phenomenal coaches.


But the downside of group training and having someone who’s never done CrossFit before, has not really trained or lifted in over four years, is not having the one on one coaching ability to really look at and understand what this individual needs. We’re taking that upon us here. It’s just like, hey man, great gym, I know they’re great coaches, they’ll give great cues, they’ll give great modifications if you need it. But we really need to put you under a microscope and look at the things that you want to do so that your concerns of not getting hurt doing CrossFit–because that was a concern of his based on other people that he knows and I think just kind of the general misconception that people get hurt doing CrossFit for reasons that are similar to this.


Okay, let’s look at those things. Works in IT, sits at a computer, lack of thoracic extension, poor shoulder mobility, really tight hips because he sits a lot. I’m like alright, here’s the breakdown. We see this going on with your body. Not a lot of pain right now but we see this stuff going on. Could you do CrossFit with all this going on and not get injured and be fine? Yes. Is it likely? Well, it depends on how hard you’re doing CrossFit and what movements you’re doing. Right off the bat, within the first few weeks, as a very common exercise you’ll see in CrossFit, they were doing overhead pressing.


Full shoulder range of motion is 180 degrees, meaning your arm is basically straight up overhead, bicep to ear. Obviously, you can’t see me from a side view or this sagittal plane. But where he was at, he was maybe 150 degrees. He’s lacking like 30 degrees of shoulder extension and he’s trying to then lift overhead. The likelihood of you not injuring something with that if you continue doing shoulder pressing, it goes down. It’s very probable that he’ll create some sort of a shoulder issue, whether that’s in impingement type of symptoms and/or overloading of the rotator cuff because he can’t stack his joints overhead and he’s having to go through that altered pattern. And so this is like, hey, if we can use this as our audit checkbox or the check points, we’re going to ensure that we have proper thoracic extension, proper overhead range of motion, proper scapular movement, while being able to still stack our core and being strong, then we’ll be able to do that.


Live Loud Chiropractic and Coaching Will Help You

Notice we didn’t say you cannot train, you cannot do these things because we didn’t get them all right, and that’s a very common misconception for a lot of sports chiropractors and sports PTs. It’s just like, hey, you don’t have the range of motion, you shouldn’t be doing any sort of training at all. We gave him the green light because he didn’t have pain but we set some parameters. And the parameters now, because he doesn’t have pain, it’s not a guide rail for pain as our parameters; it’s a guide rail based on function and ability. Your shoulders just don’t have the ability to do this so we have to do it in a different way that allows you to be able to have that full range of motion


And I think that’s so important because we’re trying to help them set guidelines based on function to help them reduce the chances of injuring something. We don’t know what that probability is. I can’t put a percentage and say you’re this likely to injure yourself if you don’t do it. No, but we want to set themselves up for success. If he’s just getting into CrossFit, why not help him and support him to our full capacity so that he reduces the chances of getting an injury, that makes it more likely that he’s going to stay at the gym, which makes it more likely that he’s going to be consistent with his training and get back to the health goals that he’s wanting to get. That’s a little bit of a different scenario when we’re talking about training with pain.


I hope this was beneficial. I know it’s a little bit more convoluted because everyone’s situation is a little different. But I want you to just kind of run through this:

  • If you’re worried about training with pain, is it acute, is it chronic?
  • What are the things that are aggravating it?
  • Can we find different ways to help you maintain a good training cycle in the presence of pain?


Also, if you’re worried about having pain, really having someone help you set up that plan and go through that audit checkbox system, if you will, to ensure that you have all the necessary range of motion and strength to do the activities that you want to do and reduce the risk of getting injured.


Thanks for tuning in, guys. This is the Live Loud Life podcast. If you know of someone who is in that cycle of training with pain and restÞ let it healÞ come backÞ get injuredÞ restÞ let it healÞ come backÞ get injured… Send this over to them, I think it would be beneficial.


And as always, that’s why we suggest working with someone like myself, sports chiropractor, a movement chiropractor, a PT, personal trainer, and a coach. Just getting some one on one time to really go under those microscopes and determine what are the things of why you’re going through this recurrent pattern, if you are in that situation. And getting more confidence in training in the presence of pain and knowing that it’s really not going to necessarily make things worse if you know what you’re addressing and how to address it properly.


Till next time, guys. Live loud!