Don’t Stop. Modify: How to Modify Painful Exercises in 5 Steps
Over the years, I’ve worked with countless people who have given up on certain exercises because they consistently cause pain. I get it, no one wants to push through pain just to stay healthy. But, there’s a right way and a wrong way when dealing with painful movements. Hint: The wrong way is completely eliminating it before trialing a series of modifications. In this article, we’re going to discuss the 5-step process to modifying painful exercises, and what symptoms are worth stopping the exercise until you see a healthcare provider.
Symptoms that should make you stop
Before we dive into the 5-step process for modifying painful movements, we need to discuss symptoms that warrant stopping an exercise and seeing a Doctor of Physical Therapy or other healthcare provider before continuing. We’ll call these “time to stop” symptoms.
Time to stop symptoms:
Very sharp pain that causes wincing or the limb to give out
Numbness or tingling that worsens as the set progresses
Feeling like a joint is unstable or on the verge of dislocating
Pain that worsens as the workout progresses, even with modifications
Pain that worsens later in the day, or lasts >24 hours
If you experience any of these, I would STRONGLY recommend you contact a trusted healthcare provider (perhaps at Strive Performance in West Ashley 😉).
The 5-step process
Now that we’ve got the serious stuff out of the way, let’s discuss how to properly modify painful exercises. I will provide examples as we go through the steps!
Step 1: Check your form
I know this sounds like a no-brainer, but this truly is the first step in assessing why you may be experiencing pain during a movement. I am not a stickler for “perfect” form, but there is definitely a right and wrong way to do exercises.
Let’s say you’re doing a barbell bench press (and you have a spotter, like a good lifter should). As you’re performing your reps your wrist continues to get more sore, and after each set is completed, the discomfort intensifies.
This is probably because you’re not keeping your wrists neutral (straight) during the lift, allowing for your wrist to extend and placing quite a bit of strain on your wrist and finger flexors. Once you remember to keep your wrists straight, the pain resolves.
Sometimes, it really is as easy as checking your form. But what if you have great form?
Step 2: Lower the weight
I can easily go off on a tangent about ego lifting, but for the sake of this article… alright fine, I will.
LIFT A WEIGHT THAT YOU CAN CONTROL WITH FULL RANGE OF MOTION AND GOOD FORM. NO ONE CARES HOW MUCH YOU LIFT, GET OVER YOURSELF!
Now that that’s out of the way, the next step in modifying a painful exercise is to reduce the load. Even if you have great form, if a joint, muscle, tendon, or ligament isn’t accustomed to a certain load, it is going to send signals that you’ve surpassed its capacity.
An easy way to test this is… to lower the weight, duh.
For example, if you’re squatting 225lbs on the bar and have discomfort in your knee (and form is in check), but you didn’t have pain when working up to that (maybe at 185lbs), then it’s a load tolerance issue.
Make your top set 185lbs, work with that weight for a few sessions, build up the knee’s tolerance to the weight, and make a smaller jump when it’s time to progress. Add 10lbs total instead of 20. Yes, you aren’t lifting as heavy, but remember: NO ONE GIVES A DAMN HOW MUCH YOU LIFT 🙂
Step 3: Reduce the range of motion
Alright, so you have great form and reduced the weight, but the pain still persists. The next step in the process is to reduce the range of motion you perform the exercise in. You can start with minimally reducing the range, but if you are still experiencing discomfort, you may end up doing partial reps (which is fine!). There are several ways to do this, but here’s a few of the most common modifications for the major lifts:
Bench press: Use a block on your chest
Back squat: Use a bench or plyo box for box squats
Deadlift: Use blocks or a rack to lift the bar off the floor a few inches
Let’s use the back squat again for this example. You’ve reduced the weight from 225lbs to 185lbs and it’s better, but the deepest part of the descent is still uncomfortable. You grab a plyo box and set it to a height of 16 inches.
Eh… still not great.
Now you increase it to a height of 20 inches and what do you know, no more pain!
Over time, the recommendation is to stick with the 185lbs and 20 inch height then reduce the box height BEFORE adding more weight. Get down to 16 inches, then no box (or something lower) and when that’s pain-free, it’s time to GRADUALLY start adding weight again.
*These things can take several sessions or even weeks before being able to remove the external item!
Step 4: Try a different variation
Sometimes, even with good form, reduced weight, and partial range of motion, that may not be enough. If you truly have done the three previous steps and given it a few weeks of regression but are still struggling, it may be time to try a new variation of the movement.
There are countless variations of major lifts, but sticking to one that is very similar in movement mechanics and weight placement is the best place to start.
Using the traditional barbell deadlift as an example, the recommendation for the first variation would be a trap bar deadlift. The plates are still at your sides, the setup position is very similar, but the placement of the weight directly to your sides vs. slightly in front can reduce stress on the low back noticeably.
Step 5: Time for a new exercise
Steps 1-4 haven’t given you the relief you’ve been looking for. The pain is still quite uncomfortable, and now the movement has been modified to its max. This is when it’s time to try a new exercise that trains the same muscles and movement pattern.
Just because a bench press might not be in the cards at the moment, doesn’t mean it’s time to stop hitting chest.
A dumbbell floor press may be an excellent exercise. It’s still a press and still hits the chest, delts, and triceps. If that’s not working, machines are great to try. You can adjust the seat height, the range of motion, and there’s a foot rest to use if you need assistance.
Can’t perform a deadlift variation? An RDL is very similar and trains the same muscles. And so on and so forth.
Bonus step 6: See a physical therapist
At some point, you can only modify and regress so much before you’ve exhausted all your options. Even if you had this knowledge beforehand of how to modify exercises, most people get to a certain point and give up.
“Maybe I’m not meant to squat.”
“Maybe I’m just getting too old for this.”
NO!
There is always an entry point for everyone. Even if barbell back squats are no longer tolerable, some form of squatting should be. We just need to figure it out, together.
This is where working with a trusted Doctor of Physical Therapy comes in. Finding a therapist who specializes in weightlifters, knows their way around the gym, and understands the principles of proper programming can be the difference between never performing an exercise again and enjoying it pain-free for years to come.
Lifting Pain or Injury in Charleston?
Strive Performance & Mobility provides physical therapy for weightlifters and active adults in Charleston and West Ashley. Our Doctors of Physical Therapy help lifters understand what is contributing to their pain, make appropriate training modifications, and build a plan to return to strength training without pain.
Book a free 15-minute conversation with a Doctor of Physical Therapy at Strive Performance & Mobility!
This article is for educational purposes and is not a substitute for an individualized medical evaluation.
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