For most settled, non-acute pain, training is the treatment. Not rest. The job of a personal trainer is to screen properly, programme around the problem joint, regress every movement before progressing, and refer to a physio or exercise physiologist when something is outside scope. About 6 in 10 new Mr PT Fitness clients arrive with a back, knee, or shoulder issue they thought they could not train around. Most can.
Why "rest it" usually makes it worse
For most musculoskeletal pain that has settled past the first few days, prolonged rest weakens the surrounding tissue and the protective patterns around it. Backs get stiffer. Quads waste around dodgy knees. Rotator cuffs deload and lose their position. By the time you feel "ready" to train again, the joint is in worse shape than it was the week of the original tweak.
The current evidence on low back pain, patellofemoral pain, and rotator cuff issues all points the same way: graded, loaded movement beats rest for outcomes at 6 and 12 months. That does not mean "ignore the pain and lift heavy." It means start light, move often, build capacity around the joint. A coach who watches every rep is the cheapest way to do that without making it worse.
The screen I run on every new client
Before a flagged client touches load, I run a 20-minute screen of the patterns that matter for their goal and their history. It is not a physio assessment. It is a "what can you do without pain, what can you do with cues, what is off the table for now" map. Roughly:
- Hinge: bodyweight RDL pattern. Can you load the hamstrings without rounding the lumbar spine?
- Squat: goblet squat to a box. Depth, knee track, brace.
- Push: push-up on a bench. Can the shoulder blades move? Any sharp pain at top or bottom?
- Pull: single-arm row, light load. Symmetry, scapular control.
- Carry and brace: suitcase carry. Trunk stability under asymmetric load.
- Local checks: single-leg balance, hip flexion range, shoulder flexion overhead.
What I am looking for: which positions reproduce the pain, which positions are clean, and what cues change the pattern. The output is a one-page programme with green-light, amber-light, and red-light movements for the next 4 weeks.
Programming around (not through) the injury
The principle is simple: load the patterns that do not provoke pain, regress the ones that do, and rebuild the provocative pattern from a position the joint tolerates. Three common examples from the Dee Why studio:
Sore lower back, hinge irritates it. Start with a hip-hinge drill against a wall. Add Romanian deadlifts from a deficit-free, mid-shin start. Progress to trap-bar deadlifts before barbell. Build trunk capacity in parallel with side planks, dead bugs, and Pallof presses. Most clients move from "cannot pick up the kettlebell" to a clean trap-bar deadlift at 60 to 80 kg inside 8 weeks.
Dodgy knee, squat depth is the problem. Goblet squats to a higher box. Split squats with the back foot elevated and a short range to start. Step-ups with a slow eccentric, prioritising the working leg. Spanish squats for the quad and tendon. Range comes back over 6 to 10 weeks as tissue capacity builds.
Sore shoulder, overhead pressing flares it. Park pressing overhead for now. Build with landmine presses, single-arm dumbbell bench at a low incline, half-kneeling cable rows, and band pull-aparts daily. Add face pulls and rear-delt work. Test overhead at 6 weeks with a light landmine press, then progress to dumbbells before barbells.
Got a niggle you have been training around for months?
Book a free 15-minute consult. Bring the history (and the physio notes if you have them). I will tell you straight whether I can train around it or whether you need a physio first. Book here or call 0422 745 334.
When I refer to a physio or EP
I am a personal trainer, not a physiotherapist or exercise physiologist. There are clear cases where a referral comes first. The list:
- Acute injury (less than 2 weeks old) with swelling, bruising, or loss of range
- Pain that radiates down a leg or an arm past the knee or elbow
- Pins and needles, numbness, or muscle weakness in a limb
- Pain that wakes you at night or stops you sleeping
- Post-surgical rehab in the first 6 to 12 weeks
- Anything with a chronic disease component (diabetes, cardiac history, neurological condition). These belong with an Exercise Physiologist. See PT vs EP vs gym instructor for who does what.
I work with two physios in the Dee Why and Brookvale area and refer clients across regularly. Plenty come the other way: physios send people to me once the rehab phase is done and the next 6 to 12 months of loading is the work.
Three real client patterns (anonymised)
Client A, 48, Collaroy, 10-year history of low back pain. Could not deadlift, avoided picking up the kids. Eight weeks of trap-bar hinges from a deficit, daily walks, and trunk work. Now deadlifting 90 kg pain-free. Lifts the kids.
Client B, 56, Dee Why, dodgy right knee from old footy injury. Walking irritated it after 20 minutes. Twelve weeks of split squats, step-ups, Spanish squats, and a slow rebuild of squat depth. Walking 5 km Dee Why Beach to Long Reef without flare-ups. See outdoor training spots.
Client C, 42, Curl Curl, chronic shoulder impingement from desk work and surfing. Could not press overhead, painful paddling. Six weeks of pull-volume, rear-delt work, landmine pressing, and daily band work. Back to surfing without ache. Pressing dumbbells overhead at week 10.
What you can do this week
Three things, in this order, regardless of the joint.
- Move it daily. 10 to 15 minutes of gentle, pain-free range. Walking for backs and knees. Band work for shoulders. Stiffness compounds without movement.
- Build capacity around it, not through it. Strong glutes protect backs and knees. A strong upper back protects shoulders. Trunk capacity protects everything. Two short sessions this week beats one heroic one.
- Get eyes on it. If it has been more than 6 weeks of niggling and not improving, either book a physio or book a PT screen. The longer it drags, the more compensations build up.
Frequently asked questions
Will training make my back worse?
Done properly, no. For most non-acute back pain the evidence points the other way: graded, loaded movement reduces pain and recurrence better than rest. The risk is a coach who pushes through sharp pain or skips the screen. At Mr PT Fitness every new client with a back history gets a movement screen, a regression plan for every exercise, and a hard rule: sharp pain stops the set.
Do I need to see a physio first?
If the pain is recent, sharp, radiating down a leg or arm, or stops you sleeping, see a physio or GP first. If it is a known, settled issue (an old disc bulge, a dodgy knee from footy, a shoulder that flares when you press overhead) a PT can train around it. The Mr PT consult is free and includes an honest call on which way to go.
Can I train with a disc bulge?
Most settled disc bulges train well with the right programming. The pattern: avoid loaded spinal flexion early, build hip hinge and trunk bracing, progress deadlifts from elevated positions, and add load slowly over 8 to 12 weeks. For acute or unstable bulges, see a physio first. I have trained clients with diagnosed L4 to L5 and L5 to S1 bulges back to deadlifting bodyweight.
Train around it, not through it.
Free 15-minute consult. Honest call on whether to start with me or see a physio first.