Exercise and Sports Science Australia: Exercising with pain: Help your clients heal

Pain and movement are often perceived as incompatible. For many clients, especially those with musculoskeletal pain, the idea of exercising through discomfort can feel counterintuitive, or even unsafe.

However, Exercise & Sports Science Australia (ESSA) Accredited Exercise Physiologist (AEP) Alice Hyslop explains, movement is not only appropriate in many cases, but also invaluable for recovery and long-term function.

“Pain doesn’t always mean tissue damage,” says Alice, who has almost 15 years of clinical experience in musculoskeletal rehabilitation.

“Pain is an output of your brain, which means it can be influenced by multiple different factors along our musculoskeletal system and in our brain. We can use those factors to help manage and improve pain. Exercise and movement are a crucial part of this.”

For exercise professionals, understanding the mechanisms behind pain and how to program effectively is essential. Here’s some ways to safely and confidently support clients managing persistent or recurrent pain.

Understanding pain: More than just injury

It can be quite common for clients presenting with persistent pain to lack a clear pathoanatomical diagnosis. For patients with low back pain, in the clinical setting this is often referred to as non-specific low back pain.

“Non-specific pain means there’s no obvious structural damage or pathology,” she explains.

“It’s often related to how your body is handling the physical demands placed on it, things like posture, muscular fatigue, or lack of movement variability.”

In occupational settings, such as healthcare or manual labour, symptoms often stem from sustained postures, repetitive movements, or insufficient tissue capacity, rather than acute trauma. This distinction is crucial when guiding clients away from fear-based movement avoidance.

Should clients exercise through pain?

Movement is an important strategy for those living with pain. Research supports the use of movement and physical activity for those living with pain and finds that it’s safe for those to do so and shows that it’s more effective than completely resting. The challenge is, even though our research supports it, there’s no one size fits all for everybody. There’s no recipe for when, what, and how we should do it.

Get your clients assessed first

A proper individualised assessment by an AEP identifies the specific impairments within their musculoskeletal system that may need addressing, such as reduced hip mobility, weak glutes, or decreased trunk endurance. It is also important to consider barriers to physical activity when assessing how your client will move or exercise. Be it time, access or fatigue, finding a solution that works on an individual level is essential.

They shouldn’t avoid movement completely

Rest has its place, but complete inactivity can often exacerbate a flare up of pain. Muscles weaken, joints stiffen, and pain perception increases. Safe, gradual, enjoyable movement can provide a key form of pain relief.

Start with what they can tolerate

Exercise doesn’t have to hurt to be effective. Begin your client with movements that they enjoy and that don’t provoke symptoms. Gradually increase their load, range, or complexity as their tolerance improves.

Focus on function over fixation

It’s easy for clients to get stuck trying to ‘fix' the pain. Instead, focus on what will make the most difference: Walk longer, lift safely, finish a shift without aching. Your program should be designed to support their goals.

The power of a structured, individualised program

The biggest mistake people make when trying to exercise through pain? Doing generic programs, random workouts, or pushing through without a plan. Poor pacing of exercise and physical activity can often lead to a peak and trough pattern, where doing too much then causes a flare of symptoms. It’s important to work within your body’s capacity.

“Pain is personal,” Alice says. “What works for one person can aggravate symptoms in another. That’s why we always start with an individual assessment and build from there.”

A structured AEP program typically includes:

• Targeted strength work: for the lower limb, trunk and upper limb.

• Mobility exercises: to reduce joint stiffness and improve range.

• Postural strength and endurance: especially helpful for people in sustained positions.

• Endurance development: to help your body tolerate physical demands over longer periods without fatiguing.

How exercise helps manage pain

Exercise doesn’t just help increase the physical capacity of your musculoskeletal system, it also affects how your brain perceives pain.

Here’s how:

• Muscle activation gives joint support and reduces strain.

• Endorphin release creates a natural pain- relieving effect.

• Mental health improvements reduce stress- related pain sensitivity.

How and why we experience pain is multifactorial. And while this can seem overwhelming, it’s this characteristic that provides us with many avenues that we can use to change our pain. Using a holistic approach, including addressing sleep, nutrition, stress, and mental health as well as exercise is highly beneficial.

“We’ve known for a long time that exercise has powerful analgesic properties,” Alice explains. “It can change how your neural system processes pain and help you feel more in control of your life again.”

Realistic advice to give your clients when exercising with pain

• Start small: Even a few minutes of focused movement is often enough in the beginning.

• Monitor symptoms: Some discomfort is okay, but worsening, or a flare up of pain is a sign to adjust.

• Modify, don’t stop: You might need to change the type or intensity of an exercise, not

eliminate it altogether.

• Be consistent: Healing is a process. Stick to your program even if progress feels slow.

• Work with an Accredited Exercise Physiologist: They can help guide you safely through each stage.

What is an Accredited Exercise Physiologist (AEP)?

Accredited Exercise Physiologists (AEP) are university-qualified professionals and experts in the prescription of exercise for treating and managing health conditions.

AEPs support individuals with chronic and complex health conditions, injuries, and disabilities to find the best exercises for their condition, ability, and health goals.

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Does my client need are ferral to see an AEP?

While they don’t need a referral to see an AEP, they might be able to claim up to five subsidised appointments via the Chronic Disease Management (CDM) plan for conditions like diabetes, cancer or heart disease.

Their GP will assess their condition and if appropriate, provide a referral to an AEP. The costs are partially covered by Medicare, making it a more cost-effective option.

When should your clients see an AEP?

If they are suffering from back pain, stiffness in joints or recurring injuries, AEPs can help. They can also help treat and manage:

• Cardiovascular disease

• Arthritis or osteoporosis

• Chronic pain and injuries

• Cancer treatment recovery

• Mental health challenges

• Recovery after surgery

Pain doesn’t have to mean pause

If your clients are living with ongoing pain, the worst thing they can do is give up on movement. With guidance from an Accredited Exercise Physiologist, they can build strength, improve function, and feel better, without fear of making things worse.

“Don’t wait for clients to be pain-free before they start moving,” says Alice. “Use movement as part of the solution.”

Need support in managing complex pain conditions? Connect with an Accredited Exercise Physiologist to collaborate on a tailored structured plan for your clients.

07 3171 3335

info@essa.org.au

essa.org.au