Chronic pain management: Why strength training isn’t always the answer

One of the personal trainers I met yesterday asked a really good question. When I mentioned that I work mostly with clients seeking chronic pain relief, he asked if I helped them with strengthening and improving range of motion.

The short answer is no.

Whilst it’s true that physical strength and flexibility may be important for physical wellbeing, it is almost never the end goal for chronic pain sufferers. All of my clients want to achieve lasting pain relief. To be more specific, they come to me so they can live pain-free within their specific daily activities and lifestyle.

Pain-free is always subjective

Living pain-free can sound like an absolute end goal. From a logic point of view, you either have pain or you don’t have pain. That much is true. It is, to a very large extent, quite binary.

The tricky part in achieving pain relief is understanding the context. You want to be pain-free doing what? For example, being pain-free whilst sleeping is not a very big goal. Most people with joint and muscle issues such as back pain or neck pain can sleep without pain.

For conditions like sciatica pain, this can be somewhat more tricky. You may still rather experience some symptoms whilst you are sleeping. This, however, usually has more to do with how soundly asleep you are rather than you experiencing pain in your sleep.

Even if you are completely pain-free in your current life, there is always a way to elicit a pain response from you. So, effective pain management is always context dependent.

Do you want to achieve pain relief sitting at a computer for eight hours a day, seven days a week?

Do you want to manage chronic pain whilst running 10km every morning, every day of the week?

Clients come to me because they cannot be pain-free in their ideal context

When I say I help people find long-term chronic pain solutions, it is usually because there are specific contexts that they can’t achieve pain relief in.

For example, they may experience pain relief as long as they go for chiropractic adjustments every week or so. Once they stop going to their chiropractor, their chronic pain returns. What this means is they can manage their pain for as long as they go to their chiropractor. Their desired end goal is that they want lasting pain relief even without having to go to a chiropractor weekly.

I work with my clients to achieve that.

Sometimes it is sports-related chronic pain. For example, a client may be able to run 2.4km every other day. Once their mileage increases, their pain returns. But the client may want to be training for a marathon instead.

Almost none of my chronic pain clients care if their strength increases. They likely also don’t care if their flexibility improves. Don’t get me wrong, it’s not like they don’t want to be stronger or more flexible. That’s just not their primary goal from working with me for pain management.

Being strong and flexible doesn’t mean pain-free

This is where the truly mind-blowing part comes. A lot of people who take a very biomechanical approach to chronic pain treatment will work a lot on, well, biomechanics. They will assess how much strength you have and how flexible or mobile you are.

From there, they would design a programme just to address these areas. The assumption is that your chronic pain will be gone as long as you fix these physical issues. For some cases, this may be true. However, for persistent chronic pain cases, they rarely hold true.

Have a think about it. Are all strong people living pain-free? No.

Are all flexible people free from chronic pain? Also, no.

To get good results and good outcomes, we must be clear about our goals. Beyond that, we must also be able to differentiate between association and causation. Not everything that seems related has a direct cause-and-effect relationship.

How does exercise work in pain management?

Honestly, we don’t really know! I would say there is strong evidence to suggest that you need to be able to carry out activities of daily living if you want to have a good chance at achieving lasting pain relief.

If you cannot squat adequately, it may be unreasonable to expect that you can reach for items in a low drawer or pick things from the floor without knee pain. Yes, there is a strength and flexibility component to squatting but it’s more to do with functional movement.

If you want to be able to sit at a computer for hours without lower back pain, you will need some endurance in your low back muscles. Endurance in your low back may be assessed by how many back extensions you can do. Perhaps how long a plank you can hold?

In my method of chronic pain treatment, I always look at where my clients want to be and where they are now, and try to close the gap. There is no point, at least for my clients, in increasing strength and flexibility just because they are good to have.

Different clinicians work with different client profiles

Most of my chronic pain clients would have sought countless treatments before they book in for an appointment with me. In other words, they would have worked with other therapists and trainers, tried pilates classes, attempted calisthenics routines, and they still can’t achieve the specific pain relief goals they want.

My clients, therefore, are not here to achieve anything but what they ultimately want. Increasing strength, flexibility, or mobility can be great goals but just simply isn’t what my clients want from me for their chronic pain management.

I am not saying they don’t see improvements in these areas. They do. But that’s not the intention, focus, or goal. Quite often, these are “accidental” improvements that are unavoidable with exercises.

Focus only on the results you want

The key takeaway here is this: if you’re dealing with chronic pain, don’t get distracted by what seems logical on paper. Getting stronger and more flexible might seem like obvious solutions for pain management, but they’re often red herrings that lead you away from what actually matters for lasting pain relief. Separate the signal from the noise!

What matters is being able to do the things you want to do, pain-free, in the contexts that are important to you. Whether that’s sitting through a full workday without back pain, playing with your children, or training for that marathon you’ve always dreamed of running.

This is why I, as a chiropractor, take a completely different approach with my chronic pain clients. Instead of chasing arbitrary fitness metrics, we focus laser-sharp on closing the gap between where you are now and where you want to be. It’s more targeted, more purposeful, and frankly, it gets better results for chronic pain sufferers.

If you’re tired of traditional pain management treatments that promise the world but leave you back at square one, perhaps it’s time to try something different. Because at the end of the day, achieving pain relief isn’t about being the strongest or most flexible person in the room—it’s about being free to live your life exactly as you want to.