Injuries and pain

Low back pain, shoulders, knees and tendinopathies: what the evidence says about pain, load and returning.

Pain does not equal damage

Pain is an alarm signal from the nervous system, not a direct measure of tissue damage. You can have pain without structural damage and damage without pain. Understanding this reduces fear and helps you move, which is usually part of the solution.

How to apply it

• Do not read every pain as a serious injury
• Appropriate movement usually helps more than complete rest

Complete rest is rarely the answer

Except for specific acute injuries, prolonged rest usually makes things worse: it deconditions you, increases fear and leads to chronicity. The current approach is progressive loading and adapted movement, adjusting (not eliminating) activity based on symptoms.

How to apply it

• Reduce and adapt the load instead of stopping entirely
• Return to movement early, within what you can tolerate

Low back pain

Non-specific low back pain is very common and almost never indicates anything serious. Scans often show 'findings' that also appear in people without pain. Moving, strengthening and avoiding catastrophising work better than rest and fear.

How to apply it

• Stay active; most low back pain gets better on its own
• Strengthen your core and hips; avoid the fear of bending your back

Shoulder

Shoulder pain (often rotator cuff related) responds well to progressive exercise. Many 'impingements' and MRI findings do not explain the pain well. Strengthening the cuff and the scapular muscles and progressing the load is usually the best route.

How to apply it

• Work the rotator cuff and scapula with progressive loading
• Adjust exercises that hurt a lot, without abandoning pushing/pulling

Knee

Knee pain (patellofemoral, patellar tendon) improves with quadriceps and hip strengthening and progressive tendon loading, not with rest. Cartilage and the 'wear' seen on scans do not always explain the pain or prevent you from training with adaptations.

How to apply it

• Strengthen your quads and glutes; progress the load patiently
• Work in the range that does not trigger pain and widen it gradually

Tendinopathies

Painful tendons (Achilles, patellar, elbow) do not classically 'inflame': they become maladapted to load. They improve with progressive, controlled loading (isometrics and heavy slow work), not with rest. They require patience: improvement takes weeks to months.

How to apply it

• Load the tendon progressively and under control, without high pain
• Be patient and consistent: tendons respond slowly

Returning to training and when to seek help

Your return is guided by symptoms: mild, tolerable discomfort that does not worsen the next day is usually acceptable; sharp, increasing pain is not. See a professional (doctor/physio) for intense pain, after trauma, with loss of strength/sensation, or with red-flag symptoms.

How to apply it

• Go by the rule of tolerable pain that does not worsen the next day
• Seek professional assessment for red-flag signs or pain that does not settle