Pain and life/training/expectation adjustment options

Training Q&A [Moderated]
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Hi docs,

On week 7 of the knee rehab template. Overall have been seeing decent progress on knee function and load tolerance. Upper body work has been going decently, although a few weeks ago I had a bit of a shoulder tweak during benching (minor at the time and not uncommon to me during benching). Shoulder has been a bit irritated since then, but has generally been tolerant to loading within program guidelines.

I’m having to manage a larger contracted job that’s new to me, and it’s required an uptick in physical work hours that primarily requires me to use my hands/arms overhead for the majority of the day. The change in schedule doesn’t allow me a day off in the middle of the week anymore (usually doing office work) since I’m working the extra day in the week.

Recently, an adjustment to bench technique helped, and was able to increase weight comfortably, but ended up with some DOMs in both shoulders I haven’t felt in quite a long time (Day 1/Week 7). Next day while working, shoulder was quite sore – would describe as “achey” and sometimes slightly “burny” in the posterior shoulder, and a bit sharper/“tighter” around the anterior shoulder/long biceps head area.

Two days after the aforementioned soreness, I had to OHP (Day 2/Week 7) after a workday and it felt fine despite being fatigued, but the next day close to the end of the work day my left shoulder experienced a “twingy” sort of sharp pain that more or less mirrors the issues on the right shoulder, albeit less severely. Wasn’t doing anything notably strenuous.

TL;DR: Shoulder pain in right shoulder, and now left as well. Not purely from training in all likelihood, but exacerbated by stress and shoulder usage demands at work.

Trying to figure out which levers to pull here as work and family obligations trump training for the time being.

  1. Recovery – Sleep and stress balance is generally far below optimal. An undisturbed 8h a night is generally infrequent due to having small kids in a small house and being a light, easily disrupted sleeper. Life stress is higher than normal after a string of nasty viruses running through the kids, work demands changing, and a pregnant wife struggling with pregnancy-related radiculopathy. I would assume this contributed to the shoulder pain as I also had a bit of a knee tweak on day 1 of last week, I assume at least partly due to the compounding effects of the aforementioned. Hard to improve this area practically.

  2. Training – Do I adjust for a period of time as I deal with a particularly busy string of weeks and adjust to work volume? The pressing volume in the programs combined with daily overhead use seems like a concerning amount of usage for that area, but perhaps this is something I need to change outlook on. I missed the pressing accessory last week due to shoulder discomfort and concern for work ability. I’m confident I’m not exceeding RPE.

  3. Work adjustment – A potential option is loading the other office day I have into the middle of the week, so that I end up having a rest day between work days, and then working Saturday. Not sure if splitting up physical work days like this would be helpful.

Any suggestions? I’d like to have the skill to modify the program effectively if necessary but I’m concerned i.e. dropping a press in favour of a pull or similar would sabotage the program in later phases when there’s an expectation of volume tolerance. I do realize aches and pains are part of the game, but I’m concerned about acquiring new pains requiring management (I haven’t had shoulder pain in quite a while). Trying to maintain optimism and self-efficacy, but it obvious adds to stress to have new issues.

PS – Having to “unlearn” some old training ideas. Is there any merit to the idea of “too much pressing” relative to pulling in the course of a week? I’ve noticed most templates heavily favour pressing and aside from 1 or 2 upper body pulls, there’s relatively little concern for pulls outside of accessories. Is that mostly due to the fatigue of lower body pulls?

Thanks for your support, patience and continually educating us!

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I get the sense that 2 things are going on here:

1- You may be giving these aches and pains more significance and attention than they’re worth, and
2- You may be trying to apply the programming too rigidly to your life situation and context, which may not be as compatible as we’d like due to things that are outside of your control.

In this light, it’s not worth the concern that adjusting the program in the short term to better fit your needs would “sabotage” a later phase of the program … because you can also simply modify the later phase based on where you’re at. I understand people’s reluctance to do this, being afraid of “missing out” on potential progress, or the idea that it is somehow “suboptimal” (even though it is unlikely that any given training template is “optimal” for a given individual, anyway), etc. Training is a long game, and you will be better off learning to “overthink” these details less, be more flexible in the short term without stressing about it, and trying to stack up consistent sessions that can be viewed as “wins” in some way over time.

If your training, work stress, recovery situation, etc., have all led to some shoulder aches, the things I would do first would be 1) dropping RPE targets by 1-2 points (or even more, if needed) on the upper body movements using the affected areas, 2) if that is insufficient to improve things, dropping some of the work set volume from those same slots, and 3) if that is still insufficient, swapping out the exercises for something more tolerable, starting with low RPE targets, relatively low volume, and, if necessary, a tempo component.

PS – Having to “unlearn” some old training ideas. Is there any merit to the idea of “too much pressing” relative to pulling in the course of a week? I’ve noticed most templates heavily favour pressing and aside from 1 or 2 upper body pulls, there’s relatively little concern for pulls outside of accessories. Is that mostly due to the fatigue of lower body pulls?​

There is only “too much” of anything relative to the amount that you have been prepared for, and are ready for at that particular time.

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Thanks Austin, much appreciated.

  1. In previous threads I mentioned my proclivity to pain that I perceive to be abnormal. I have no medical diagnosis on this front as everything from bloodwork to xrays have come up as normal with no signs of OA, RA or anything similar, and pain is not regular or global enough to be consistent with fibromyalgia or similar as far as I’m told. As such I’m trying to learn to reinterpret pain when it occurs by neither ignoring it (have made things chronic this way) nor giving it more attention than it needs. I’ve had a good stretch with this recently with some elbow pain by following BBM protocol, but with something like shoulders there’s a bit more anxiety there given work/life demands. I have the knowledge now thanks to your education on the subject but it seems to take a good amount of practice to genuinely update heuristics when pain strikes. I was previously unfortunately fairly steeped in the McGill/Boyle/DNS “if it hurts don’t do it”/“pain=damage & dysfunction” way of thinking and it seems to be taking a while to flush that out on a more emotional, rather than intellectual level.

  2. You may well be correct here as well, at least in the short-term given increased work volume. Regarding recovery, I’m extremely confident that what I’m currently involved in vocationally isn’t a shred as stressful or consuming as residency, which is why I still suspect that my pain is to some degree abnormal at times, but I do understand that all of this is highly individual. The sleep and stress problems experienced on my end aren’t so much acute as they seem to be more chronic, but am attempting to work on those things as far as I’m able.

Re: Training – Great points, and I completely agree. I’m shooting for the long game and don’t mind short term changes as I’m not aiming for a particular number by the end of the program, for instance. As long as I see progress and am training consistently I’m quite happy. I’m internalizing that SOP for adjusting programming when pain is present, but what I’m less certain about is how to adjust the program down the line.
For instance, if in Week 6 I’m supposed to do 1x5 @ RPE 8, then -5% x4 sets of 4, and I end up having to bump that down to 1x6 @RPE 6.5 then -5% x2 sets of 4 (as a random example let’s say this was Week 4’s plan), when the issues resolve three weeks later and I can scale back up, how do I continue to adjust the program 3 weeks later considering the program “expects” me now to be able to handle 1x4 @RPE 9 with a higher volume of backoff sets? Do I basically just follow the progression back up from the regression I took? So in this example, 3 weeks later the upper body pressing would be at week 7 and the lower body would be at week 9. I assume jumping into the program at the scheduled level of intensity would be perilous but I could be wrong there. Let me know if this makes sense.

Good to know re: pressing and the like. I’m not sure where the notion of “pulling should be at a ratio of 2:1 or 1.5:1” for athletic development and “shoulder health”.

Thanks for the help!

-Rohann

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I am not suggesting that you simply ignore these things when they happen, but rather I observe this (and other) lengthy posts where you seem to analyze every detail of your symptoms, program, and life context when this happens, when there are never perfectly clear, single answers to these things. I certainly recognize that the mindset change can be challenging, but combining all of this with your subsequent concerns about following the program, things falling “off schedule”, etc., can probably become overwhelming.

It doesn’t matter what the program “expects” you to do anymore, once you’ve had to make such modifications. View the programs as a template to be molded to your situation, rather than needing to mold yourself to the program. Even if you don’t ever make it back “on track” with what is programmed by the end of the scheduled weeks due to modifications & detours … that’s completely fine. Trying to force yourself back “on program” if you aren’t fully ready for that (or if you tolerate it poorly anyway) isn’t worthwhile.

As an example: if you have shoulder pain impacting your ability to do 5@8, -5% x 4 x 4, you could modify it to 6@6, -10-15% x 6 x 2-3 sets (and, to be clear: this is just one among many possible made-up options). If that is very well tolerated, you could try that again the next week and see if performance improves with less pain, and keep running that as long as you’re responding. If you want to bump the intensity back up in subsequent weeks, I’d try bumping just the top set up to 5@6 (keeping the larger back-off %), then either 4@6 or 5@7, etc. In this way, maybe you figure out something that you respond to even better than what is originally programmed in the template, in the context of your own life. And of course, if you continue struggling with figuring out such an approach on your own, this is where coaching has a role.

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Apologies, didn’t mean to imply you were. And you’re right, it obviously leads to more focus and anxiety than is necessary, will work on sweating training expectations less. The process with pain since my teen years has been nebulous on a variety of different fronts, from finger pain with musical instruments and typing to back pain with lifts. It’s been a process to try and keep a finger on when or when not to take it seriously vs focus elsewhere and keep going, as well as trying to improve lifestyle aspects that contribute without micromanaging.

Relevant to programming, learning to continue on despite pain has been helpful. I was concerned previously about overshooting due to knee pain symptoms on the program but Jordan encouraged me to keep going with the prescribed RPE values and sets and improvements/adaptations continued positively. Jordan’s symptom guide of “if it’s not worse than a 4, keep going” was helpful in the context of rehab specifically.

Practically, coming up with loosely held “procedures” to follow seems to be helpful to be able to adjust on the fly and not sweat programming, i.e. keep trying to train around the issue and see if things stay the same, improve or worsen; take a mental note of any obvious contributors and whether or not they’re adjustable; follow the program adjustment guidelines as necessary, etc.

It doesn’t matter what the program “expects” you to do anymore, once you’ve had to make such modifications. View the programs as a template to be molded to your situation, rather than needing to mold yourself to the program. Even if you don’t ever make it back “on track” with what is programmed by the end of the scheduled weeks due to modifications & detours … that’s completely fine. Trying to force yourself back “on program” if you aren’t fully ready for that (or if you tolerate it poorly anyway) isn’t worthwhile.

As an example: if you have shoulder pain impacting your ability to do 5@8, -5% x 4 x 4, you could modify it to 6@6, -10-15% x 6 x 2-3 sets (and, to be clear: this is just one among many possible made-up options). If that is very well tolerated, you could try that again the next week and see if performance improves with less pain, and keep running that as long as you’re responding. If you want to bump the intensity back up in subsequent weeks, I’d try bumping just the top set up to 5@6 (keeping the larger back-off %), then either 4@6 or 5@7, etc. In this way, maybe you figure out something that you respond to even better than what is originally programmed in the template, in the context of your own life. And of course, if you continue struggling with figuring out such an approach on your own, this is where coaching has a role.

Right, good points. Programming modification with the combo of RPE and volume is somewhat new to me, so it’s a new skill to learn.

Thanks, will try that modification for OHP. So last week for benchpress I completed 12 reps @RPE 8, -5% from 12 @8 for 2 sets x12 reps. Tried regressing back to 12 @ RPE 6, -15% x 2 sets. Still some discomfort/irritation there while lifting, but will gauge if symptoms progress or stay the same. I’m considering moving away from benchpress for a time, or switching to dumbbells, as I’ve found my numbers have significantly gone down since April when I was just running something akin to the Beginner Prescription at lower volume, although OHP numbers have marginally increased. Obviously this isn’t a specialization block of training, so I wouldn’t expect these numbers specifically to fly.

I know there’s no hard and fast rule here, mostly looking for principles to follow. So the general order of modification (according to the Pain in Training article) would be rep range, RPE values, and then volume? Is there any one factor that you’d rather prioritize, i.e. would you prefer to keep volume, or would you bump volume down and prioritize upping the RPE range when appropriate? I realize this may also be contextual, since in my case I have a significant volume of overhead work that’s low in intensity in addition to property work involving manual labour, so perhaps volume would be something to back off.

I also understand much of this is iterative and a skill that develops over time, I just want to be careful of potentially harmful beliefs about tolerance (i.e. “I don’t tolerate benchpress/volume/high RPE well” or similar if I’m instead missing something).

Thanks for your time, greatly appreciated!

PS – Will submit a questionaire for coaching as I’d like to get more programming education, but don’t want to bog you guys down further. Thanks again!

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I know there’s no hard and fast rule here, mostly looking for principles to follow. So the general order of modification (according to the Pain in Training article) would be rep range, RPE values, and then volume? Is there any one factor that you’d rather prioritize, i.e. would you prefer to keep volume, or would you bump volume down and prioritize upping the RPE range when appropriate? I realize this may also be contextual, since in my case I have a significant volume of overhead work that’s low in intensity in addition to property work involving manual labour, so perhaps volume would be something to back off.
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In general I tend to increase rep ranges and decrease RPE targets simultaneously, then decrease volume if needed after that. As you noted, there’s a fair amount of variation in practice between individuals though.

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Thanks doc, will keep this thread for reference and keep working at the mental shift.

In lieu of starting another thread:

-Phase 3 of the Knee Rehab Template calls for 4 days a week but I likely don’t have the time currently. Should I cycle the days (i.e. D1-D2-D3, D4-D1-D2, D3-D4-D1, etc) or just do the first 3 days for the final few weeks?

-Assuming I can train mostly normally on the Beginner Template following, should I retain some of the GPP work into phase 1 or should I keep it out until phase 2 as prescribed? If I’m still having to back off intensity/volume of push work due to shoulder pain, would your recommendation change or stay the same?

Thanks a bunch for your time!

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Whichever you’d prefer is fine. The concept of scheduling things over a “week” is arbitrary anyway.

If it’s already well-tolerated and not causing issues, would be fine to continue. The recommendation regarding GPP would only be modified if the GPP itself is provocative.

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Thanks, good to know.

I realize now I foolishly neglected to follow Jordan’s earlier recommendation of doing the upper body work from the Beginner Template along with the lower body work from the rehab template. I didn’t realize the rehab template scaled volume and intensity more quickly and the BT was probably more appropriate for where I’m at, as I would have likely been continuing with the rep and total volume scheme from the last week of block 1. I’m continually impressed and appreciative of the precision/accuracy of your recommendations, thanks again.