Back Pain? Knee Pain? Shoulder Pain? Here’s How You Handle Them.

Alex McMillan

Alex McMillan

Head Trainer, Mid Age Man

Today, a client presented with pain in his shoulder. Knee and back pain are other common concerns. How should you treat it? If your answer is "rest and recuperate," you're wrong. Even surgery and painkillers don't really work. Painful experience yields one clear result ...

Today, I was just starting a workout session with a client when he told me he had some pain in his shoulder. “Stress,” is how he put it. Stress on the shoulder, and maybe stress caused, it too!

I used to know how to treat such nagging pain. Give it some rest. You’ve probably overworked that part of the body. Avoid any strenuous exertion to that area, take it easy, and then very gradually inch your way back into activity.

Today, I told my client we should go right at that part of the body. Work it over. Surprisingly, he agreed. And you know what? It worked.

Why? I’ve had a total rethink. With anything other than an acute injury – think bone sticking out of skin – it’s likely that the muscles surrounding the point of pain need strengthening. It may even be the case that the fascia, tendons or ligaments have grown in a bunched-up manner.  In which case, they need untangling.

In any case, when presented with nagging dull pain, I say attack that area. Go after it. It’s counterintuitive, but the best medicine for a painful part of the body is to give it more work, not rest.

It turns out I’m not totally crazy. Back pain is the world’s leading cause of disability, but it is routinely mishandled by doctors. Surgery, opioid pain relievers and other intrusive treatments are routinely and incorrectly administered.

“Exercise and psychological therapy are the only things that work for most cases of chronic back pain, but too many people wrongly believe the myth that rest is best for the condition,” doctors concluded in a series of articles in The Lancet, the world’s top medical journal.

“Doctors prefer to offer useless and often harmful treatments rather than tell patients there is nothing to be done except stay active,” the scientists conclude, according to this article from The Times.

A TRX can provide just the right amount of “torture” for a painful shoulder, since you can easily adjust the weight and pressure on the joint.

An interesting side note is that psychotherapy and your mental attitude also help with pain. If you feel like you’re going to tackle the pain and make it better, it will get better. If you feel like there’s nothing you can do about it, and you’re doomed to a life of permanent pain, that may be self-fulfilling.

Psychological techniques can help with pain and even stop it leading to permanent disability. “Your belief system and psychological state are important predictors of whether you’re going to end up disabled. It’s a difficult message to get across,” Martin Underwood, one of the authors of the Lancet series, said.

My previous attitude essentially amounted to “Ignore it, and it’ll go away.” Now I’d prefer to be much more proactive.

I’ve come to this conclusion through painful personal experience. Just after Christmas, I headed to Hokkaido for eight straight days of snowboarding. When I say “straight,” I mean it, too. Once I get out on the slopes (which, granted, may not be first tracks – I’m not a morning person), I stay on the slopes. Until they shut. Then I get up again and do that the next day.

Of course, I overdid it. I pretty much only get to board once a year!

By the end of the seventh day, my knee had begun to ache, and then got very swollen. With the last day of boarding ahead, I ignored every brain cell in my body and got back on the board. At lunch time on the eighth day, my knee was about the size of a football. Which meant I kept going, but slower. By the end of the trip, I couldn’t really walk at all.

I knew I would pay for it. It’s taken until now to rehab my knee, and I’m still not sure it’s “right.” From the advice on both the British National Health Service and the U.S National Institutes of Health, though, unless things are so bad I need to go for surgery, the best solution is to let nature take its course.

I’m done with rest. Some days my knee is totally fine, other days it still hurts. But I’ve noticed from workouts that if it is getting a little uppity, working it out in a very targeted and careful way really helps.

Romanian lunges, in which you carry weights of your choice (20 lbs x 2 right now), suspend your back leg on a workout bench, then lunge on one leg, work well. So do regular weighted lunges. And squats.

Working out my legs for 20 minutes or so typically ensure my knee feels better for the rest of the day, and more than likely the next one, too.

Romanian lunges can help rehabilitate a knee if the movement is carefully controlled.

That’s why, today, when my client presented this shoulder problem, I suggested we go after it.

First we tried some “foam rolling,” which sounds very pleasant, but shouldn’t be if you do it right. “Self-myofascial release,” to give it a fancy name, requires finding your points of tension, then applying pressure.

I have a nasty little ActiveBall, which is not foam at all. It’s more like two baseballs, covered in rubber and joined together. You roll your muscle over the ball until you find that pain, then press. Oh and the ActiveBall vibrates, to give you an extra goosing.

Then my client and I worked out with the TRX: back extension, 45-degree back row, chest flys, deltoid flys, chest press … anything we could figure out that would get that shoulder going.

The pain eased. We’re not kidding ourselves that it’s gone. More often than not, if you have a muscle problem, the muscles on the other side of your body are too tight. That’ll take longer-term stretching to ease up.

So I gave my client homework, with lat (latissimus dorsi = back) stretches on the stability ball, and pec (pectoralis major = chest) stretches that you can do just standing against a wall. And I’ve told him to keep that shoulder ticking over.

Now there are plenty of warnings in my training that, as a personal trainer, I shouldn’t overstep my bounds. I’m not a doctor. I’m not a physiotherapist. So if you have serious pain, you should consult those professionals. And in fact I have a vested interest in telling you to move your body – I wouldn’t have a job without it!


I want to make it clear that I’m not talking about acute pain, or sharp shooting nerve pain. If you have sudden symptoms, stop.

But for mild, ongoing, irritatingly dull but persistent pain, I recommend working the muscles surrounding that joint, and strengthening that part of the body.

If life is a pain in the neck, do something about it!

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About the author

Alex McMillan

Alex McMillan

Head trainer at Mid Age Man. Alex believes there are four pillars to being healthy: physical fitness, sensible nutrition, mental strength, and wellbeing for your body and soul.

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