When someone in your bootcamp or training group is limited by lower-back, shoulder, or knee pain, here are 15 creative ways to modify the program without compromising results.
Group training, when it works, is an amazing process. By training more people in the same amount of time, it’s profitable for you and a fun, cost-effective way for your clients or participants to get a great workout. It’s also an unparalleled showcase for your personality and coaching skill.
But the best feature of group training—the idea that a group of individuals can do the same workout in more or less the same way—can turn into the biggest challenge. What happens when one participant can’t do the same exercises? How do you help that client work around a minor injury or nagging pain?
I’ll start with the usual disclaimer:
It’s not our job to diagnose or treat injuries. But if we turned down everyone who has aches and pains, we’d be out of a job. Thus, we have to find ways to give our clients what they pay for—a good workout—without making their injuries worse.
Most of the time, pain stems from poor movement quality, overly ambitious loads, and too much volume. Which means that, most of the time, you can relieve the problem by cleaning up the client’s form, working with lighter weights, and using fewer sets and reps.
When the problem persists, you have to get more creative with your exercise selection. I’ve successfully used these exercises for clients dealing with lower-back, shoulder, and knee pain—the most common injuries we encounter.
Shoulder pain usually stems from some combination of soft-tissue restrictions in the upper back, poor scapular movement, and past injuries. You rarely have enough time in a group setting to figure out which is the most likely culprit.
Instead, I employ two strategies:
- For the client who has pain, I use the following mobility drills between sets of lower-body exercises, or in place of a pain-triggering exercise the rest of the group is doing.
- The strength exercises typically work well for everybody in the group, and help me avoid singling out the injured client.
Acumobility Upper-Back Release
This exercise with Acumobility balls helps release tension in the middle back and restore upper-back and shoulder mobility while also engaging core and hip muscles.
Done properly, most clients will benefit from this combination of thoracic extension and rotation, and get a good pec stretch in the process. Be careful though: Some clients will throw their arm around in a circle, rather than initiating the movement from the shoulder blade.
Don’t worry if a client can’t get his arm to the ground at first. The range of motion will improve with practice.
You can also regress the drill with the side-lying rib roll, as shown here.
Another regression option, if your space allows the setup, is the assisted T-spine rotation.
The landmine press is my go-to exercise for clients with shoulder issues; most can do it without pain, and it delivers similar benefits to other horizontal-press variations. Still, it’s not completely foolproof.
The video shows three different stances, in a progression from half-kneeling to staggered-stance to standing with feet parallel. The latter is the most common variation, but because some clients will go into lumbar hyperextension to achieve the range of motion, it’s probably not the best one to start with.
Dumbbell Chest-Supported Row
Rowing variations can get ugly. Even uninjured lifters will often avoid using the targeted muscles by rotating their shoulders on single-arm rows or shrugging their shoulders on cable machines.
But there’s another problem you’ll see with someone who has dysfunctional shoulders: too much range of motion, leading to or exacerbating shoulder pain. The telltale sign is when the elbows travel past the torso.
The chest-supported row limits that risk, although it doesn’t eliminate it; you’ll have to watch your client to make sure she gets a good squeeze through the shoulder blades and stops the movement with her upper arms on the same plane as her torso.
Double-Kettlebell Front Squat
A client who lacks upper-body mobility will struggle with seemingly unrelated exercises, like barbell squats. That’s why this front-squat variation works so well.
“Knee pain” is a highly subjective term. You’ll see a lot of clients in group settings who have it, but few who can help you pinpoint the cause. These exercises will help you avoid putting stress on the knees.
Clients with knee pain often lack movement quality of the hips. The shin box is my favorite hip mobility drill. It improves both internal and external rotation, which can help reduce knee stress on squats.
Be careful with clients whose discomfort in on the medial side of the knee; this exercise can make it worse.
Goblet Box Squat
The box squat tends to be more posterior-dominant, reducing knee stress during the eccentric phase. But most clients will require coaching. Otherwise, they’ll tend to rock forward as they come off the box, which could put stress on the anterior knee.
If the box squat still causes knee pain, you can punt on knee-dominant exercises and substitute hip hinges. The band pull-through and double-kettlebell deadlift are two of my favorites.
Slideboard Reverse Lunge
The slideboard reverse lunge recruits the glutes and hamstrings more than a traditional lunge, which should minimize knee discomfort, as long as the trunk and tibia remain upright and there’s no side-to-side knee movement.
Two-Arm Single-Leg Deadlift to Dead Stop
The short range of motion is extremely knee-friendly, and using two weights should minimize the hip rotation you often see with the more common single-arm version.
Back pain can have any number of causes, but there’s a simple reason why you’ll see so many clients who have it: Many of them hurt their backs while working out. Spine biomechanist Stuart McGill, PhD, typically sees the toughest cases, and in this article for The PTDC, he notes that more than half the people he sees were injured because they were following the advice of personal trainers.
Offset Kettlebell March
For most clients with back pain, the safest and most beneficial options are tried-and-true stability exercises like side planks, bird dogs, and dead bugs. You probably do those anyway, and you’ve probably seen that your more advanced clients quickly adapt to them and soon need something more challenging.
That’s why I like these variations on the suitcase carry. They challenge the body to resist lumbar extension, rotation, and flexion, while also promoting hip mobility and single-leg stability. Even clients who are fairly strong will benefit from this drill.
I’ve had great success with bridges among clients with back pain. But it really depends on two things: the severity of pain, and whether they can initiate the movement through the hips, rather than the lower back. With good form, slow movements, and a full contraction at the top, your clients can get all the benefits without using the extremely heavy weights you often see in videos.
Lunges and step-ups typically work well with clients who have back pain, as long as they don’t also have knee issues. When you hold the weights at your side, you avoid putting an excessive load on the lumbar spine without sacrificing strength or muscle gains.
No Matter What, Give Your Clients a Training Effect
These are just a handful of the many ways you can work around your clients’ injuries, with the goal of giving your clients what they pay for: a training effect. Usually that means an improvement in body composition, although, as we all know, no client has ever complained about increasing strength and endurance in the process of getting leaner.
Just keep in mind what I said at the beginning: We aren’t in the pain-management business. If a client still experiences discomfort after you adjust her program to accommodate the issue, recommend a visit to a qualified and licensed health professional. (Ideally, you can refer them to one you trust.)
In other words, you need to be aware of your own limitations, along with those of your clients. Don’t take risks with their health, or your career.