Chronic Pain Coaching Through Strength Training
An innovative, evidence-based, and compassionate approach to chronic pain management.
How Strength Training Can Help Your Chronic Pain
Living with chronic pain can be a frustrating experience where it can seem like your body has turned against you, particularly if you’re caught in a cycle where the pain itself leads to distress and makes it harder to do daily activities, which in turn makes the pain feel even worse.
At Strength In Motion PT, we understand this profound challenge, and our mission is to empower you to break free from the grip of chronic pain and reclaim an active, fulfilling life through the power of strength training, guided by expert coaching.
do you want to train with someone who understands your pain history?
How We Approach Coaching Differently
We believe that your pain does not have to define you. Our approach is built on the latest understanding of pain, emphasizing a holistic, patient-centered method that addresses not just the physical symptoms, but also the psychological and social factors that influence your experience.
01.
We know you are not imagining your pain
You are not imagining the challenges your body faces, especially in a high-elevation area like Denver¹, where shifts in air pressure can intensify chronic pain symptoms. Or, in a dense urban environment like New York City², where daily elements like traffic congestion, noise, and air pollution can increase the stress and inflammation that exacerbate pain
02.
We take an educational approach
We will guide you through our comprehensive approach, explaining how chronic pain coaching woven with targeted strength training, can help you gain control over your pain, improve your function, and enhance your overall quality of life.
Learn About Chronic Pain Coaching Through Strength Training
Understanding Chronic Pain: More Than Just a Physical Sensation
Understanding Chronic Pain: More Than Just a Physical Sensation
Traditionally, the medical approach to chronic pain treated it as a purely physical problem, with the main goal of completely eliminating the pain. However, modern pain has revealed chronic pain has a biopsychosocial framework – and let’s unpack that.
In simple terms, the biopsychosocial framework is an approach to health that looks at the whole person, not just their physical symptoms. It recognizes that pain is a complex experience influenced by three interconnected factors:
- Bio (Biological): This is the physical part of pain, such as an injury, inflammation, or genetics.
- Psycho (Psychological): This includes your thoughts, emotions, and behaviors, like stress, anxiety, depression, and your personal coping strategies.
- Social: This refers to your life circumstances and environment, including your family, social support, and work life.
Essentially, this framework acknowledges that your mind, body, and social environment all play a role in how you experience and manage chronic pain (1).
Chronic pain often persists long after any initial injury has healed and is rooted in how your brain and nerves process signals, leading them to become hypersensitive and overreact, amplifying normal sensations into widespread pain. This oversensitive nervous system is a core component of many chronic pain conditions.
In many chronic pain conditions, the pain continues long after an initial injury has healed because your nervous system becomes oversensitive and stuck on high alert, turning normal sensations into widespread pain. For example, after a back injury has healed, the light touch of a shirt against the skin might be felt as intensely painful, or a simple movement could trigger aching that spreads far beyond the original site.
This can create a vicious pain cycle: pain stops you from moving, which makes your muscles weak and stiff, leading to even more pain. This downward spiral can seriously impact your daily life, causing you to lose function and feel anxious or depressed. Old treatments that just target the symptoms often fail because they don’t break this cycle, leaving people feeling hopeless. However, through coaching and targeted strength training, it is possible to break this cycle, manage the pain, and improve your life (1).
(1) The biopsychosocial approach to chronic pain: scientific advances and future directions
High Altitude of Denver, Colorado & a Chronic Pain Coach
High Altitude of Denver, Colorado & a Chronic Pain Coach
For those living in high-elevation areas like Denver, the local climate can add another layer of complexity to chronic pain. While you might feel like you’re imagining a link between changing weather and your pain, scientific evidence suggests a real connection.Denver’s high altitude means we experience lower average barometric pressure compared to sea level. This reduced external pressure can cause tissues within your body, including those around and within your joints, to slightly expand. Even the joint lubricant (synovial fluid) can expand, increasing pressure within the joint capsule and potentially irritating existing arthritis. In a healthy joint, this might go unnoticed, but in a joint already affected by osteoarthritis or rheumatoid arthritis, this slight expansion can increase tension on membranes and irritate nerves, leading to increased pain and stiffness (1).
Research indicates that the speed of barometric pressure change also matters; a sudden drop, like before a Colorado thunderstorm, can significantly stress pressure-sensitive cells in joint tissues, causing a noticeable spike in inflammation and pain (2). Additionally:
Increased Nerve Sensitivity: The “thinner” air at high altitude means less oxygen in each breath, making you more susceptible to bouts of hypoxia (insufficient oxygen). This can make your entire nervous system hypersensitive and overreactive, lowering your pain threshold and amplifying pain signals.
Lighter Air, Heavy Feeling: The lower air pressure causes subtle expansion of body tissues and joints. For a body with an already hyper-alert pain system, this subtle swelling can be misinterpreted as a major pain signal, intensifying symptoms.
One-Two Punch for Your Stress System: Living at a high altitude puts a constant strain on your body’s stress management system. This strain, combined with the stress of managing chronic pain, creates “a one-two punch” that can overwhelm your system. This can result in normal contact with your body intensifying all your symptoms and make both the pain and the feeling of stress much more difficult to manage.
While we can’t change Colorado’s barometric pressure, chronic pain coaching with a physical therapist can be a powerful tool for managing the unique challenges of living at a high altitude. Our expertise helps clients build a stronger, more resilient body to counteract the physical effects of low barometric pressure and reduced oxygen. This includes a personalized strength training program that improves joint health, reduces nerve sensitivity, and boosts the body’s overall ability to handle stress.
Furthermore, a coach helps clients overcome the mental and emotional hurdles associated with chronic pain, such as the fear of movement and feelings of discouragement. By providing consistent encouragement and a system of accountability, we coach you stay committed to your treatment plan. This approach empowers you to take an active role in their recovery, turning the challenges of living at high altitude into an opportunity to build lasting health and a better quality of life.
(1) McAlindon, T. E., Formica, M., Schmid, C. H., & Fletcher, J. (2007). Changes in barometric pressure and ambient temperature influence osteoarthritis pain. BMC Musculoskeletal Disorders, 8, 1-6.
(2) “Influence of Barometric Pressure in Patients with Migraine Headache” by Motoo Yamagami, et al., published in the journal Internal Medicine. Research supports the idea that the speed of barometric pressure change can induce physical pain, particularly for conditions like migraines and various forms of chronic pain.
Urban Environment of New York City & a Chronic Pain Coach
Urban Environment of New York City & a Chronic Pain Coach
For those living in a dense, fast-paced metropolis like New York City, the environment itself presents a unique set of challenges that can dramatically influence chronic pain (1). It’s not just your imagination; the daily grind of city life—the noise, the pollution, the sheer density of it all—is scientifically linked to physiological changes that can turn up the volume on pain sensitivity.
The constant sensory input and psychological demands of New York City can keep your body in a sustained state of high alert that has direct physical consequences. The city’s environment creates a perfect storm of stressors that can exacerbate the biological and psychological drivers of chronic pain. Research shows that factors like air and noise pollution trigger inflammation and stress responses, while the psychological pressure of urban living can keep your nervous system in a state of overdrive, making you more susceptible to pain (2). It’s worth noting:
- Systemic Inflammation from Air and Noise Pollution: The air in a traffic-congested city is filled with pollutants like fine particulate matter, which are known to increase inflammation and oxidative stress throughout the body. This low-grade inflammation can worsen the conditions that cause chronic pain. At the same time, the relentless noise from traffic, sirens, and construction acts as a chronic stressor, activating the body’s stress-response system and elevating hormones like cortisol, which can heighten pain sensitivity and lead to constant muscle tension.
- The “Commuter’s Burden” and Psychological Overload: The daily commute in New York City, whether driving in traffic or navigating crowded subways, is a significant source of psychological stress, frustration, and anxiety. This daily stress is linked to increased blood pressure and musculoskeletal problems, feeding directly into the chronic pain cycle. Furthermore, the fast-paced, high-pressure culture and lack of quiet, green spaces for mental restoration can lead to burnout and attention fatigue, making it harder for your brain to down-regulate pain signals.
While you can’t change the fundamental nature of New York City, understanding how these environmental factors impact your body is the first step toward developing targeted strategies to build resilience and better manage your pain. A chronic pain coach provides support for New Yorkers by helping you build a stronger, more resilient body to counteract the physical effects of noise and air pollution, and the high-stress urban lifestyle. This includes a personalized strength training program that improves resilience and boosts the body’s overall ability to handle stress.
Furthermore, a coach helps you overcome the mental and emotional hurdles associated with chronic pain, such as the fear of movement and feelings of discouragement. By providing consistent encouragement and a system of accountability, the we help you stay committed to your treatment plan. This approach empowers you to take an active role in your recovery, turning the challenge of living in NYC into an opportunity to build lasting health and a better quality of life.
(1) Back Pain and NYC’s Concrete Jungle: How Urban Living Contributes to Chronic Pain
(2) City Living with a Chronic Illness
Chronic Pain Coaching Through Strength Training Physical Therapy
Chronic Pain Coaching Through Strength Training Physical Therapy
Despite the challenges posed by chronic pain and unique environmental factors, there’s extensive evidence that strength training is one of the most effective non-pharmacological tools for managing chronic pain, improving the range of motion, and revitalizing joint health(1).
When you’re in pain, it’s natural to want to protect yourself by resting and avoiding movement. While short-term rest can be helpful for an acute or severe pain, long-term inactivity actually creates a debilitating cycle: muscles weaken, they become less able to support your joints properly, and this leads to more pain and further physical decline. However, adopting a strength training program is an effective way to break this vicious cycle, manage your pain, and improve your life.
Strength training reverses the debilitating cycle of chronic pain by rebuilding your muscles into a supportive structure that also acts as a shock-absorbing system for your joints, making everyday tasks easier and helping you return to your full active lifestyle. It’s important to know that research has disproven the common myth that strength training could harm your joints if you have osteoarthritis or rheumatoid arthritis. Studies actually show that when properly guided, strength training is a safe and effective way to reduce pain and get stronger, without making the disease worse (2).
However, starting a strength training program when you live with chronic pain can feel intimidating and the fear of causing a flare-up is a valid concern. This is where the guidance and support of a strength training coach who is also a trained physical therapist is uniquely valuable.
As physical therapists we understand anatomy, biomechanics, and your specific abilities and condition, all enabling the design of a safe and tailored program. You’ll learn the correct form to prevent injury, and be shown how to modify exercises during difficult pain days. As a coach, we provide the motivation, accountability, and support to help you overcome the psychological barriers, like fear of movement, that often accompany chronic pain. You’ll build confidence, stay consistent, and turn the principles of strength training into a sustainable part of your life, ensuring you not only get stronger but also gain long-term control over your pain and well-being. There’s also plenty of research that shows that exercise programs are more effective when supervised, and we’re ‘dual experts’ providing guidance in strength training and physical therapy.
(2) Strength training in older adults: The benefits for osteoarthritis
The Science Behind Strength Training Physical Therapy for Chronic Pain
The Science Behind Strength Training Physical Therapy for Chronic Pain
The effectiveness of strength training for chronic pain management is rooted in several key physiological and biomechanical mechanisms (1):Natural Shock Absorption & Joint Stabilization: Strengthened muscles surrounding a joint can bear more of the load during movement thereby offloading pressure from inflamed joint capsules and delicate cartilage. This reduces pain (3) and protects the joint from further stress.
Anti-Inflammatory Effects (Myokines): Your muscles have a sort of “built-in pharmacy” and when contracting during strength training create and release natural anti-inflammatory substances called myokines throughout your body. As a natural anti-inflammatory myokines calm inflammation from conditions like osteoarthritis, rheumatoid arthritis, and more.
Improved Bone Health: According to Wolff’s Law, weight-bearing such as squats or lunges, and resistance exercises with elastic bands apply controlled stress to your body that signals bone-building cells to deposit new minerals, reinforcing bone structure and increasing bone density. This is particularly beneficial for those coping with osteoarthritis and rheumatoid arthritis.
Neuromuscular Control, Balance, & Coordination: Strength training fine-tunes the connection between your brain and muscles, leading to more precise movements, better balance, and improved coordination. For anyone with unstable joints or a fear of falling, this enhanced stability builds confidence during daily activities and significantly lowers the risk of fall-related injuries.
Responding to Muscle Loss (Cachexia): Chronic inflammation, particularly in rheumatoid arthritis, can lead to rheumatoid cachexia—a significant loss of muscle mass. Research confirms that strength training can counteract Cachexia without worsening joint damage or inflammation (2).
Today, strength training for chronic pain is based on the biopsychosocial model, which recognizes that pain is a complex experience influenced by biological, psychological, and social factors. As physical therapists we use strength training as a way to relieve pain, restore function, improve joint stability, and teach the nervous system that movement is safe.
(1) Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews
(2) Benefits of Exercise in Rheumatoid Arthritis
(3) Pain sensitivity is reduced by exercise training: Evidence from a systematic review and meta analysis
Patient-Centered Chronic Pain Coaching
Patient-Centered Chronic Pain Coaching
Health coaching by definition is a patient-centered, collaborative partnership wherein you are determining your own goals with the support and guidance of a coach. Strength training’s success is profoundly boosted by chronic pain coaching, an overarching approach designed to empower you towards an “I can do this” mindset, where you actively engage in your own healing journey. Key aspects of chronic pain coaching include:Action Strategies: Coaching involves applying ‘action strategies’ which are evidence-based behavior change techniques, such as goal setting and principles of positive psychology. This isn’t about you being told what to do; it’s about using skillful conversation to help you set realistic goals, identify obstacles unique to your situation, and develop personalized strategies to overcome them. What does this look like? When the aim is to establish clear, measurable goals, instead of a vague goal like “get stronger,” a coach helps you define specific targets. This could involve setting a goal to increase your squat by 20 pounds in 8 weeks or to consistently train three times a week, etc. We’ll celebrate even small victories and frame setbacks as learning opportunities rather than failures. If a lift is missed a coach focuses on what you can adjust for the next attempt.
Supporting Self-Discovery: As a Physical Therapist Strength Coach, my goal is to guide you in discovering your own internal reasons for a healthier, stronger life. Rather than simply assigning exercises, I serve as a facilitator of self-discovery. This involves providing you with foundational knowledge about strength training and how it can build resilience in your body. From there, I create a supportive environment for you to explore what truly motivates you, asking questions that help you connect your physical goals to your life aspirations. This approach moves beyond simply following a plan to helping you develop an internal drive for long-term change. For example, if you’re dealing with back pain, our conversation wouldn’t just focus on the mechanics of exercise. Instead, I’d ask what activities you miss the most. If your answer is “playing with my grandkids,” this becomes a powerful internal drive, the core of your motivation and something you will sustain.
Accountability and Support: As a Physical Therapist Strength Coach I am your partner in the challenging, sometimes unpredictable journey of recovering from chronic pain. I do more than just give you an exercise plan; I create a system of accountability and support to keep you engaged and moving forward. We’ll set clear expectations and when you face setbacks, I’ll provide encouragement, help you problem-solve, and help you see those obstacles as a normal part of the process, not a failure. Recovery from chronic pain is rarely a straight line, which makes this consistent support vital. For example, if you have a pain flare-up and miss a few workouts, my response won’t be critical. Instead, I will immediately offer support, validate your experience, and praise you for communicating the challenge.
We’ll then work together to adjust your plan to accommodate the setback, focusing on what you can do rather than what you can’t. This approach keeps you accountable to your health and reinforces that I’m here to support you through the ups and downs, which is crucial for achieving lasting results.
Chronic Pain Coaching: The Strength In Motion Approach
Chronic Pain Coaching: The Strength In Motion Physical Therapy Approach
At Strength In Motion PT, your safety and well-being are our top priorities. We understand that when you’re dealing with pain, the natural instinct is to rest, and starting a new exercise program can feel scary. That’s why we’ve designed a smart, custom-tailored strength training and exercise program to help you actively manage your chronic pain. While every plan is unique, here is a general idea of what you can expect on your journey with us:
Phase 1: Personalized Baseline Assessment and Goal Setting
Your journey begins with a thorough, personalized assessment and we start by listening to your story. We’ll ask specific questions about your pain – where it is, what it feels like, what makes it better or worse – and delve into the nature of your fatigue, sleep quality, and, most importantly, how these symptoms impact your daily life and what specific activities you hope to be able to do again. This detailed conversation is important for us to understand the emotional, physical, and psychological complexities you face.
Following this, we conduct a gentle physical assessment to establish a safe baseline for your treatment plan. This hands-on evaluation may involve looking at your posture, checking the range of motion in your key joints, performing simple strength tests, and observing how your body handles functional movements like standing up from a chair or walking.
A significant part of this initial phase is education. We will begin to explain concepts like the “pain cycle” – how pain can lead to inactivity, which then causes weakness and often more pain – and the critical importance of pacing yourself to avoid triggering symptom flare-ups. We’ll help you understand the “why” behind your pain, focusing on how your nervous system, thoughts, emotions, and behaviors interact to influence your symptoms. This foundational understanding is key to helping you reconceptualize your pain and embark on real, lasting change.
Finally, based on everything we’ve learned, we’ll work collaboratively with you to set realistic, meaningful, and patient-determined goals. These goals will be important to you and align with your values, ensuring that your path to recovery is truly your own. When we say “your values“, it means connecting your health goals to what you truly care about in the context of chronic pain recovery. Instead of simply aiming to “get stronger,” your recovery path is shaped by what strength will allow you to do. For example, if your value is family, your goal might be to have the endurance to play with your children or the strength to pick up a grandchild. If your value is independence, your goal could be to be able to lift a grocery bag without pain or climb stairs without a flare-up. By aligning your health goals with these personal values, your motivation to stick with a challenging recovery process becomes internal and transforms a clinical plan into a deeply personal mission.
Phase 2: Gentle Introduction and Gradual Progression
Initial strength training plans are fairly gentle, designed to activate muscles without stressing painful joints. We begin together with low-resistance exercises, focusing completely on proper form to ensure your joints are always supported and protected. This might include simple breathing exercises to calm the nervous system, one or two very specific stretches, or advice on how to modify a daily task to reduce strain.
It’s always sensible and prudent to “start low and go slow”. Sessions usually begin with a gentle warm-up and end with a cool-down to prevent soreness. Many people find it helpful to use a heating pad or take a warm bath for about twenty minutes before and after a session, as heat can be wonderful for easing stiffness.
As you feel stronger, we will progress gradually and at your own pace. Our programs are adaptable, and during pain flare-ups, we won’t push through the pain. Instead, we can shift to gentle range-of-motion movements or even simple muscle tensing without movement, just to keep those muscles active without stressing them. We empower you to listen to your body, always feeling able to adjust or stop if an exercise causes discomfort.
Phase 3: Targeted Strength Training and Exercise Selection
With a solid foundation in place, the focus shifts to more dynamic strength training. This involves moving your joints through a full range of motion with resistance from light weights, elastic bands, or your own body weight. You’ll learn the proper technique for each exercise, minimizing stress on vulnerable joints and preventing injury. Examples of exercises we might implement, depend on your condition and goals:
For Knees and Hips (common in osteoarthritis): Controlled chair squats, straight leg raises, glute bridges, seated leg extensions, hip flexion/extension, and step-ups. These exercises build powerful shock absorbers and provide stability, helping you move with more confidence and less pain.
For Hands and Wrists (vulnerable in osteoarthritis and rheumatoid arthritis): Low-impact exercises such as gently squeezing therapy putty, performing slow wrist curls with very light resistance, or spreading the fingers against a rubber band. These target forearm flexors, extensors, and intrinsic hand muscles, shielding delicate, inflamed joints when gripping or manipulating objects.
For Back and Shoulders: Overhead and lateral arm extensions, single arm dumbbell rows, facepulls, rear delt flys, single arm dumbbell bench presses, and kneeling shoulder presses. Core exercises like planks and side planks also support spinal stability. We’ll advise on appropriate depth and weight, avoiding above-the-shoulder exercises if arthritis is present in the upper body, or modifying them.
We may also include multi-joint (compound) exercises like squats, push-ups, and lat pull-downs for greater overall benefit, while minimizing eccentric loading and pain-provoking postures. A typical starting point might be two or three non-consecutive days a week, performing a couple of sets of 8 to 12 repetitions. As you gain strength, there will be gradual increases, always prioritizing how your body feels.
Phase 4: Coaching and Behavioral Change Integration
Throughout your program you’ll receive continuous support to help you navigate the complexities of chronic pain management including:
Motivational Interviewing: In coaching, motivational interviewing is a way of talking that helps you find your own reasons for change. Instead of telling you what to do, we as your coach act as a guide, helping you explore your personal values and goals. This approach helps you work through any doubts you have, so you can develop a strong, personal drive to move forward.
Identifying Obstacles and Strategies: Coaches work with you to identify specific obstacles that might hinder your progress and collaboratively develop strategies to overcome them. This could involve finding ways to fit exercises into a busy schedule, managing competing demands, or addressing the impact of life’s challenges on your motivation.
Emotional Support and Validation: Living with chronic pain can be emotionally exhausting. We provide empathy, encouragement, and positive reinforcement, helping you navigate the emotional challenges and build resilience. We understand that recovery is not a straight line, can ebb and flow, and we’ll be there every step of the way to explain what’s happening during challenging times, reassuring you that you’ll emerge stronger.
Accountability and Self-Efficacy: We help you build a system of accountability for your strengthening journey. This structured support, along with your growing physical abilities, helps you develop self-efficacy—your belief that you can manage your condition and reach your goals. Studies show that when people feel more in control of their health, they experience a significant benefit.
Phase 5: Lifelong Strength and Function – Sustaining Your Gains
The ultimate goal of our program is to empower you with a stronger, more resilient body that can better manage the daily challenges of chronic pain, and sustain your gains long-term. We understand that chronic pain is a long-standing condition requiring strategies that ensure lasting change.
Progressive Overload: We will continue to gradually increase the weight or resistance over time, ensuring your muscles are always challenged to grow stronger. This principle is key to continued improvement and adaptation.
Functional Movements: Exercises will increasingly mimic daily life activities to improve your functional capacity. For example, a “farmer’s carry” (walking while holding weights) builds the core and grip strength needed for carrying groceries.
Continued Support and Resources: We emphasize consistency, which is key for long-term benefits. We can offer strategies for self-care, like applying heat before exercise and ice afterward. We also equip you with the skills and confidence to safely and effectively manage your own strength and well-being for years to come, empowering you to be the primary expert in your ongoing journey with chronic pain.
At Strength In Motion PT, we don’t just provide a course of treatment; we provide a therapeutic journey that helps you move beyond managing pain to actively improving your overall strength and resilience. You should leave your first appointment feeling heard and understood, with a clear and safe roadmap for moving forward, establishing a trusting partnership that will help you begin to manage your symptoms and improve your quality of life.
Chronic pain is a complex, multifaceted challenge,
but it is not a life sentence.
While traditional medical approaches often fall short in addressing the full scope of the biopsychosocial experience of pain, the integrated approach of chronic pain coaching through strength training offers a powerful, evidence-based pathway to recovery and resilience.
Evidence-based Approach
While traditional medical approaches often fall short in addressing the full scope of the biopsychosocial experience of pain, the integrated approach of chronic pain coaching through strength training offers a powerful, evidence-based pathway to recovery and resilience.
A blend of physical therapy & health coaching
We offer a unique blend of expert physical therapy and compassionate health coaching, designed to meet you where you are and guide you every step of the way. We are here to walk beside you, providing the knowledge, guidance, support, and empathy you need to discover your own courage and thrive despite your pain.