Strength Training for Pain Tolerance
Common misconceptions about pain, weakness, and strength training
“You can’t go wrong getting strong.”
Have you heard statements like these from friends, family, or healthcare professionals?
“Your back hurts because your core isn’t strong enough.”
“Your knees are in pain because they’re weak and unstable.”
“Your glutes aren’t firing properly—that’s why your hips feel so tight!”
It seems simple. If we strengthen “X” then my pain goes away!…Right?!
This month, we’re unpacking common misconceptions about pain, weakness, and strength training. Many clients come to SiM asking which specific exercises will help them eliminate pain. While strengthening can be part of a rehab plan, it’s important to understand that strength training is just one of many tools for managing painful conditions.
A Shift in Perspective
Early in my career, after graduating from physical therapy school, I noticed that much of what I had learned about pain and strength didn’t align with real-world experiences. In school, we were taught that most painful conditions stem from some kind of weakness.
However, in my first clinical experiences, I worked with patients who had neurological injuries and significant weakness but little to no pain. On the other hand, I treated strong powerlifters and athletes who were in tremendous pain despite showing no signs of weakness—only altered movement patterns. If strength was the key to being pain-free, how did that make sense?
Over time, I’ve realized two important things:
Understanding persistent pain is incredibly complex (so if it feels confusing, you’re not alone).
Pain is rarely caused by just one factor.
Capacity vs. Tolerance
Now that I work with a broader range of people, I’ve found that most clients already have relatively strong bodies—they can move and generate force, but many struggle with tolerating certain types of forces.
For example, someone with low back pain might find it difficult to bend over and pick something up (a low flexion force) which leads to adopting movements to prevent any type of bending of the spine. While they may still have the capacity to lift a heavy object, their tolerance for that movement is low, thus triggering behaviors such as avoidance of bending out of fear or concern of injury.
In rehab and training, distinguishing between capacity and tolerance is crucial:
Capacity: Your ability to produce maximal force through a range of motion.
Tolerance: How much of that capacity you can use with minimal to no symptom response.
Many people struggle to find the right balance in training while dealing with chronic pain. Some push too hard and experience flare-ups, while others avoid discomfort entirely, fearing it will worsen their symptoms. Often, people fail to realize which movements or forces they are intolerant to and how that relates to their daily activities.
As a result, some may avoid certain movements altogether (going too easy), while others keep forcing movements that repeatedly trigger flare-ups (going too hard).
Training for Tolerance
Instead of viewing strength training as just a way to get stronger, think of it as training for tolerance. The goal is to gradually build your ability to handle different forces without triggering pain.
For example, a client experiencing low back pain with deadlifts may have a one-rep max of 255 pounds but consistently flares up anytime they approach this weight. We might adjust their training by:
Reducing the load to a more tolerable level
Implementing a slow tempo to improve movement control
Introducing alternative movements to accommodate mobility limitations
By finding a manageable tolerance threshold, we create a sustainable starting point for progress.
But What About Training for Strength? (I’m weak!)
If you are deconditioned or have genuine weakness after an injury, what can you expect from strength training?
Short-Term (2-4 weeks)
Neuromuscular Adaptations: Your body becomes more efficient at recruiting muscle fibers, leading to noticeable strength improvements without much muscle growth.
Technique Improvements: Better form and movement patterns help you lift heavier weights safely.
Medium-Term (6-12 weeks)
Muscle Growth (Hypertrophy): Visible muscle gains contribute to increased strength.
Steady Progress in Lifts: Beginners can typically add 5-10 lbs per week to compound lifts (squat, bench, deadlift).
Long-Term (6+ months - years)
Significant Strength Gains: With consistent progressive overload, you can double or even triple your starting strength over time.
Plateaus & Refinements: Strength gains slow down, requiring advanced techniques like periodization, deloads, and varied rep schemes.
Why Is Time Important?
Building tolerance takes time. Once your tolerance increases, you can also build your capacity. Too often, people follow an approach that is either too aggressive (leading to flare-ups, time off, and the rehab cycle) or too easy (resulting in inconsistency and deconditioning).
Rehab requires consistency and patience. If you’ve been experiencing pain for a long time, progress will require a structured plan and accountability. (That’s where your programming and TrueCoach come in SiM clients!)
What Do We Suggest?
If increasing tolerance takes time, so does increasing strength. That’s why we use at least an 8-week pathway with our clients. A few weeks is simply not long enough to see meaningful changes in tolerance and strength. Rehab is akin to learning, when was the last time you learned something really complicated and felt like you had a masterful understanding of it? Think back to semesters of school, we would devote weeks/months/years to better understanding “math”, “science”, “history” etc – yet so many of us do not give ourselves the same opportunity when it comes to better coping with pain.
This is where we need to think about long-term health and pain management. While our goal is to increase what we can do (higher capacity), we often need to start by building a solid movement foundation (increasing tolerance). The great thing about this is that there is no secret recipe or set of exercises that are better than the next. Movement should be fun, personalized, and progressive – when we have those ingredients in place the rest of the process becomes much easier.