Training While Sick, Injured or Hurt

by Hayden-William Courtland December 6, 2023

Time to Read: ~13 Minutes

Take Home Points:

Whether you live a sedentary or active life, you will encounter sickness, injury and hurt. So, don't let that deter you from training.
If you are not feeling great during or before a training session, there are some red flag symptoms that indicate seeing a doctor right away and some yellow flag symptoms where you can likely continue training, but should still see a doctor.
If you are sick, you should likely wait until symptoms abate and then restart again a bit under (less volume and intensity) where you left off. Depending on how sick you were, this may need to be several steps back from where you left off.
If you have pain that is not entwined with red/yellow flag symptoms, you should plan to train and see what you can do. If you can't do anything even at body weight, consider resting a bit more.
When you can start training with more than body weight, build up slowly and assess pain. If things get worse, stop. Consider, for the time being, altering range of motion or the version of the exercise you are using.
For issues that do not seem to be improving, medical advice may be warranted. Just be aware that the first recommended course of action will often still be to modify load, range of motion, and exercise selection.

Introduction

A reality of life: each one of us will experience numerous occasions where we do not feel 100%; we get sick, injured, or hurt. Make no mistake, all of these will happen regardless of whether you choose to be sedentary or physically active. Since it is best to be physically active, this article will assume you are doing just that. The above being said, if you are training and sickness, injury or something hurting crops up, it's best to consider what exactly is going on and approach your training accordingly. Unfortunately, the terms sick, injured, and hurt don't really have distinct, universal definitions and they don't really inform us of severity. For example, you could be sick with a cold and just feel little bit "under the weather" or you could be sick with the flu and be utterly unable to function. Further, while the term "hurt" is often associated with minor damage to your body (i.e., a pulled muscle) and "injured" is often associated with something major (i.e., a torn tendon), where the line is drawn can be murky. It's also extremely likely that when do you start feeling sick, injured or hurt, you won't know the specifics of what is going on (at least not right away). Therefore, I recommend my clients approach these situations of feeling off your game by setting aside the labels and using the symptoms to guide next steps. Before we dive in, remember that this article (and all content on SFF) does not constitute medical advice; it is an opinion piece based on my experience.

Red Flag Symptoms - Do Not Train & See a Doctor

The best place to start your assessment is with red flag symptoms. These symptoms (in my opinion) are ones that should stop you in your tracks. You should not train with these and you should speak to a doctor as soon as possible:

Having a fever, chills, or night sweats.
Having extensive numbness/tingling in a limb.
Having an upset or uncontrollable stomach/bowel/bladder.
Having significant fatigue and regular nausea and/or vomiting.
Having numbness, tingling or burning in both hands or both feet.
Having unexplained shortness of breath.
Having frequent or sudden onset dizziness.
Having chest, back or abdominal pain where you can "feel" your heartbeat while resting or lying down.
Having chest pain if you are over 40.
Having chest pain associated with any additional symptoms.
Having unilateral or bilateral limb swelling.

Now, I know what you are going to say. Some of the symptoms above could simply be a result of a cold or mild flu (e.g., chills, fever). I recognize that most people will not see their doctor in these cases if they are confident that is what they have. This is fine, but to be conservative I listed them as reg flags. If these conditions became severe, or if they exist in someone who is part of a high-risk demographic, it's a good idea to keep one's doctor in the loop. While we are on the topic of having a mild cold (or similar), my recommendation is to not train until your symptoms abate. The reasons are twofold: 1) training will likely not be very productive with symptoms and 2) you are likely to get someone else sick by going to the gym with symptoms.

Yellow Flag Symptoms - Continue to Train But See a Doctor

There are a few symptoms where you can likely continue to train as normal, but should probably see a doctor to make sure there isn't something going on that might become a bigger problem down the road. These symptoms are as follows:

Having a sudden onset of sexual dysfunction.
Having non-specific pain that is independent of movement and does not dissipate with rest.
Having pain that wakes you up at night, but does not manifest in training.
Having unexplained body weight changes.

Other Acute Pain During Training - Continue to Train (Maybe)

Putting red and yellow flag symptoms aside, an inevitable occurrence if you train long enough, is that something will happen during training and this will immediately be followed by pain where there wasn't pain before (acute pain). When this happens outside of red and yellow flag scenarios, you should still try and finish your workout but may have to make some concessions. For example, the pain may vanish and you can proceed as normal - excellent. It may not vanish and thus prevent you from completing that specific part of your workout, but it may not interfere with other parts of your workout - still a pretty good outcome. Lastly, it may be so bad that you can't continue in any way - not great and pretty rare, but it happens (i.e., severe muscle strains) and there is no point putting yourself through agony. Call it a day and see how your symptoms are the next day.

When Fatigue Manifests During Training

It's possible the onset of an illness will first appear during an actual training session. Or maybe you just aren't feeing great from a lack of sleep or life stress. In either case, you will notice things not feeling so great as you continue through the warm-ups of one or more of your lifts. If this happens, and you are not feeling great by the time you finish your final warm-up for a lift, consider doing less sets for that lift (i.e., do 4x5 or 3x5 instead of 5x5). If that doesn't appear to help, consider dropping the weight by about 10% for each set. If that still is a problem, you likely are approaching a fairly big hole and should call it a day.

Approaching Your Future Training Sessions

So, how should you approach future training sessions? If you are no longer sick and your current symptoms are not red or yellow flag symptoms, you should plan to train in some form. Do you have to train while having these symptoms? No. Your life is your own and you can decide for yourself. If you want to take a few days off to see if symptoms improve, you can. Just be aware that too much time off can cause you to detrain. Once you are ready to train, if you are not feeling 100%, this likely means you are either 1) getting over a sickness and have residual fatigue or 2) still experiencing some non-red/yellow flag pain (which may be acute or chronic). We will discuss how to handle each of these scenarios next.

Training With Residual Fatigue

If you decide to start up again after having a cold, flu, food poisoning, etc., you will likely be good to go on some fronts but will have detrained from the time off and from a probable loss of body weight. The safest thing to do in these cases is drop your training weights down by about 10% and build back up again. If the sickness was very bad, you may need to drop the weights down even more. Also consider dropping the volume of your workload down as well; it will take some time for your body to recoup its full work capacity. Build back up slowly each session paying careful attention to how your body is feeling. Once it feels 100% for a few sessions in a row, then you can consider taking bigger jumps in your weights/volume to get back to where you were before the hiatus.

Training With Acute Pain

In the situation where you have pain, but it's not entwined with red/yellow flag symptoms, how do we approach training after the initial session where it cropped up? First, you have to determine if you have a reasonable chance of even being able to function in a training setting. If the pain you have is so severe that daily activity is extremely challenging, don't even bother going to the gym to train yet. An example would be you can't stand up or sit down in a chair or tie your shoes normally because your back pain is too severe. On the other hand, if you feel that you can do all or most human movement patterns with body weight no problem, then you'll want to go train and see what you can do.

One more thing. Before we get into next steps, you must know that your technique in each of your lifts/exercises is solid. This is important. If you have not had a professional coach eye your form *recently,* this could be the issue. So, get a coach to check you out (I can help).

Assuming your training technique has been on point, plan to evaluate each movement for pain during your training session. Some movements may be fine. Do them. Other movements may not be. Assess all movements first with no weight (body weight). If the pain is significant, skip that movement for a while. Consider altering range of motion or substituting a different movement that works similar muscles (i.e., leg press machine instead of barbell squat). If the pain is not present in body weight movement, warm-up to your working weights and assess pain. If pain is low (below 5) and stable during warm-ups, you can consider continuing. If pain increases with warm-ups, stop. Consider altering range of motion, substituting a different movement, or seeing if things are better for that movement in the next training session.

The above process should be repeated each day you plan to train. How long you will need to keep assessing in this manner will vary with the severity of what your body is dealing with. If you are seeing improvements over time (i.e., empty bar was a bit painful, but now even warm-ups are not painful), stay the course. If you are seeing no progress over an extended period of time you may have 1) an injury that will just take a very long time to heal or 2) a chronic condition that will not heal on its own. An example of #1 would be a badly strained adductor muscle. I suffered this once and it took over a year to heal. In these situations you should substitute in new movements and test the old movement periodically to assess healing. In my case, I had to stop low-bar squatting but was able to high bar squat until my adductor healed. Examples of #2 are numerous and include things like tendinitis, rotator cuff tears, disk bulges, and so on. In these situations you would still try and substitute movements, but more specific care might be helpful depending on what is going on and what kind of training goals you have. Indeed, for many of these conditions you likely won't know if you have them without a consult from a doctor.

Seeing a Medical Professional

If you do decide to see a medical professional for a chronic condition, be aware that there are two likely outcomes from their assessment (which may or may not include expensive imaging like X-rays or MRIs): 1) they will advise that the best thing to do is rehab the injury or 2) they will note that surgery is an option. In many cases if surgery is an option, doctors will still suggest you try physical therapy/rehabilitation first. I mention this because the best *initial* rehabilitation options are generally variations of what I alluded to above (alter range of motion, vary the specific exercises you are doing, change the rep ranges, change the tempo of the movement, etc.) and if this does work, it will save you a bunch of money in the long-run. If these don't work, there are specialized forms of physical therapy that can help. For these, make sure you seek out a physical therapist that understands the importance of compound barbell movements and doesn't feel that unilateral muscle isolation movements are the *only* useful tool out there. Of course, if you want to get imaging early on, you certainly can. Just be aware that if you are over 30 years old your imaging will almost always show some abnormality (you aren't a spring chicken after all). Make sure the doctors you see for this imaging understand this - and if they do they will be unlikely to push for surgery unless your condition is serious enough and where surgery is highly likely to help.

Final Thoughts

There are a variety of situations where not feeling your best and/or having pain means you should skip training for a while (and possibly see a doctor), but where pain is concerned, in the vast majority of cases it need not be a roadblock to training - it can and should be something you manage and work around. Taking extended breaks from training can set you back and if you can avoid such breaks, you really should. This way you can stay/become as fit as possible for when life throws you obstacles that do truly force you to take a break.