Knee, back or shoulder hurting on a favourite exercise? Pick the sore area and the movement that hurts to get safer swaps that usually keep you training, how to change the load, range and tempo, a simple pain rule, and the red flags that mean you should stop and see a doctor or physio. It is not a diagnosis.
How these exercise swaps work
Most aches from training are a sign that one movement is loading a sore area more than it can handle right now, not a reason to stop exercising altogether. The usual physiotherapy approach is to keep you moving and change what you do: swap the exercise for one that loads the area less or differently, or keep the exercise and change the load, the range of movement or the speed. This tool gives you both options for each area and movement, plus a pain rule to tell you whether a change is working.
- Swaps keep the same muscles working with a different angle, range or support. For example, a box squat lets you pick a comfortable depth, a landmine press is usually easier on the shoulder than pressing straight overhead, and push-up handles keep the wrist straight.
- Load: lighter weights, fewer reps or less body weight (a band or a bench).
- Range: stop short of the position that hurts, then gradually get it back over the weeks.
- Tempo: slower lowering and pauses mean you can use less weight for the same effort and stay in control.
Change one thing at a time so you can tell what helps. If a swap still hurts beyond the pain rule, drop it and try another, or rest that movement for a few days while you train everything else.
The pain rule
Physiotherapists often use a simple pain-monitoring approach. In a well-known trial in Achilles tendon pain, people kept running and jumping as long as pain stayed at or below 5 out of 10 during activity, had settled by the next morning, and was not creeping up week to week; they did as well as people who rested. NHS physiotherapy leaflets use a similar traffic-light idea: mild pain (under about 3 out of 10) is OK, moderate pain means make the exercise easier, and severe pain means stop. Our version is deliberately cautious:
- Green, 0–3/10 during the exercise, settling within 24 hours and no worse the next morning: carry on and progress slowly.
- Amber, 4–5/10: make it easier (less weight, smaller range, slower, fewer reps) and recheck.
- Red, 6/10 or more, sharp or catching pain, pain that builds every rep, or pain and stiffness that are worse the next morning: stop that exercise and step back. If this keeps happening, see a physiotherapist.
Red flags: when not to train through it
The pain rule is for ordinary aches. It does not apply to the warning signs listed in the tool for each area, such as numbness or weakness, loss of bladder or bowel control, swelling straight after an injury, a joint that changes shape, pain that is worse at night, or chest pain with exercise. Those need a doctor, urgent care or emergency services, not an exercise swap. In an emergency, call your local emergency number (911 in the US and Canada, 999 in the UK, 000 in Australia, 112 in the EU) or go to an emergency department. For urgent but not life-threatening problems, see your doctor (GP) the same day or use an urgent care or out-of-hours service.
Related guides and tools
- Strength training after 35
- Collagen, joints and tendons
- Start working out after 40
- Anti-inflammatory foods
Sources
- Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J (2007). Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med 35:897–906
- Kingston and Richmond NHS Foundation Trust: After your physio appointment (pain traffic-light guide)
- NICE NG59: Low back pain and sciatica in over 16s: assessment and management
- NHS: Back pain (urgent and emergency symptoms) and NHS: Back pain treatment (when to see a GP)
- Gloucestershire Hospitals NHS Foundation Trust: Red flags in back pain
- NHS: Knee pain
- NHS: Shoulder pain
- NHS: Elbow and arm pain
- NHS: Hip pain in adults
- NHS: Wrist pain
- NHS: Sprains and strains
- NHS Fife: Achilles tendon rupture
- NHS: Heart attack symptoms
- Heiderscheit BC et al. (2011). Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc 43:296–302
This tool gives general education, not medical advice, and it cannot diagnose the cause of your pain. Persistent, worsening or unexplained pain should be assessed by a physiotherapist or doctor. If you have had surgery, a recent injury, or a medical condition, follow the advice of your own clinician.
More free tools: Sport warm-up and prehab builder · Workout generator · Exercise library · All tools