Training Through Chronic Pain: A Whole-Person Approach for High-Performing Men Who Refuse to Slow Down
You’ve probably already been told to rest
To slow down. To stop doing what you love because your knee, your back, your shoulder, your hip is “not what it used to be.” If that worked, you wouldn’t be reading this.
Here’s something that took me years of clinical work to believe: for chronic pain, total rest is often one of the worst things a high-performing man can do. Rest isn’t bad. The problem is that chronic pain works differently from a fresh injury, and treating it like something that just needs more time is how it ends up running the next twenty years of your life.
Here’s what pain research says about training through it.
What chronic pain actually is
Acute pain is what happens when you tear a hamstring or break a bone. The signal matches the damage. Heal the tissue, the pain resolves.
Chronic pain is different. By the time pain has lasted more than three to six months, the tissue is often well past the point of structural healing. What’s left is a nervous system that has learned to amplify pain signals even when the underlying tissue is fine, or much closer to fine than the pain suggests.
This is called central sensitization. Pain scientists like Lorimer Moseley and David Butler have pointed at it for more than twenty years, and it has changed how musculoskeletal pain is treated. Pain doesn’t simply report tissue damage. It’s your brain’s judgment about threat, built from signals in the body plus your history, beliefs, expectations and surroundings.
None of that means it’s all in your head. The pain is real. It just isn’t always proportional to what’s happening in the tissue, so treating only the tissue often misses.
It also explains why your MRI came back “fine” and your back still lights up every time you run. The alarm system has become oversensitive, even though the structure has healed.
Why “just rest” is failing you
When you stop moving, three things happen.
First, the tissue itself deconditions. Tendons, muscles, and joints all respond to disuse by getting weaker. Less capacity. Less tolerance.
Second, your nervous system gets more cautious, not less. Without regular safe movement signals, the brain interprets even normal activity as potentially threatening. You move less, the threat threshold drops, the pain shows up earlier and lasts longer.
Third, and almost nobody talks about this one, your sense of yourself as a capable, strong man takes a hit. That matters. Fear-avoidance, where you stop doing things because you expect pain, is one of the strongest predictors of chronic pain turning into disability. Men who quit what they love because of pain often end up doing far less than the pain itself would require.
That’s why “take six weeks off” doesn’t work as a plan for chronic pain.
What training through pain actually looks like
To be clear, I’m not telling you to push through, ignore the signals and hurt yourself.
What pain research supports is graded exposure. You start where your nervous system is, load it just below the point that causes a flare, stay there until it adapts, and slowly expand what you can tolerate.
In practice, that looks like:
Identifying the actual threshold
Find the load and range of motion that doesn’t increase your pain during the session or noticeably the next day. That’s your starting point, and it’s usually well below what you’d tolerate. Most men start way above it and wonder why they keep flaring.
Loading it intentionally
Strength training has some of the strongest evidence for chronic musculoskeletal pain across the literature. Heavy slow resistance for tendinopathy. Strength work for chronic low back pain (Hayden et al., 2021 Cochrane review). Knee strengthening for osteoarthritis. Tissue needs load to rebuild, and your nervous system needs it to recalibrate.
Expanding gradually
Think monthly gains, not weekly PRs. The measure that matters is “I can do something now that I couldn’t do six weeks ago without a flare.”
Tracking your actual data
Pain on a 0 to 10 scale, before, during, immediately after, and 24 hours after each session. Patterns show up that you can’t see in real time.
The mental side nobody addresses
My clinical background matters most here.
Catastrophizing (expecting the worst and fixating on it) independently predicts how much chronic pain interferes with your life. Men tend to do it quietly. They don’t talk about it. They stop doing things and tell themselves they have to live with it.
Fear-avoidance is the same pattern in behavior. You start avoiding the movement, then the activity, then the situation, then the identity. Six months later you aren’t the guy who hikes anymore. You’re the guy who used to hike.
Getting past this takes more than physical rehab. You also have to break the thinking and behavior patterns that have grown up around the pain, and that’s the part most programs skip.
What works is doing all three together: loading the tissue, retraining the nervous system and working on how you think about the pain.
When to push, when to back off
Men ask me this constantly.
Push when:
The discomfort is fatigue-related, not pain-related (they feel different)
Pain during the session is below a 3 out of 10
The 24-hour follow-up isn’t noticeably worse
You’re progressing in the metrics you actually care about
Back off when:
Pain during the session is above a 5 out of 10
The 24-hour follow-up is significantly worse and stays worse for days
You’re getting flares with no obvious trigger
Sleep is being disrupted by the pain (this is a clinical red flag)
The men who struggle most with this are usually the ones whose identity is built on never backing off. That’s worth talking through with someone, because it’s often what keeps the pain from improving.
What a whole-person approach looks like
A whole-person plan for chronic pain includes:
Movement assessment and graded loading, done by someone qualified, not pulled off Instagram
Bloodwork through your physician, who can check markers like inflammation, hormones, and thyroid. If something there is feeding the pain, rehab alone won't fix it
Sleep. Poor sleep makes pain worse and pain wrecks sleep, so you have to work on both
Stress. A wired nervous system is a more sensitive one, so breath work and recovery habits belong in the plan
Pain education. Understanding what pain actually is, what it isn’t, and what the brain is doing has been shown in multiple trials to reduce pain itself
Work on fear-avoidance, catastrophizing and how you see yourself as someone who’s hurt
Realistic timelines. Chronic pain doesn’t clear up in three weeks, and the men who recover usually commit to six to twelve months of steady work
Few programs pull all of that together for high-performing men, and that’s the reason Sparking Change exists.
Frequently asked questions
Should I get an MRI first?
That's a call for your doctor. It helps to know that MRIs often show “abnormalities” in people who have no pain at all. Imaging matters most with red-flag symptoms (numbness, weakness, bowel or bladder changes, night pain that wakes you up), so tell your doctor right away if you have any of those.
What if my doctor told me I need surgery?
Take it seriously and ask your surgeon about every option. A second opinion is reasonable, and for some conditions (lumbar disc issues, partial rotator cuff tears, knee meniscus tears) research shows conservative care can do as well over the long term. That decision stays with you and your medical team.
Can I lift heavy with chronic pain?
Often yes, with the right programming. Heavy slow resistance has good evidence for several types of chronic pain. Intensity itself isn’t the problem. Intensity that doesn’t match where you are is.
How long until I feel different?
Many men notice a real change after six to twelve weeks of consistent work. The full picture, including the mental side, usually takes six to twelve months.
Is this the same as physical therapy?
No. A good PT runs the movement and loading work, and Joey works alongside them. His piece is the stress, sleep, habits, and mindset around the pain, coordinated with your PT and physician.
Take the next step
If you’re dealing with chronic pain that has outlasted the timeline your doctor predicted, the worst thing you can do is keep doing what isn’t working. The best thing you can do is get the right people looking at the right pieces. A call with Joey is free, takes 30 minutes, and will tell you whether this work fits what you’re dealing with. Take the free Burnout Quiz, or book a free call.
Written by Joseph Sparks, LCSW, founder of Sparking Change Wellness. Joseph pairs his clinical training and performance coaching with a network of physicians, physical therapists, dietitians, and trainers to help high-performing men train through pain and get their lives back. He works with founders, physicians, executives, and attorneys through one-on-one coaching, wellness intensives, and small-group retreats.
