Neither "work around it" nor "don't do it" is the right default answer for pain during exercise. The more useful question is whether what you're feeling reflects a capacity issue, meaning your body isn't yet prepared for that specific demand, which can often be built up, or something that genuinely needs medical evaluation.
You're mid-squat and you feel something in your low back you weren't expecting. Do you push through it? Work around it? Stop the exercise entirely? Most advice you'll get falls into one of two unhelpful camps, according to Dr. Sean Pastuch, a chiropractor and former personal trainer who's spent years working specifically at the intersection of fitness and healthcare.
Two Common Answers That Both Miss the Point
According to Dr. Pastuch, a trainer who says "if it hurts, work around it" isn't actually solving anything, just avoiding the movement. A doctor who says "if it hurts, don't do it" isn't bridging the gap either, it's treating the activity itself as the problem rather than identifying what's actually going on.
The person who tells you if it hurts we can work around it is not bridging the gap. The doctor who tells you if it hurts don't do it is also not bridging the gap. The person who has a solution so that you can get back to doing it, that's the person actually bridging the gap.
The Difference Between a Capacity Issue and a Medical Injury
Dr. Pastuch draws a clear line using two categories: activities of daily living, which fall under a doctor's scope, and what he calls activities of daily interest, which fall under a trainer's scope.
"I can't wash my hair." This involves diagnosing tissue damage or a disease state, something outside a trainer's ability or license.
"I get low back discomfort when I squat more than 200 pounds." This is a capacity issue, meaning the body isn't yet prepared for that specific load.
Trainers, as Dr. Pastuch emphasizes, are never licensed to diagnose. They don't know which tissue is involved or what disease process might be at play. What they can assess is what's tight, what's weak, where motor control is lacking, and whether recovery and training load are out of balance, all of which can often be addressed through training itself.
Pain Isn't Automatically Proof of Damage
One of the most important distinctions Dr. Pastuch makes is definitional: pain, in his framework, is the negative emotional interpretation of irritation, and irritation is simply the conscious awareness of a sensation. The sensation itself doesn't inherently mean something is wrong.
This matters because irritation is often what drives adaptation. If every unfamiliar sensation gets immediately labeled as bad and avoided, the training stimulus that would have led to genuine improvement never gets the chance to happen.
Irritation drives adaptation. If we feel something and immediately decide we don't like it and stop, that can prevent the adaptation we actually want from happening.
Dr. Pastuch experienced this firsthand with his own knee pain, which improved significantly once he started training his lower body with intentional, technically sound strength work, rather than avoiding load on the area entirely.
Injury as a Decision, Not Just an Event
Dr. Pastuch frames injury itself as a decision point, similar to a coach asking an athlete whether they're hurt enough to come out of a game or able to keep playing. A true structural injury, like a broken bone, removes that choice. But most of what people label as an "injury" during training sits in a gray area where the actual decision is whether to stop or to work through it appropriately.
- "Work around it" and "don't do it" are both incomplete answers to pain during exercise.
- A capacity issue, your body not yet being prepared for a specific demand, falls within a trainer's scope, not a diagnosis.
- Pain is the negative interpretation of a sensation, not automatic proof that tissue is being damaged.
- Irritation from training often drives the adaptation you're actually trying to achieve.
- Most training discomfort is a decision point about how to proceed, not an automatic stop sign.
The goal isn't to ignore every sensation during training, and it isn't to avoid anything uncomfortable either. It's figuring out whether what you're feeling is a capacity issue you can build up through smart, technical training, or something that genuinely needs a doctor's evaluation first.
Frequently Asked Questions
Should you work around pain during exercise or stop completely?
Neither extreme is the right default. "Work around it" avoids addressing the real issue, and "don't do it" assumes the activity itself is inherently unsafe. The better approach is figuring out whether the pain reflects a capacity issue that can be built up, or something requiring medical evaluation.
What is a "capacity issue" versus a medical injury?
A capacity issue means your body currently isn't prepared for a specific demand, like low back discomfort when squatting heavier than you're used to. That falls within a trainer's scope. A true medical injury or diagnosis falls within a doctor's scope, and trainers should never attempt to diagnose it.
Is pain always a sign that something is being damaged?
No. Pain is the negative interpretation of a sensation, not proof of tissue damage. The same sensation could be interpreted as pain or as simply an unfamiliar feeling, depending on the context and what someone has decided about it.
Why does "irritation drives adaptation" matter for training?
New sensations from training are often the stimulus needed to trigger a positive adaptation, like getting stronger or more resilient. Reflexively stopping at any unfamiliar sensation can prevent that adaptation from ever happening.
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