Can You Strength Train With Chronic Pain? | Get Back PT Denver
I hear a version of this almost every week: "I have chronic pain, so I probably shouldn't be lifting weights, right?" It's an understandable instinct. If something hurts, avoiding it feels like the responsible choice. But for most chronic pain, that instinct is working against you, and the research backs that up.
Why "just rest it" became the default advice
For a long time, the standard advice for pain was rest, and for acute injuries, that can make sense for a short window. The problem is that advice got applied to chronic pain too, where the tissue has usually healed but the pain has stuck around anyway. Chronic pain and tissue damage aren't the same thing, and treating them the same way tends to backfire.
This is where the fear-avoidance model comes in. It's a well-established framework in pain science that describes how people get stuck in a cycle: pain leads to fear of movement (kinesiophobia), fear leads to avoiding activity, avoidance leads to deconditioning and weakness, and that weakness makes everyday movement feel even more threatening, which feeds right back into more fear. The body gets weaker while the nervous system gets more sensitive, and pain often gets worse, not better.
What the research actually shows
A 2025 systematic review and meta-analysis looked specifically at resistance training for chronic nonspecific low back pain and found meaningful improvements in pain intensity, disability, and quality of life. Separate research on knee and hip osteoarthritis has found similar patterns, with resistance training improving pain and function. There's also growing evidence supporting resistance training for fibromyalgia, a condition that's historically been treated as something people should avoid exercising through entirely.
None of this means lifting heavy makes pain disappear overnight, and I'm not going to oversell it. What the evidence consistently shows is that structured, appropriately loaded resistance training tends to improve pain and function for a lot of chronic conditions, more reliably than rest does. The World Health Organization's own guidance on chronic low back pain reflects this too, recommending exercise, including resistance training, as a first-line approach rather than something to be cautious about.
"Motion is lotion"
I say this to patients constantly, especially with something like knee osteoarthritis. People get told that they're "bone on bone" and hear that as a reason to stop moving, when in most cases it's the opposite: movement helps circulate the fluid that lubricates the joint and can directly reduce pain. Less movement usually means more stiffness, more pain, and more fear, not less.
So how do you actually start if you're scared to load a painful area?
I like to tell people that exercise for pain and exercise for fitness are different but have overlap. For pain, you don't start at maximum weight and full range of motion, and you don't need to. Think of exercise as a spectrum rather than a binary of safe versus dangerous. If a joint or area is irritable, you start with a low load, a controlled range of motion, and you build from there as your body proves it can handle more. That might mean isometric holds before dynamic movement, partial range before full range, or lighter load before heavier load. The goal isn't to avoid discomfort entirely. Some muscle fatigue and mild soreness are normal parts of getting stronger. What you're watching for is a sharp increase in your baseline pain that doesn't settle down afterward.
This is exactly why working with someone who understands both the injury and the training side matters. Progressing too aggressively can genuinely flare things up, and that flare-up often confirms the fear that got someone stuck avoiding movement in the first place. Progressing too cautiously, on the other hand, means you never actually build the capacity that gets you out of the cycle. Finding that middle ground is the actual skill.
When to be more careful
I want to be honest about the limits here too. If you have pain with red flags like unexplained weight loss, night pain that doesn't change with position, numbness, progressive weakness, or pain following a specific trauma, that's not a "push through it" situation. Get that evaluated first. Chronic pain that's been assessed and cleared of anything serious is a very different situation than pain nobody has actually looked at yet.
The bottom line
If you've been told to avoid exercise because of chronic pain, or you've avoided it yourself out of fear that it'll make things worse, it's worth getting a second opinion from someone who can look at your specific situation. For most people with chronic pain, the path forward involves getting stronger, not staying still. That's a big part of why we built our approach around combining evaluation and training instead of separating them.
If you're dealing with pain that's been sticking around and you're not sure where to start, I'd be glad to take a look and figure out a starting point that makes sense for you. We're based in Denver and work with people throughout the metro and up into Boulder.
Sources referenced for the research claims above:
