FSHP Academy
Personal Training (ACE-aligned) — all lessons

Introduction

Role and scope of practice for personal trainersIntegrated fitness training models (ACE IFT framework)

A Client-Centred Approach

Basics of behaviour changeEffective communication, goal setting and teaching techniquesPreparticipation health screeningNutrition for health and fitness

Assessments, Programming and Progressions

Resting assessments and anthropometric measurementsCardiorespiratory training: physiology, assessments and programmingMuscular training: foundations and benefitsMuscular training: assessmentsIntegrated exercise programming: from evidence to practice

Programme Modifications for Special Considerations

Considerations for clients with obesityConsiderations for clients with chronic diseaseExercise considerations across the lifespanConsiderations for clients with musculoskeletal issues

Professional Responsibilities

Legal guidelines and business considerations

Considerations for clients with musculoskeletal issues

Training clients with pain or past injuries — guideline-consistent care, pain-monitoring approaches, load modification and when to refer.

Advanced Evidence: Strong evidence 3 min read Reviewed 2026-10-31 Status: draft

Learning objectives

  • Summarise best-practice recommendations for musculoskeletal pain
  • Use a pain-monitoring model to guide training
  • Modify exercise selection, range, load and tempo
  • Coordinate with clinicians and recognise referral needs

Before this lesson

Why this matters

Many clients arrive with sore knees, backs or shoulders. Clinical guidelines favour staying active and exercising for most musculoskeletal pain — so trainers can help a great deal, within scope.

What best practice looks like

A review of high-quality clinical guidelines found consistent recommendations: patient-centred care, screening for serious pathology, education and reassurance, physical activity and exercise, manual therapy only alongside active treatment, avoiding unnecessary imaging and surgery, and addressing psychosocial factors [lin2020]. For knee osteoarthritis, exercise reduces pain and improves function [fransen2015].

Pain-monitoring approach

Pain during exercisePain next dayAction
Low (e.g., ≤3/10) and stableBack to baselineContinue or progress
Moderate (e.g., 4–5/10)Settles within 24 hMaintain; don’t progress
High or worseningHigher than baseline next dayReduce load/range; review

Numbers vary between clinicians; the principle is acceptable, settling pain rather than zero pain.

Modifying exercise

Working with clinicians

For clients post-injury or post-surgery, follow the physiotherapist’s or surgeon’s plan and timeline. Share session notes. See pain science and progressive loading.

Common mistakes and misconceptions

Case study

A runner with patellofemoral pain reports 6/10 pain on stairs. The trainer, with physiotherapist input, replaces lunges with Spanish squat isometrics and leg press in a comfortable range, keeps pain ≤3/10, and reintroduces running gradually. Pain falls to 1/10 within 8 weeks.

Further learning: video lessons

Video links are only marked “verified” after a human has watched them. Unverified entries open a YouTube search for that channel and topic rather than a guessed link.

Practical demo needs verification — opens a YouTube search

Exercising with pain — pain monitoring model

physiotherapy educators (search)

You will understand: using pain responses to guide loading

Why: Practical clinical approach.
Technical needs verification — opens a YouTube search

Best care for musculoskeletal pain

BJSM podcasts/lectures (search)

You will understand: guideline recommendations explained

Why: Research-led.

Knowledge check

Knowledge check · 0/5

1. Lin et al. (2020) identified consistent guideline recommendations including…

Answer B. Imaging only when serious pathology is suspected.

2. A common pain-monitoring guide allows exercise pain up to about…

Answer B. Approaches vary; the principle is acceptable, settling pain.

3. Exercise for knee osteoarthritis according to Cochrane review…

Answer B. Fransen et al. found benefits comparable to some drug therapies.

4. Which modification keeps a client training with painful deep squats?

Answer B. Adjust range and load to tolerance.

5. Which needs referral before training continues?

Answer B. Possible serious pathology.

Short-answer & application questions

  1. Create a pain-monitoring plan for a client with patellofemoral pain.
  2. List four ways to modify a painful exercise.
  3. Explain to an anxious client why movement helps most back pain.

Key takeaways

  • Guidelines consistently recommend education, staying active and exercise for most musculoskeletal pain.
  • Some pain during exercise can be acceptable if it settles within ~24 h and does not progressively worsen.
  • Modify range, load, tempo or exercise rather than stopping all activity.
  • Refer for red flags, unexplained or worsening pain, and post-injury/post-surgery clients.

Connected topics

prehab rehab

Understanding pain science and tissue healing

prehab rehab

Progressive loading techniques

corrective exercise

Rationale for corrective exercise (and its limits)

womens health

Osteoporosis

References

  1. Lin I, Wiles L, Waller R, et al. (2020). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British Journal of Sports Medicine, 54(2):79–86. Systematic review check pending
  2. Fransen M, McConnell S, Harmer AR, et al. (2015). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, CD004376. Systematic review check pending
  3. Bryant CX, Green DJ, Newton-Merrill S (eds) (2020). ACE Personal Trainer Manual (6th ed.). American Council on Exercise. Textbook check pending

Educational content only — not medical advice. Consult a qualified clinician for diagnosis or treatment.